Mr. James was cold. An internal body temperature of 84.2 degrees Fahrenheit qualifies as severe hypothermia. When I first met him in the Emergency Department, his grey hair was poking out from under a warming blanket. Warm fluids were running through an IV into his veins and through a catheter into his bladder. He responded incoherently when I asked his name. His 67-year-old brain and body had frozen.
I ordered a battery of blood tests searching for the cause of Mr. James’ hypothermia. As I’d been taught in medical school, I considered infection, hypothyroidism, adrenal insufficiency, and carbon monoxide intoxication. All the tests came back normal.
It turns out Mr. James was cold from sleeping outside. Someone stole his blankets and the temperature dropped, a simple formula for hypothermia. He’d had three identical hospital admissions in the last year, each of which involved the same process: We warmed him up, gave him a few hot meals and a warm bed for the night, and then discharged him to the street with a taxi voucher to a homeless shelter. He walked out of the hospital and right back into the cold.
Discharged to the Street
As a resident, or doctor in training, one of my key roles is coordinating discharges from the hospital. Every time I sign a discharge order, I must select the patient’s destination from a dropdown menu of options including home and other levels of care such as skilled nursing facility. “Street” is not an option and yet this is where patients like Mr. James end up.