Working as an emergency medicine physician, I come into contact with people on the wrong side of the law regularly. We evaluate local inmates for a variety of complaints such as chest pain, sports injuries, falls, seizures, etc. We also get a number of patients from the back of police cars and the city jail holding center. These come in as requiring “medical clearance for incarceration.” Most of the time, those patients are trying to prolong their impending time to being in jail for as long as possible by complaining of chest pain, shortness of breath, abdominal pain, having a seizure, etc. Sometimes it’s just a problem of being “too drunk” to be in jail.
The “incarceritis” patients are relatively simple. You work up their complaint and send them off with the nice police officer, sheriff, homicide detective. Usually after an hour or so in the emergency department they are more sober, less volatile, easier to work with. I don’t ask about what brought them to the ED, but sometimes I’ll hear about their circumstances from the arresting officer. Usually, it’s nothing too serious and might even be a bit of amusement on a long shift.
When it comes to the inmates, though, I never want to know what any of these patients have done. I used to be curious. Then a polite young man, covered in prison tattoos, showed me where he got hit on the side of the head with a pillowcase full of cans. He conversed pleasantly while I sewed his ear and put the side of his face back together again. I sent him off with wound care instructions and thought, well maybe he’s in prison for something simple. He stole a car. Maybe a drug dealer. Then I found 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 fighting for their lives in the trauma bays. You think about the trauma. Fix what’s broken. Heal the sick.
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 screen I started, “Patient presents with.” Back to the medicine. Back to a place where I could feel safe again.
Veronica Bonales is an emergency physician.
