During a recent ER shift a patient arrived late at night who was released from prison just 9 days prior. He was dropped off in San Jose and was walking or hitching in hopes of getting to Morro Bay to labor on the docks. He wanted to get as far from the shelters in San Jose as he could, and wanted no exposure to anyone using drugs. Unfortunately, after his time in prison he didn’t have enough cash to stay in a motel. No smart phone. No bus pass. Dead parents. No food stamps. And very few teeth.

Whether he was in prison for drug dealing or murder, I don’t know. But this kind of catch, hold and release approach just feels nuts. We solved his medical problem, fed him, and as he was leaving I saw one of the nurses hand him some money, which doesn’t happen often. He was a nice guy just finding his way.

How that’s our system I’ve no clue, but it reminded me of my reaction to the “Starfish Parable” about 15 years ago when I first came across it. “Well I made a difference for that one” is the punch line. Today I sometimes ask premed students and others who ask me for career advice what they think about that parable. Most react positively. My initial reaction was the opposite. Get a backhoe! Build a wall! Teach starfish to swim in deeper waters!

My reaction to the Starfish Parable was evidence that I’m a square peg in a round hole in medicine too. The “see and street” dynamic of emergency medicine just isn’t enough. The more years I spend in ERs, the more I feel like I’m working in a remarkably flawed system.

Endorphin Power Company was my first attempt at attacking a system in Albuquerque. Pre-R feels like my second. Who knows where it will lead, but at least it still feels right.

The world needs both brands of people, those who want face to face uplifting moments one starfish at a time, and others who take interest in the social systemic gears.

I vacillate. Truth is, today I just want to play with Max.