Samaritan Snare

It was a hot summer evening, and I had just completed an emergency department shift. I was exhausted, again. As I headed down the street toward the subway, I came across a man lying on the sidewalk.

He was disheveled, unshaved, dressed in dirty clothes, probably in his forties. He wasn't moving, but I could see he was breathing.

Everyone else was walking past him, but I... I'd been a doctor for several weeks, at this point. I was still in my scrubs. I looked around -- maybe a more senior resident would walk by? We were literally a few hundred yards from the hospital.

But there was no one I could consult. So I assessed the man. After a vigorous sternal rub, I learned the man's airway was intact, he could move all extremities, open eyes, and mumble. His pulse had a regular rate and rhythm. If there was a triage note for him it'd read, "EtOH-like smell on breath." There were no deformities, lacerations or abrasions on his face or hands. But I started to wonder -- sure, he was drunk, but what if he'd been assaulted, too? What if a car had hit him? There was no bottle lying around, no shopping card or cardboard box.

I looked around again, in vain. I had to make a decision. I picked up my cell and dialed 911.

As I waited for EMS to arrive, I thought about the Tipping Point. In Malcolm Gladwell's first book, he recounts a study of opportunity and conduct:

Seminarians were asked to give a sermon on a biblical story, across campus. Along their path, each student encountered an actor, playing a destitute man lying down, coughing and groaning. What factors influenced whether the seminarians would stop and help the man? The designers looked at three variables: 1) whether the student had expressed a desire to help others as a major reason for enrolling, 2) whether the assigned sermon was on "The Good Samaritan" or 3) how much time the seminarian was given to get across campus.

It turns out third variable was by far the most important -- hurried people don't stop to help strangers in their path, even if they're seminarians on their way to preach on the Good Samaritan.

Of course, in this instance, I was not exactly hurried. In fact, I was done for the day -- so I had the time and the means to help. My big reluctance in calling 911 had nothing to do with me, but rather, that I didn't want to make work for my colleagues -- the people in the ED I had just signed out to. Because the truth was, I suspected, that this guy would be ok -- he'd sleep it off, either under the warm summer sky or in the ED, and he'd be back at it the next day.

If that were the case, then I really wasn't helping the man at all -- I was just passing along a problem.

As it turns out, Gladwell had something to say about this problem of chronic homelessness and substance abuse, it just hadn't been published, yet.