For every single mother working three jobs. . . .

The hulking figure across the table glared at Howard Collins, pointed at him, and said, “Hey, I pay your salary, man. You have no right to hold out on me. You know damn well I’m allergic to Tramadol. I need Percocet. I’m in pain! Can’t you see that?”

Howard considered the irony. He had spent several years and $140,000 on his education to secure his job as a physician assistant, and now a homeless man with a drug addiction and no money was claiming to pay his salary when, in fact, a significant portion of Howard’s income paid for the man’s Medicaid services. Howard said, “Look, Larry, there’s no evidence that you’re allergic to Tramadol. You and I know your medical history. We pull it up on the computer every week when you show up. Your condition doesn’t warrant narcotic pain meds. I can give you non-narcotics, that’s all, and for good reason. I also direct you to a number of resources every time you come in. We discuss real options for you, but you refuse to take advantage of any of them. We both know that. I try my best to help, but you have to help yourself, too. Besides, I have to follow professional protocol. Otherwise, I can’t help anyone.”

Larry lunged toward Howard and faked a punch, stopping his fist just inches from Howard’s face. He stared at Howard for a few seconds, said, “Fuck you, Howard. You better watch your back,” and walked out of the room. Howard sat silently in his chair for several minutes before packing up and heading out. Larry was the 60th person he had seen that day. Howard was so tired, he wondered if he would be able to drive home safely. Around 10% of the people he treated described their conditions honestly and were trying to improve their circumstances. The other 90% just took advantage of the system because they didn’t know any better due to mental illness or drug addiction, or because they were predatory users who saw nothing wrong with abusing and manipulating those around them.

Between his years working as a paramedic and now as a physician assistant at a state-run for-profit hospital, Howard had seen it all. He helped people in Urgent Care with basic problems like broken fingers, sprained ankles, and respiratory illnesses, but he also worked in the Emergency Department, where people needed treatment for everything from diarrhea to cardiac arrest. He was responsible for CT scans, X-rays, full blood work, ultrasound for blood clots, MRIs, EKGs for heart attacks, and so on. Most people came in to be treated for lower back pain, headaches, sore knees, abdominal problems, and chest pains. At least 50% of the time, the hospital staff couldn’t find anything wrong with the patients. A fair number of homeless patients claimed to have chest pains because they knew the Emergency Department never turned anyone away for this. Getting into the Emergency Department meant warming up, getting a good meal or two, and having a safe place to stay for a little while.

But for every single mother working three jobs, raising children, and needing serious medical help, a stream of users poured through the hospital doors, working the system because they were either lazy or filled with a misguided sense of entitlement. They lived to exploit whatever the government was willing to give them. They could buy cigarettes whenever they wanted to, and several owned TVs much bigger than Howard’s. Yet they claimed they never had money to pay for anything, and they clogged the system, badgering, begging, and bullying Howard for strong prescription narcotics. Howard had become expert at reading people over the years, but now the lines were beginning to blur. He couldn’t always tell who was lying to him and who was telling the truth, and he was drinking every night.

Howard was just biding his time at this point, waiting for the opportunity to practice medicine in a better environment. He still lived to help others. He figured he always would, and he tried to seek positives in his job, but it was hard to help so many people who didn’t want to help themselves, and he wanted to be liked and respected, not despised for refusing to pander to his patients’ basest instincts. He saw no end to this cycle of misery. Too many people were living at the poverty level or close to it, which meant the tax base would never meet the needs of a country that kept growing in size but shrinking in wealth. Howard’s job was a front-line testament to this reality.

All the same, dwelling on these problems wasn’t going to do him any good. A few beers and some TV would settle him down. He would try to forget everything until the next morning. The more dismal reflections on human nature could wait.