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.