By Kelly O’Brien, MD, FACP, CCHP
Posted on January 4, 2010 – Score! Rural County has sentenced another chef. It’s a small jail nestled in the base of the Rocky Mountains along Interstate 70, which leads to such popular destinations as Vail and Aspen. When a chef becomes a guest of the county, he’s promptly assigned to cooking duties. There’s an immediate lifting of spirits. Mac and Cheese becomes Three Cheese Pasta. Eggs have both texture and taste. Diabetics are no longer well controlled. Everyone, including staff, complains about the weight gain and then goes by the kitchen in case anything’s left over.
It’s beautiful when someone can bring special talents to any situation. Take Mr. H, an IV heroin user with osteomyelitis. MRSA, of course, IV vancomycin is the drug of choice. His jail doesn’t do IVs, so he’s now staying with us in the hospital correctional care ward for 6 weeks of therapy. The judge is unmoved by the sheriff’s pleas for financial mercy. His case will be heard in 7 weeks.
Due to MRSA, which according to the evening news will kill you instantly if it jumps on you at school or in the gym, all of Mr. H’s disposables are put into a trash can inside his room. Recently, he had a low grade fever, tachycardia and a mild hypoxemia. CT-PE was negative, CXR was unremarkable, repeat blood cultures were negative, and there was no change in his inflammatory markers. He must have gotten just plain tired of all the tests, because he confessed he’d gotten a syringe out of the trash, crushed his pain pills and injected them into his Hohn catheter, just out of sight of the room camera. Such planning! Such cunning! Why he confessed so readily I’ll never understand, because it wasn’t something I was figuring out. The whole thing could have gone on quite a bit longer.
We changed our MRSA disposable policy, and started cheek checks with him. As a staff we learned a lot about trust—such that now we have less of it. Mr. G was another patient whose ingenuity was a source of awe. As a child, he’d been burned by his father. He had bilateral BKAs and scarred skin up to his chest. Amazingly, his face and his hands had been spared. He’s been active, working and getting around well on bilateral prosthesis. So well in fact, that when he didn’t believe he needed an ambulance transport, he solved the dilemma by leaving with the ambulance. He pushed the surprised paramedic out the door and drove right off. This had to be dealt with on the legal front, of course, but I hope that if I ever lose two legs I’ll still have the balls to steal an ambulance. And you have to feel a little bit sorry for the paramedic. Aren’t you the one whose rig got taken by a guy with no legs? Maybe you better let me drive.
Cooking for crowds. Pharmaceuticals. Vehicle procurement. Just a short list of the talent we’ve seen this year. And people ask why I work in corrections.
