Holistic Health Care: More than 'The Drunk'

It's 7:30 on a Tuesday morning. I am bright eyed and eager for my first day as a nursing student shadowing at the Emergency Department in North Carolina. I sit listening to the morning report at the nurses’ station. My nurse for the day is assigned two patients that have already been checked-in to their rooms. She decides, however, that only one is worth her time.

I hear, "you have ‘The Drunk’ this morning.” “…The Drunk?..." I think in my head. “Who is ‘The Drunk’?” My mind is struggling to wrap itself around the fact that to this nurse, this patient is simply a physical health diagnosis, and has lost all other attributes of what makes him a human being, i.e. their sex, gender, age, race, profession, all of which are significant to being able to care for a person.

My day continues with addressing an upper-class, White female patient with a minor ache in her ankle with three nurses and one MD at her side. Yet, a middle-aged Black male blue collar worker who is suffering from alcohol intoxication is left in a room without any staff attention, any medical intervention and not even a blanket to keep warm. Time continues to pass and as we sit down to “take a break,” my White instructor for the day begins to explain that she has no sympathy for a “drunk” because “they woke up and decided to put that bottle to their mouth.” She continues to share her sentiment that it is a waste of her time and resources to even lay eyes on him. She had now gone so far as to decide what patient resources were going to be allocated, not because of hospital policy, but because of her very own biases and discriminatory beliefs.

Without any further investigation of this man’s life she has already labeled him. She does not consider the possibility for addiction that is out of his own self-will or the possibility of a very stressful life. She does not consider the potential struggle to find a stable job because the community he grew up in did not even have grade schools that met district standards. Instead, she chose to blame his hospital admission on choices and a path that most likely was never left up for him to decide, but a result of the environment and society he was born into. As a result of her judgment, she never truly found out for herself that this was not something he “woke up” one day and decided to bare. He did not choose a life that forces him to carry the weight of racism, inequalities, poverty, and the effects of poor mental health.

I understand hospitals are busy and we, as a medical team, have to prioritize our care, but what bothered me the most was the lack of concern for a human being under our care. This nurse did not utilize this situation as an opportunity to intervene and advocate for a person’s life. What I observed instead was that this Black man’s life was not valued; he was considered a nuisance who took up a bed in the ER.

My heart and my passions were opened to a whole new way of practice nine months later. I had the amazing opportunity to travel to Barbados for my community health rotation as a nursing student. All I was told prior is that I was going to experience a healthcare system in need of “our help.” However, what I came to find was quite the contrary. I witnessed nursing and medicine in its true and purest fashion. I watched nurses care for a person’s whole being. These women, no matter how ridiculously busy or how stressful their personal life was, took their time to ensure that they were truly serving as an advocate for their clients. Whether coming in for a small cold or upset stomach, these nurses made sure to assess the mental, emotional, and social well-being of everyone that walked through the door to the clinic. What I found completely ironic was an American, predominately White-serving institution sending students to a place to help and intervene, when in fact, we as students needed to go there to learn a way of healthcare that would truly benefit people of color in our very own country, in our very own neighborhoods.

It's when we forget to look at a person as a whole that they become The Drunk, The Diabetic, The Obese, and other reductions not “worthy” of our care. When we do this we turn them from individuals into a simple scientific disease process that can be read about and studied in a classroom with a simple black or white answer. A person who starts drinking because they are depressed that they can't find a stable job and just lost their house needs more than IV fluids and rest.

We are not truly providing care when we send home a diabetic who doesn't have money for insulin. We are not caring when we send an alcoholic back into the world without finding the reason for their daily habits. We are not accepting their humanity when we ask a person who is overweight to change their diet and exercise regime when they have no access to healthy fruits, vegetables or safe sidewalks to walk on. These are things we need to be diligently thinking about as healthcare providers in providing wellness and a holistic model of care.

So, where do we go from here? As a healthcare professional myself, I want to commission myself, as well as every other healthcare team member in this country, to promise and dedicate our jobs to ensuring that ALL people receive the just, fair, and thorough care and attention they need and deserve. It is our moral responsibility to do so. We not only inadequately care for clients when we don’t meet these standards, but we sell ourselves short of fulfilling the noble duties in which healthcare should stand upon.

However, it is not just professionals who are responsible, it is us as a people who are responsible for seeking that level of care and not being satisfied with anything less. Having a voice for our bodies, but also seeking out the care we need to prevent the accumulation of health ailments. That is because the years of stress, alcohol abuse, lack of social support, and depression that present as just “The Drunk” coming into the ER could be eliminated with preventative healthcare and an assurance that value is placed on our lives in any and every medical setting. It starts with you.

Nicole Forlan obtained her Bachelor of Science in Nursing from Duke School of Nursing in December of 2015, and throughout the academic program she conducted research on women in homelessness and the Social Determinants of Health. She completed her first Bachelor of Science at University of California, Santa Barbara where she studied Bio-Psychology in June, 2012. As of January 2016 she has joined University of North Carolina at Chapel Hill Women's Hospital and is continuing her research endeavors at Duke University School of Nursing.