Devil In Disguise

Taz the Tasmanian Devil

Working at the County facility, I come in contact with prisoners regularly.  We have a very active telemedicine service that is connected with most all of the prisons in the New York state system.  We get several telemedicine connections a shift where we evaluate prisoners for a variety of complaints such as chest pain, sports injuries, falls, seizures, etc.  We can give some medical direction to the nurses in the infirmary, and we decide if and where a prisoner will transfer to if they need more definitive care.

A lot of those prisoners come through our emergency department.  We also get a number of patients from the city jail holding center.  Most of the time, those patients are trying to prolong their impending incarceration for as long as possible by complaining of chest pain, shortness of breath, abdominal pain, faking seizures, etc.

I never wanted to know what any of those prisoners had done.  I used to be curious.  A polite young man, covered in prison tattoos, showed you where he got hit on the side of the head with a pillowcase full of cans.  He converses pleasantly while I sew his ear and the side of his face back together.  You send him off with instructions and think maybe he’s in prison for something simple.  He stole a car.  Maybe a drug dealer.  Then you find out he killed someone, stuffed their body in a truck, dismembered it and spread it around several areas.  Yeah… now I just don’t want to know.  Let me deal with their medical issues and not think about anything else.

How do we manage to keep working a case objectively when faced with people who have committed such crimes?  I don’t know that I’ve ever had an ethical dilemma when it comes to treating the gang banger who just shot the innocent bystander and both are in the trauma rooms.  I don’t think twice about giving pain relief to the drunk driver with the broken arm who crashed into another car whose passengers are now rolling into the E.D.  You think about the trauma.  Fix what’s broken.

I thought about this recently as I gently cleaned the self-inflicted wounds on a murder suspect.  After they had described their actions in a chilling flat affect which left me knowing a hot shower and several glasses of wine would be required later that evening, I went back to the desk and sat staring at the patient chart.  What would I write?  What should I write?  After a few minutes of staring at the blank sheet I started, “Patient presents with… ”  Back to the medicine.  Back to a place where I could feel safe again.

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