RX GOMER

You've got a bad headache. You've got a bad headache because somebody beat you up, and took your wallet and your backpack. You can barely see the wet flecks of red something all over your torn jacket because your eyes are so swollen from the beating.

Or you tripped over your boot laces and fell down a couple of days ago, and at first what seemed a minor bump has now swollen your leg to three times it's normal size, and you can barely walk without screaming out in pain.

Or, that cold that started out as a mild cough and stuffed nose has turned into a monster thing crawling around inside your chest and threatening to stop your breathing.

Or maybe, you just ate the wrong sandwich at the shelter, the one that was dated 'expired' about fourteen days ago, and you know that if you don't die from the tainted meat in that sandwich, you surely want to.

Wait and see, the usual remedy for all things medical in homeless nation just isn't going to cut it today. You can no longer put it off. Time for the trip all street puppies fear. The trip to the ER.

If you're in homeless nation, it's very likely you have no health insurance. Not even medicaid or county insurance, and forget about a doctor.

Dr. Vinnie Boom Bah in that building on the corner which houses a record store on the ground floor is about as close as you're going to get to a doctor. And he's never inhis office because He owns the record store.

What you do have is EMTALA. That's geek speak for The Emergency Medical Treatment and Active Labor Act. EMTALA was passed as part of the Consolidated Omnibus Budget Reconciliation Act of 1986, which is sometimes referred to as "The Cobra Law".

That's the law that states if you see a Cobra just outside the ER, you can pull your gun and shoot it, but if you see it inside the ER, you have to conceal your gun beneath your shirt and shoot it through the button hole.

The COBRA law also states that the ER must treat anybody who is in extremis ( hurt or nearly dead or real sick) if they get within 250 yards of the ER and ask for help. The trick there is getting within that 250 yard limit and hoping the last ten yards isn't over Cobra infested water.

See this whole EMTALA thing also governs when and how a patient may be (1) refused treatment or, (2) transferred from one hospital to another when he is in an unstable medical conditions and also, how far you can be outside the ER room while you're dying or something before they have to legally treat you....or stabilize you and send you to another ER. Where the same thing happens all over again.

So let's say you got into the ER, and only had to shoot two Cobras to do it. And under EMTALA you are entitled to have that head wound fixed up, or the broken leg tended to, or admitted with a serious case of pneumonia, or your stomach pumped and admitted for fourteen days of nothing but fluids through an IV.

Ah ha! But now you run into GOMER.

GOMER isn't that big guy over in the corner with apple juice all over his white coat. Yeah, the one picking his nose with his gloved hand. That's Billy Bob, the on call neurosurgeon. No, GOMER is ER nurses and doctors speak for "GET OUT OF MY EMERGENCY ROOM,"

And GOMER is a whole differnet way to triage in an ER.

Chalk it up to the weariness which plagues all those nurses and doctors and attendants scurrying around the ER in their cute scrubs whose job it is to determine who is about to kick it, and who just needs an aspirin and a pat on the fanny and a cheery "good night, honey, feel better."

Or chalk it up to genuine dislike many of those nurses and doctors and attendants actually have for people who look dirty, smell funny, and are maybe missing a few teeth and are carrying most of their belongings in bulging backpacks...and don't have insurance. My bet is on the latter chalk it upper.

I've seen more than a few upturned noses on the merry band of ER employees during the ER triage interview. You know, where they look you over and ask you a few questions to determine if you're in the may kick it or aspirin mode. It goes like this.

Q. When did it happen? The beating.
A. I don't know I was sleeping. can you clean the blood, please.
Q. Where did the beating take place?
A. Uh, um... behind the billboard over the underpass....uh...the blood...
Q.On a scale of one to ten, what would you say your pain is.
A. Um, the pain, heck, I can hardly see...could ya clean the blood...
Q. SIR, the pain, on a scale of one to ten.
A. Ten.
Q. How about if we give you some vicodin and you can go home to that billboard and sleep for awhile. Will a bottle of 60 do?
A. Sure. Um, could I have a wet washcloth?

There ya go, problem solved. no surture for the cut behind all that blood, no cat scan to see if there is brain damage. Just the bottle of vicodin, and a referral to see Dr. Vinnie Boom Bah above the record store in ten days.

And the guy who tripped over his boot laces, and the one with what is probably pneumonia and the one who ate the nasty sandwich will all get the same treatment. Except the guy with the sandwich thing will get a sample of kaopectate along with the vicodin.

And the ER attendants will have gotten around EMTALA rules because they were able to determine the patient did not have to be transferred to another facility; took care of the Cobras and was within the 250 yard limit when when he asked to be treated, or was stabilized, (meaning he didn't pass out right then and there) and was not refused treatment.

Nice work if you can get it, and the scrubs were'nt even soiled. And just about every ER we street puppies know of do that work every day and night. And who knows, the guy with the head injury might drop dead of a blood clot to the brain in a couple of days; the guy with the leg injury might walk around permanently on a broken limb which never heals right, and be crippled for life; the guy with developing pneumonia will be back probably, in an ambulance and near comatose, and the guy with the nasty sandwich? Well, it won't be the first time somebody starved to death from fear of eating expired food.

The real RX in homeless nation is, don't get sick or hurt. And if you do, tough it out. It's either that or develop a vicodin addiction. Or worse, actually have to get to know Dr. Vinnie Boom Bah!