By Kelly O’Brien MD, FACP, CCHP
Posted on September 8, 2008 – An important part of our job in corrections involves allowing patients in many circumstances to be able to maintain a sense of dignity while conveying the appropriate sympathy level.
My morning starts at City Jail. Most inmates are there 1 to 3 days—mouth swabs (no toothbrushes) and showers are available, but either social protest or fear keeps many patients from showering. Their socks have been on anywhere from a day to a year. Entering the small, warm exam room and not missing a beat or a breath can be a challenge. I practice mouth breathing and try to not let my eyes water.
My first patient is a handsome 19-year-old with a big cut across the bridge of his nose. He can attend to it himself if he makes bond. I ask if his mom is coming, and he reports that Mom knows he’s there, but she had some errands to do first. This makes me suspect this isn’t the first time he’s done this to her. Not knowing if Mom’s errands include moving to Arizona, I send him to the ER for stitches. Statistically, he’ll outgrow being a thug – better that he not look like one.
The second patient has a bruised left face but it’s his right ear that’s bothering him. He doesn’t remember what he did to either side. An otoscopic exam finds a moribund fly, feebly waving her wings in a graceful gesture of goodbye. I remove some wax, and start extracting the fly. The nurse reports the wax is moving. I assure her it is not. She then assures me that it is, and sure enough, the wax is a little busy ball of baby flies (often called maggots) now crawling around our exam table. The fly, liberated from her aural trap, struggles bravely on the exam table next to the patient, but she’s not long for our world. Every officer in the area has to come by to look, so now the exam room is crawling with people (commenting loudly) and maggots (more quiet). The patient himself looks very depressed. My memory reaches back to the Bedside Manners class and finds no specific instructions for Conveying Sympathy and Dignity to a Patient with Live Bugs in Body Cavities so I have to improvise some comforting remark.
The third patient has handcuff injuries. He demonstrates an excellent range of motion and a limited vocabulary by waving his fingers, hands and wrists repeatedly in front of me, while yelling, The cops broke my f****** wrist several times. He goes on, They’re not supposed to be that tight! Usually they’re not this tight. Any time I get arrested, they’re never this tight! He clearly knows more about police protocol than I do, so I try to offer insight and reach him at what we call a teachable moment.
Me, a voice of tender concern: Were you being a bigger jerk than usual?
Patient: No, man. I wasn’t even resisting. I’m not even charged with resisting so you know I wasn’t resisting.
No visible damage, but he gets some sympathy Advil.
A young man acutely short of breath is brought in. He is Spanish speaking only and appears very young. (In fact, the sheriffs are trying to find some ID.) I ask him about his breathing, and he responds that he wants his mom and starts to cry. I’m trying to offer some sympathy, because this sobbing is not good for his dignified demeanor when he gets back with the guys in the holding cell. He can’t even take a breath deep enough that I can listen for wheezing. Just then we get the word—he is indeed a juvenile and his parents are waiting for him downstairs. In what can only be described as a medical miracle, the shortness of breath is cured and he’s out the door.
My first patient at the hospital unit walks in slowly, and even the deputies look sympathetic. Amazing story, really. He was going through a door, heard a noise and a bullet had gone through his penis for no reason.
Whose door? Not sure.
Were you carrying a gun? No, that was the amazing part—no gun and no one else was around
Was it a jealous boyfriend? Oh, no, he reassures me. If that was the case, it would have happened along time ago (gives me a suggestive wink).
The natural response, of course, is Dude, you haven’t seen a shower or a toothbrush in 36 hours, and your private parts are mottled purple with a tube hanging out—don’t even think you are impressive right now.
But that would not be sympathetic nor would it allow him much dignity, so I nod quietly and order pain meds and elevation (with a pillow, that is).
The next patient was admitted from the grass outside. Despite an officer standing right next to her, she suddenly jumped out of the second story window at the OB clinic. Her plan was to run, the reason being I didn’t want to have my baby born in a jail. This is a good general plan, but the wrong approach. Her two broken ankles kept her from getting too far, she’d lost a certain amount of dignity and the officer had very little sympathy.
Later, discussing the day with the kids, I offer Life Lessons. One is called Let’s Not Be in Custody When We’re Having a Family and another is Never Run With a Loaded Gun in Your Waistband. The latter lesson is much more impressive to the 13-year-old boy. He’s just beginning to appreciate how precious these things are. Besides, this is will be a cool story to tell at school and at this age, cool has it over dignity. It occurs to me, I am indeed privileged to have a job with the right amount of dignity, sympathy and cool.
Dr. O’Brien is an SCP member and physician with Denver Health and Hospital. Readers may contact her at kelly.obrien@dhha.org.
