01 April 2011

Bizarre Juxtaposition

My last couple of posts reminded me of another interesting situation I once found myself in when I was in training at the Big Hospital in the Inner City.

It was a routine day. I was seeing a young inner city youth who had been administered some street justice in the form of a "punkin head." We'd done the primary survey and were moving on to the next segment of the trauma exam when the charge nurse told me that she had put another patient into one of my rooms. It was an old lady named Mrs. B_________ and I needed to go see her right away. She was being evaluated for fainting. Perplexed as to why I was being asked to leave the trauma for an apparently stable elderly syncope, I instructed her to get an things started with the trauma and I'd be right back. I went over as soon as I could and introduced myself to Mrs. B_________, took a brief history of what sounded like garden-variety old lady syncope, and did a quick exam. Nothing seemed out of the ordinary, and I ordered an ECG and labs and went back to my trauma.

Now this young man who had been beaten had assured me that he did not do or have anything to do with drugs, and he had seemed earnest. Since, in that neck of the woods, there was so little stigma involving drugs most users/dealers freely admitted their involvement. So I took him at his word (I know, I know -- rookie error, but I was still in training), and I was really mad when I took off his shoe and a couple dozen vials of high-grade purified heroin fell out and into my hand. (No needles, fortunately) The vials were neatly packaged for sale and probalby represented several thousand dollars worth of inventory. I was really angry at being lied to, and I needed to walk away to cool off. At that time, the nurse brought me the ECG from Mrs. B_________, and I reviewed it. The heart rate was quite slow, probably from her beta-blockers, and that was, I surmised, the cause of her syncope. I wandered back over to her room while the techs were doing x-rays on the trauma kid. I stopped by my attending to show him all the heroin and to see if he knew what I should do with it. He opined that I should find a cop in the ER and give it to him. A nurse volunteered that I should just flush them. Someone else said I should put it back in his shoe or the kid might get killed for losing the drugs.

Still musing, I walked into the room to check on Mrs. B_________. She was okay, and I explained what we had found on the ECG. In walked her husband, whom I immediately recognized and greeted as Senator B_________. It was a delight and an honor to meet him, a famous and historic national politician, and I eagerly shook his hand. He was warm and personable, and I explained that we had a good idea why his wife had fainted. I wanted to show him the ECG, but I had been forced to juggle the packages of heroin and the ECG in my left hand while I shook his right hand. So, I said, "Well, Senator, I think we know why your wife fainted," while holding out a fistful or heroin vials towards him. At least that's what he saw! His eyebrows went up quizzically, and I quickly moved the ECG back onto the top of the pile to show him the tracing. I dropped the vials into the pocket of my scrubs and reviewed the situation with him. He was polite enough not to mention it further, though during the rest of our interaction I couldn't help but notice his eyes kept going back to the pocket of my scrubs with a curious expression.

So eventually it all worked out. The kid went to the OR for his facial fractures, Mrs. B_________ went to the CCU, and the heroin was placed in the custody of hospital security (and I never found out what they did with it). But it was a, how shall we say, unique experience, that I was shaking the hand of a US Senator while clutching a fistful of heroin (insert politician joke here).

Ah, I miss life in the Big ER. It was pretty crazy there. But I don't miss it too much; I'll not be leaving my lower-middle class suburban paradise anytime soon.


  1. So...from your story, I get the impression that the nurse suggested you give priority to Mrs. B____ because she was a senators wife. If that's the case, what do you think about the ethics of the situation? I'm not suggested you did anything wrong...it was after all the nurse's call to bring Mrs. B____ to your attention, and it sounds like you were able to juggle both patients without any problems (just not the heroin... :-))...but I do wonder.

    If an old lady who wasn't a senators wife came in, she wouldn't have gotten as prompt service.

    Should a senators wife get better experience than a regular old lady?

    What if this preference had made a difference in one of the patient's outcomes?

  2. yes, for what it's worth, I do think it was inappropriate for the VIP to take precedence, though in this case it was more forgivable because both of them were "quasi-stable" meaning one (the trauma) looked OK but still had the potential for serious injury not yet diagnosed, and the other looked OK but had at least one seriously abnormal vital sign. There are shades of gray, and this one seems to fall on the side of acceptable.


  3. I once thought I missed that inner city knife and gun club stuff from the first eight years of my career. I went back and tried it out again for a few months and realized that, no, I didn't really miss it at all. Many things look better as memories than they did when you were experiencing them...


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