Context: Illness as unhomelike
We start by asking a seemingly straightforward question: what might compel someone to come to the doors of an emergency room in the middle of the night, asking for help? Building upon Weber’s premise that civilizations organize themselves around certain understandings of the nature of suffering and the means by which suffering can be transcended and salvation achieved,12 Good suggests that medicine has come to occupy this role in contemporary Western societies. Specifically, he notes that “the maintenance of human life and the reduction of physical suffering have become paramount”; modern health care practices are powerful agents of deliverance from the anxieties of sickness, finitude, and death.13
To further understand the vulnerabilities that accompany the arrival of a patient in the ER in the middle of the night, we need to consider that most people manage disturbances to their usual baseline of health and well-being without seeking the support of professionalized medicine.14 Even if clinical attention is required, it is only a small minority of health care interactions that occur in the acute care setting.15,16 By the time someone has presented to clinical attention in the middle of the night, usual attempts to address illness have likely been insufficient. We might say that illness has unmoored a person from the intimate familiarities of everyday life, putting them into a state not just unfamiliar but distinctly “unhomelike” in both one’s self and the world.17,18 The anxiety that accompanies this loss of home is existential: to give but one example, we might consider parents watching their previously well baby who had just a runny nose a few hours prior struggle to breathe. Being unsure as to why and feeling powerless to help the person they arguably know better than anyone else is terrifying.
The acute care hospital, previously described as “the stage on which the miracle play of modern medicine reaches its climax”,19 is a key location in which medicine offers the promise of delivery on societal expectations of deliverance. Admittedly, the acute care hospital’s position as the central hub around which medical education and practice turns is receding. Among these reasons include a decreasing number of acute care beds, shorter average length of stay, and an ability to manage conditions in an outpatient setting that used to require in-patient resources.20,21 Yet in the current design of the Canadian health care system, there really is not anywhere else to go at 2:00 AM, leading us to ask how those waiting on the other side of those doors are to act when someone arrives.