In the case of your elderly patient, it seems like your efforts were wasted – as well as the efforts of the hospital and staff – when the patient was deposited back in his own filth. A great deal of resources and tax dollars went into this useless “transaction.”

But would classifying this man as retarded have solved anything? A life of institutionalization – albeit a clean one?

Can a retarded person also be ignorant? Where is the line drawn?

Ultimately, the answer can be found in some of the training you received in your career: identifying those who are most likely to survive and adapt.

The problem is that we’re too bound by weak-willed legislation and illogical elements of a spineless morality that just won’t allow otherwise intelligent people to make such distinctions.

Believe me, I am all about personal freedom and choices. Alternate lifestyles don’t freak me out either. Go ahead, be a gay couple who adopts children. I’m fine with that. Go ahead and be religious. No one should interfere until your religion is a bunch of people worshipping a comet and trying to drink poison Tang. I get that. Go ahead and be goth and liberal or conservative, or what ever you want. Its all good. There are a few situations that aren’t though.

1. Filth. This is a fire hazard and it spreads disease. I have walked into houses where the stench is not tolerable and people are coughing and wheezing due to inhaling the methane and ammonia from there own waste. Why? Because they are too lazy or drunk or high to make it to the bathroom. The lazy ones get me. I actually ran a call recently for a guy that was not disabled or affected in anyway. As a matter of fact, he works in a warehouse that is known to me. He pees in a bucket by his bed. Last time I saw him there were about 3 gallons in this bucket. WTF?

2. Children. I have been in EMS for 15 years. I have seen dozens of cases of child abuse, neglect, and poor living conditions. I have reported dozens of cases. CPS workers are always very nice when I call, and most of the time they even follow up with me later. To my knowledge not one of my phone calls has led to a child being placed anywhere. Ever. As a matter of fact, I have never even heard of any coworker or student who has ever had this result from a report either. And I used to ask this to entire classrooms full of professionals. Hundreds of people…no reports of results…ever…FAIL.

I guess what frustrates me is that the thing I am complaining about actually has laws. There are agencies to deal with it. But these laws are not enforced and the agencies are powerless. So why do we continue to pay these people for wasting time and money? My taxes go to pay for salaries, office space, vehicles, courts and lawyers, and not a damn thing happens from any of it. These filthy people continue to collect food stamps, draw SSI, or fake some sort of disability and so my taxes go to make sure these people get just enough money to get by living like they do.

I want social programs. But I want EFFECTIVE social programs. This is why you will hear me say horrible things about Republicans and Democrats alike. Republicans simply say, “Look, it didn’t work. Now screw these people. Lets all look the other way and let rich people get richer.” Democrats talk big and then spin their wheels. Every well meaning idea is hampered by the fact that it is unrealistic or gets watered down to the degree that it is ineffectual by the time it is set in motion.

BOTH ARE WRONG.

The alternative, of course, is even more governmental intrusion in our own lives. There are already adult protective services and the like who are more than happy to swoop in and interfere with their lives. To propose more would lead to the unacceptable — government health and welfare inspections, perhaps? Or Great Britain-style video monitoring of “at risk” families?

What you describe is truly awful, and I don’t doubt that it deeply upsets you. However, the alternative should as well.

I can feel the frustration in this letter and I find it interesting that the authors wife is an antropologist. It reminds me of an article I read years ago about how some society’s dealt with their aged members. I seem to remember an eskimo tribe that merely placed thier aged family member on an ice flow and shoved them out to sea. While by today’s standards this seems cruel, the hard core reality is, that one older member of the group would have taken up so many resources that they could have endangered the survival of the group. The survuval of the group, now this is where we need to be. Have you ever thought that maybe ever pre-hospital care provider is screwing up evolution? Lets face it, the only reason we are here is because our ancestors where the smartest, strongest, and fastest of all the other humans. Our ancestors survived by strength of mind and body. The weak, died. Since they died, their lineage was terminated. Is this as cruel as the eskimo tribe? Maybe. It is this natural selection that has allowed us to become the people we are today. So where do we draw the line now? The author speaks of transporting this patient to the hospital for care and then apparently over hears a conversation of another crew that returned this patient to his previous residence. How have we improved his life or improved society as a whole? We have defenitely used resources from the health care field but were they used to the maximum benefit? I will wait here for all of the scourning and hushed remarks about how dare he write these thoughts down.

Still waiting for everyone to finish up.

Rationed healthcare!!! Now here is a slippery slope! As anyone ever stopped on wondered about the medicine we provide to the people we provide it too? Should we change the question from, “What can we do?” to “What should we do?” and if we do change the question, who should make up the answers?

I will leave this post with more questions than answers, because that is what I have.

I leave satisfied that I have added to the confusion.

Now please talk amongst yourselves.

There is a lot to think about and discuss, and precious few “answers.”

I’ll keep it to a few things.

One is that there is no way to decide, to judge, what is appropriate and what is not, for how people choose to live. Yes, there are extremes, but not everyone even sees the same things as “extreme.” Some seem obvious- like your patient with couch cushions fused to his back- but short that, where do you draw the line? Over the line is sometimes easy to see, but the line, itself, is not.

Life is very different in different places. I have friends who choose to live in yurts, no running water, no electricity, no permanent location. They are very happy. I have other friends who live in very cluttered houses, with more stuff than should be there, and although many people might be uncomfortable that way, they are happy. I have friends who live in apartments that look like they are right out of some design magazine. Happy again. It’s a matter of choices, of preferences, that I wouldn’t want to mess with.

But clearly, there are also situations that are, in a word, bad. And you’re right, the “system” isn’t working. Yes, they can be reported, but what happens next? Does it really help anyone? I haven’t seen an example where someone has gone into a situation, and made it better. Take someone out of a situation, maybe. Fix the situation? Haven’t seen it. There is so much involved it’s difficult to even know where to start. Personal freedom, upbringing, preferences, habits, knowledge and skills or lack thereof, and money. Don’t forget the money. And to be able to help someone out of a mess, while treating them respectfully as a person.

I’d love to hear anything anyone has to offer on how to get at the root of the problem.

I do have to disagree with one part of what you wrote, though. While overall, the dominant culture has moved to an information-based culture, there are still plenty of places where it is still an agrarian culture. It’s not just people hanging onto the way things were, it’s the way things are. The ones who will survive, I believe, are those who find a way to merge the two, and use the information culture to improve the agrarian one.