I don't typically think of my job as dangerous. Quite the opposite, actually - the trauma bay is supposed to be a safe place where people who have done something particularly dangerous and/or stupid come to get something fixed. Whenever we get a rowdy patient (who is usually either A) drunk, B) high on PCP, C) an asshole, or D) some combination of the above), everyone in the trauma bay knows that, with one quick phone call, several very burly men who could easily pass for moderately large bears will descend upon the asshole and defuse the situation in approximately 4.72 seconds.
Sometimes, however, even that isn't enough.
Unlike the trauma bay, prisons are violent places, and violent things tend to happen there. Granted my information regarding the violence inherent in the penal system is mostly limited to what I learned in The Shawshank Redemption and O Brother Where Art Thou, but that knowledge base expanded significantly recently when I met Ervin (not his real name™).
I don't usually get too worked up when my trauma pager alerts me to an impending "assault". That may sound callous, but it's for several good (I think) reasons: 1) When people are assaulted, it is most commonly limited to the face, 2) if these people suffer any injuries (past lacerations and contusions), it is most often a broken nose or other facial bone, 3) those fractures rarely require surgical intervention, and 4) if they do, I call the maxillofacial surgeon to do it. So when my pager alerted me to an assault arriving in 8 minutes, I sighed and put away the blog post I had been trying diligently (yet failing miserably) to make sound less stupid.
But then something caught my eye - the patient was arriving by air, not ground. Hm. That could mean it was more serious than I was imagining. Or it could mean the patient was injured further away than an ambulance could drive in a reasonable amount of time. Or it could mean something else. Yes, the dreaded "other".
And of course it was "other".
When Ervin was wheeled in, the first thing I noticed was the prison jumpsuit. The second, third, fourth, and fifth things I noticed were the various handcuffs and shackles pinning him to the stretcher. The next thing I noticed was the mask over his face (think Hannibal Lecter). Finally came the bevy of police officers accompanying him. This bodes poorly, I thought.
And I didn't even know the half of it yet.
"Hi there, Doc. This is Ervin. Ervin has been (god damn it Ervin, stop fighting!), uh he's been tussling with the prison guards for the last (damn it, Ervin! Stop fucking spitting!), um for the last two days. He's being transferred, and (fucking hell guys, he's trying to claw my arm again!), he's being transferred to another facility and doesn't want to go I guess."
Imagine trying to wrangle a cat into a pet carrier. Now imagine the cat is extremely angry. Now also imagine that cat is 2 meters tall, weighs 110 kg, and can curse constantly. Yeah, that's Ervin.
He was covered head to toe in abrasions and contusions, and he had obviously earned every single one of them. Ervin continued fighting as we moved him to our stretcher, and I've rarely seen such a relieved medic crew get the hell out of my trauma bay so quickly. The officers, on the other hand, thankfully stayed.
"You want us to uncuff him, Doc?" one of the officers asked me.
"Hey wait," one of the nurses said. "I know this guy! Yeah, Ervin! He was here as an 'assault' two days ago after he fought with the prison guards! He injured two techs and a nurse, and he tried to kick me in the face!"
The police officer looked at me askance.
Uncuff him? Seriously?
"Hell. Fucking. No. Under no circumstances. NO." Yes, those were my exact words.
The tech moved towards him to place an IV, and I immediately stopped her. I made it clear to everyone in the room that no one was to come near this guy with anything sharp, and all we were going to do was get a quick 5-second CT scan of his brain, see that it was normal, and then send him right back from whence he came. Fortunately when we brought Ervin to the scanner, he decided the CT doughnut wasn't as threatening as a roomful of cops, so he stayed still long enough for me to see a normal brain.
Thank you for this one small thing, Call Gods.
As I was chatting with a few of the guards a short while later, one of the nurses beckoned to me. "The radiologist is on the line for you. He has a critical finding he needs to tell you about."
Oh come on, no. No. NO.
It turns out I had missed a tiny subdural haematoma and an even tinier cerebral contusion. I looked at the scan again and still couldn't see it, so I had another radiologist look at it. He confirmed that I was indeed not a radiologist and the other radiologist is. The finding was, in fact, real.
God. Damn. It. Fuck You, Call Gods. Fuck you.
So now I was obligated to admit this asshole, put an army of security guards and police officers on him, start an IV, try to do neuro checks on him every hour, repeat the CT scan in a few hours . . .
Fuck. Just, fuck.
I did exactly that, apologising to everyone involved in the process. No one wanted to take care of Ervin, though we all did dutifully and respectfully. Ervin, however, was not nearly as accommodating. There were two very large police guards inside his room at all times, and fortunately his outbursts were mostly limited to hurling verbal abuse at anyone he could see.
The following day his repeat CT scan was stable, his neuro exam was stable (read: he was still a violent asshole), and I kicked him the fuck out of my hospital before he could injure anyone else.
I have no doubt I will see him again. Soon.