By Kelly O’Brien, MD, FACP, CCHP
Posted on June 14, 2010 – Note: All names were changed to protect the innocent (and the guilty, for that matter).
The nurse’s station, Monday morning. I read the patient board:
Shawn Harris- transfer from Ortho
Shane Harris-transfer from Ortho
Not an error. Chart reviews introduce me to brothers, 19 and 20 years old, charged with eluding. Their fleeing car was struck broadside on the left, and we had two young men with left-sided femur fractures.
The guys were quiet initially, but eventually their personalities emerged. They were roomed separately, of course, but inquired after each other, sending messages through the nurses and even the deputies. One was friendlier, easy-going, had a better pain tolerance. The other was more cautious, had a harder time trusting us, and took longer to fully work with the therapists. The oldest was especially worried about Mom. He’d been charged with keeping his brother out of trouble, a mission he’d not accomplished. The upcoming court appearance didn’t faze him but he was terrified to face his mother’s reaction.
Physical therapy and pain management kept them in our sub-acute unit for a couple of weeks. Mom came, checking out her boys. Apparently all was forgiven, or at least accepted, because the older Harris visibly relaxed after her first visit. Their medical needs paralleled each other so they became the Bone Brothers. Really– the nickname was part of the hospital-wide efficiency move. It saved time in staff-to-staff communication and actually improved patient care. They were discharged a few days apart, going to the County Jail to complete their legal obligations.
They mended their bones, but not their ways. Now, over a year later at City Jail, I see a strapping smiling Harris brother at Intake. Well, hey! Glad to see you moving so well. How’s the other half?
The smile fades. He got shot a couple a months ago. Died.
Offering and accepting the obligatory condolences, we complete the exam in silence. I’m thinking of a mother who foresaw this possibility and was unable to re-chart the future.
Later, I start the trustee physicals, usually a good time for patient education. Listening to lungs, I ask the young patient if he’s a smoker. I am, but not in here. He laughs a little. The standard line is set to trip off my tongue- One thing you can get out of being here is to stop smoking. It’s the single most important thing you can do for your future health. But the standard line gets tripped up looking at this smiling young man. Maybe the one most important thing you can do for your health is not get shot. Stop this foolishness that’s putting you in harm’s way. Go to school. Get a job, even If it’s a crummy one. Work within the system. It doesn’t work great, but it’s got to be better than what you’re doing now.
I pat the trustee’s shoulder. You’re fine. Take care of yourself. For the first time in my professional life I offer no word on prevention, no advice on health maintenance, no look toward tomorrow. I’ve seen through a tiny crack into the world of barely existing day-to-day.
This will pass. I’m an optimist. Glass half-full. The 5-year plan updated daily. By tomorrow I’ll be preaching the importance of blood pressure control and weight management again. But right now, I need a moment. I’m just a little sad.
