I wasn't there. I don't know what happened in that Texas Emergency Room, when Thomas Duncan arrived, symptomatic for Ebola, and was sent home with the proverbial 'take two aspirins and call me in the morning' advice. But as the events unfolded, they suggested the GOMER scenario to me.
I am not a physician. I am also not a judge, and as such, I try not to be judgmental- a difficult task these days. But the events in Texas around the initial ER appearance of Thomas Duncan, whose Ebola symptoms were missed at that Texas ER, resonate strongly with my experience as a professional in the field of human services, and who has had a lot dealings with hospital ER's.
In another life, I spent five years doing emergency mental health outreach work in Buffalo- literally talking people off the ledge, or doing hostage negotiations- or trying to convince people having acute mental health crises to seek help. I spent another 12 years running a homeless shelter. In the course of both jobs, I had a ton of interaction with hospital emergency rooms- in fact, I was a licensed EMT for a few years, because we saw some many medical issues in the population that I felt CPR and First Aid just wasn't enough.
In my time as an Outreach worker, I did over 1,400 visits to individuals in the community who were in crisis. We often brought people with mental health and existing medical issues into the ER. And invariably, the poor, people with mental illness, minorities had a different experience than you or I have at the ER- I saw it play out many dozens of times. Often, they wait for service. For hours. And some of the medical staff greet them and treat them with condescension, not compassion. And when they get services... well, let me share some examples.
I once brought in a young woman who was a brutal self-mutilator; and watched the staff stitch her up without the use of anesthesia. Another time, I got a call from a local ER that one of the people staying at our shelter had gotten intoxicated and fallen, striking his head, would I come and get him. I did. When I got him back to the shelter, and examined his wound, I noticed the injury was peppered with what look grains of sand; and it was still bleeding, despite being stitched. I took him to another ER; and was told that the grains of sad were actually bone- parts of his skull- that had not been cleaned out of the wound before stitching. I saw this happen time and again to people I brought in. It never happened to me personally, or to any of my own kids when we needed ER services.
I have a good friend, a physician- I asked him about what I had seen- the kind of treatment some of these folks were getting in the ER's. He explained to me that the people I was bringing into the ER were called 'GOMER's' by some ER staff. The acronym means "Get Out of My Emergency Room". He explained that these people- because they drink, or hurt themselves, are looked on by some medical staff as people who create their own problems- that they 'make work' for the staff of the ER, who then treat proceed to treat them accordingly. A far cry from the Hippocratic Oath, but I saw it with my own eyes. It did not occur with the majority of medical staff; but it did occur often, and with all levels of hospital personnel- from the intake admins to the nurse, doc's- even custodians.
Fast forward to Texas, and what was running through my head when I read the story of Duncan's first attempt to get treatment.
The guy shows up, symptomatic. It was clear from the history that he gave that anyone who had been reading the newspapers could tell he was at risk for Ebola- and yet he was patted on the back and sent home. My first thought when I read that was that he had been treated like a "GOMER". He fit the criteria, certainly. A person of color, with a foreign accent. Poor. Immigrant. Unlikely to pay for treatment.
GOMER.
Perhaps he was perceived by the hospital staff as 'less than,' and perhaps he was treated as such by some staff- enough to compromise the existing protocols for dealing with a human being, let alone one so clearly at risk for Ebola.
I'm not playing the 'race card' here because in my experience, this isn't about race. It's about seeing each human being as a person, it's about the obligation ER staff undertake as medical professionals to do no harm- it's about doing what you are trained to do, because regardless of the circumstances, you have committed to an obligation to serve. Again, let me be clear- this GOMER dynamic is not universal in ER's, but it is pervasive. I saw it many times, both in New York, and in Massachusetts.
I've seen the ubiquitous echo chamber posts blaming President Obama for the presence of Ebola on US soil- as if American Exceptionalism would serve as a shield from a toxic virus, if only the President did his job. My thinking is that all the training and precautions in the world won't work, if people continue to see patients and their issues through their own biases and filters. And that, in the end, is my take on what happened.
I don't know what happened in that ER, but it sure looks like a scene I witnessed a lot in my professional life.