Friday, December 2, 2011

Asthma and Detention

     Nearly every medical and surgical intern spends at least a month rotating through the emergency room (ER). I did both my internship and residency at the same institution, a large training program in a major city, replete with a sprawling downtown county hospital, which was the area's catchement for indigent care. At that time, there were only 4 other comparable hospitals in the United States, one of which is the now-defunct Charity Hospital in New Orleans. To describe this particular ER as "busy" would be an understatement; chaotic was more like it. I have to admit that I was less than enthusiastic  about my ER rotation because it coincided with a period of  time during which I was seriously contemplating 1) whether I wanted to continue with surgical residency, and 2) whether I wanted to continue with residency at all. I felt stateless, disillusioned, and disenfranchised from the whole residency gig, and was alarmed at the degree of uncertainty issuing from within me.
     When you arrived each day for your shift, you could be assigned to any of several areas within the ER. There was the Red Zone, which comprised trauma and surgical emergencies. There was the Blue Zone, which was for medical emergencies. My least favorite, yet perhaps the most strange and fascinating option of all, was Asthma and Detention. This consisted of a small, glassed-in room, with two rows of reclining chairs, one right in front, and the other along a side wall. The front row of chairs was filled with asthma patients, some in mild distress, others descending the downward spiral toward status asthmaticus. Treating these patients generally consisted of breathing treatments, oral or intravenous steroids, and possibly, a hospital admission. The asthmatics, in their varying degrees of respiratory embarrassment, were usually also quite anxious, sitting bolt upright in their recliners, breathing their oxygen, and looking worried. I can't help but think that some of them may have been worried because, if they looked across the room, they could see a row of prisoners in orange jumpsuits and shackles, sitting in the recliners against the wall. What a bizarre combination: asthmatics and detainees! The prisoners were brought in for a host of complaints, the usual being hand and wrist fractures, along with facial lacerations or abscesses that needed to be drained. Many of them were actually pretty appreciative of anything you could do for them. A few of them were nasty, rude, and chauvinistic, and it was a struggle to be courteous to them. 
     There is a certain amount of morbid curiosity that comes with caring for a prisoner. Obviously, you want to know why he (or she) is in jail, but is it prying to ask? If he has a broken wrist, you wonder if he's been in a fight, and if so, is he going to behave violently coming out of anesthesia? Has he been using drugs? Does he have HIV or hepatitis or MRSA? Over the years, I've taken care of a fair number of prisoners. Every now and then, he presents in the form of a gentle, poignant, broken spirit, who for whatever reason, has met with especially bad fortune. He could have been the kid on the playground, always being chosen last for kickball, or relentlessly bullied. He could have been teased because he was different or fat or funny looking. He could have been abused, or even worse, not loved enough. He could have been my brother. Regardless of the circumstances, real or imagined, a prisoner is a human being, and is still just as deserving of compassionate care as any other patient.


  1. ....that is...until they try to choke you! When I was in there, an orange-jump-suit tried to come out of the chair and choke me while the police played cards in the table next to me. That was my least favorite place to me. After that incident, and since he was in no acute distress, I sent him back to the Grady detention area. :(

  2. agreed, toddles...i had a couple of cases where i ended up having to refuse to treat. being abused by a patient, after having given him or her the benefit of the doubt, is a unique sort of betrayal.