in case of emergency
By: Lauren O'Connell
Tags: Family, Homelessness, Emergency, Social Justice, Healthcare

A few days ago, I received a call at work that is, sadly, far too common.

One of our patients was in the ICU/intubated/emergency room/etc. and had no emergency contact on record. The resident noticed the patient was connected to our program — Would I happen to know anyone to call for decision making? A family member, a friend, a distant relative? I had never met this particular patient.

My obvious first move in these scenarios is to check the emergency contact the person originally listed when they registered at our facility. But, the not-so-obvious first discovery is that the vast majority of our patients never list an emergency contact in the first place. And, often times, the contacts that do make it into our medical record are certainly not close enough (biologically, socially, legally) to make health decisions on a patient’s behalf.

When I first started working in this field, I was shocked by practically everything I witnessed. The food insecurity, the housing crises, the effects of addiction, the violence, the physical damage of life in poverty. My upbringing, my social networks, my privileges — they all protected me from even hearing about so many of society’s inequities, and guaranteed me a certain (yet unknown) amount of security for the rest of my life. An unquestioned safety net of confidence. And, while many of the events I witness every day have been normalized from a professional perspective, the issue of emergency contacts continues to carry its original shock value.

Not one person to be listed?

No one to trust?

Not a single friend or cousin or neighbor to lean on in a potential crisis?

I simply will never fully grasp the magnitude of this feeling. The isolation, the loneliness, and the estrangement that often accompany homelessness, substance use, and overall instability are concepts beyond my imaginary. Truly, I have developed an imagination so vast in order to have the empathy and patience for handling situations I have yet to experience myself, but when it comes to this — I admit I struggle greatly.

The community we serve at work is resilient beyond measure. There are friendships so genuine, emotions so raw, relationships that run quite deep. Yet, there is a noticeable seed of distrust scattered throughout life on the streets. The weight of broken family ties and past betrayal slowly but surely weaken the promise of future happiness; while the impacts of mistrust are yet again beyond the scope of my blog musings and reflections, one thing is for sure: there are real health outcomes shaped by this reality.

The resident who called me the other day went above and beyond. He reached out in creative ways while still focusing on his clinical duty to care for this person inching closer to death. Fortunately, another case manager and I were able to do some on-the-fly social mapping and track down an ex-step father who pointed to a long lost sister who pointed us to the patient’s daughter. At the end of the day, the patient had someone to advocate and make decisions during their final moments. But, what if we had not found anyone? What if I had not answered the one phone call nor had the time to engage in the social mapping of shelter life? Was the estranged daughter really the best person to step in during the patient’s time of need? Who was the patient’s ideal emergency contact — was it a friend with no phone? Was it an aunt who had lost touch? I wonder about the hesitations this person had to writing down even one emergency contact.

There are many clinical providers who are willing to go the extra mile to find a family member or relative to be a social support during someone’s final moments. There are social workers who can apply their emotional maturity to intervene when a crisis emerges. But there are also many patients who do not get the “privilege” of a care taker with time to mend the broken relationships of the past and energy to commit to the social chaos that often surrounds housing instability or a “broken family.” Part of me wishes clinical providers were more in-touch with the fragility of an emergency contact and part of me knows this is much greater than a health care issue.

cambridge crew = emergency contacts for cambridge adventures!

I have always put down one of my parents as an emergency contact. I just recently started to instead use my brother who lives near me and could physically be present in an emergency. Beyond these three, I would confidently be able to list dozens of other people — aunts, cousins, friends, family friends — who would genuinely be eager to help out in an emergency situation. My privilege is immeasurable when I am asked to list an emergency contact. My great fortune to have the stability and love that I do (and without really working for it) is beyond words.

I feel discomfort and sadness when I learn of empty emergency contact sections on a consent form or medical record. I challenge myself to sit in this discomfort, to really let myself imagine the hardships that contribute to this situation, to let this discomfort make me a better emergency contact candidate for someone else.

I am challenging myself to express gratitude to my emergency contacts and my backup emergency contacts and my backup backup emergency contacts. I need to put in the work to sustain these — not because they may offer me a service in a time of need or health emergency but because building trust and friendships and genuine relationships is a safety net I cannot afford to lose. I want this for myself. I want this for others.

So, thank you to all the emergency contacts out there. May we not take this title lightly nor undermine its significance.