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Opinion: On a frigid night, do I let a homeless patient keep an ER bed or free it up for someone who may need it more?

Frigid nights intensify the constant compassion clash in the emergency department: Do we release a homeless patient who is better, freeing the bed for someone else who needs medical care,…
A homeless man rests above a warm air vent during a winter storm. Emergency physicians who treat homeless individuals have their compassion tested on frigid nights. Source: BRENDAN SMIALOWSKI/AFP/Getty Images

It’s taken awhile, but Mr. Green, a heavy drinker, is finally sober enough to be discharged from the emergency department. As I examine him, I note that his scuffed hands aren’t shaking. His speech isn’t slurred. His gait is steady and proud. But he’s homeless and the clock shows 1:35 a.m. and we have a problem.

It’s a problem that can’t be solved without creating another one. And the root of it, sadly enough, is compassion.

When an emergency medical services team pushed Mr. Green into the ED seven hours earlier, the alcohol in his bloodstream was at a level that would send most social drinkers into a coma. His body shakes with withdrawal at a blood alcohol level where most people

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