I often talk to my patients in the ER a little more than I need to, mostly because I like them. Sometimes I ask them what they do for work, or if they have kids. Sometimes I ask them how they are doing in school or at home. And sometimes it is a mistake to ask, and perhaps it was recently when I asked the third-generation Mainer in Room 2 if he was worried about paying for home heating oil and keeping warm this winter.

He was an old “lunger,” huffing and puffing with a flare-up of his emphysema, waiting for the meds we had blown, fed, and injected into him to start taking effect. When I asked him about heating his home this winter you would have thought I had suddenly shut off his oxygen; he got anxious and antsy, started tapping his feet and looking around, and then said flatly, “I have no clue how we are going to pay for heat this winter. Not a damn clue.”

I was afraid he might say that. He and his wife dressed as though they were not on the L.L. Bean’s catalog mailing list, and he was on a ton of meds that probably cost a lot of money. I know several of my office patients will be cutting back on prescriptions medicines this winter in order to pay for home heating oil.

He and they will not be alone. The rapid rise of fuel, food, and other costs this year is putting unprecedented numbers of Mainers and other Americans on the margins of economic survival. Around Maine and other northern states heating oil dealers and social services agencies are looking at this incoming Hurricane Katrina of Cold and also wondering how a lot of people are going to stay warm this winter. They, like my patient, have no clue.

I thought I might have a clue, however. When you are the great and powerful Dr. Oz sitting in your ER surrounded by wonder drugs and gizmos that can produce miracles you think you can solve just about any problem. But it is a curse of the smart to be totally ignorant sometimes; one by one he shot down all of my ideas.

What about family — could you stay with them, I asked? He and his wife had none. Had he talked to his town government about heating oil assistance? Yes, the town was going to have nowhere near enough money to meet the blizzard of needs coming their way. Could he go south to someplace warm? That takes money he said, to pay for travel and a place to stay. Besides, the part-time job he had to supplement his retirement income was here, and if he left it behind there was no guarantee in a lousy economy that an “old fart” like him with health problems would find another. And Maine was home — why should a person have to leave home to stay warm, he asked?

At the end of the conversation I was right where he started; I also had no clue how he was going to stay warm this winter. He told me pray for a warm winter and make him feel better that night so he could stay out of the hospital, work some extra hours, and try to put more money aside for the winter’s oil. Those two things I could do for him and did.

As I left the ER that morning I had a couple of thoughts. The first was that Maine, for all its beauty, will be an ugly place of cold misery for many this winter, a place in which all of us warm in our homes should be chilled by the knowledge that so many others are cold in theirs. An old farmer who once told me “You are more useless than teats on a bull” prompted this second thought; America is a great country, capable of great things, but when the richest country on Earth cannot keep an old couple warm through the winter all that greatness is more useless than teats on a bull.

Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems and is on the staff of several hospital emergency rooms in the region.