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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?

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 are considered drunk. We’ve monitored him meticulously, striving for that sweet spot of intoxication where he’s functioning as if sober.