Diary of a Hospital: Lisa Miller

"There's No Room in the System' A plan to institutionalize the homeless has little meaning in the ER.

ABOUT 3,400 PEOPLE sleep on the streets or subways of New York each night, and the week after Christmas, EMTs dropped off one of them, a young white woman, at a Brooklyn emergency room. She had overdosed on an assortment of meds and called 911 on herself. Now she was, as the ER psych nurse on duty that night put it, "decompensating"-her mind running the familiar course from okay to unraveled to not coherent at all. The woman was focused on the subject of her boyfriend, her companion on the street, convinced that he was duplicitous and "trying to be slick" At the thought, her voice rose to a sharp, panicked pitch. "If he really cared about me, why didn't he ride in the ambulance with me?" And then, as if reconsidering, she corrected herself. "When you love somebody, you push through," she said.

Her confusion emanated toward the nurse, a calm Black man in his 40s. He sat at a computer behind a high counter, and his main problem that night was this woman who would not stay in her bed but kept circling back to his station trying to make herself understood. She had been judged by a doctor to be a danger to herself and thus in need of immediate hospitalization, so she was waiting for a bed on an upstairs floor. But the nurse had other patients to care for, too. He came out from behind the counter. "It sounds like you're having a hard time right now," he said to her. She responded loudly, angrily, about the boyfriend and the ambulance. "I can't talk if you're talking," he said. He suggested a dose of Ativan, and over time, she grew calm but still had concerns. "Where am I going to go when I get discharged?" she asked the nurse.