Chapter 16: Getting To Know You

April 17, 1990, McKinley, Ohio

"What do you have?" I asked.

"Nineteen-year-old female with multiple contusions and a significant abrasion on her forehead. Claims the injuries are from Rollerblading, but I don't think so based on her demeanor and the VERY controlling vibe I get from the boyfriend who brought her in."

"Don't take this the wrong way, but by vibe, you mean intuition?"

"Girls know," Mary replied. "I know that's not medically defensible, but it's real. Some guys give off a very creepy vibe. This guy sure does."

"I take it he insisted on coming into the room with her?"

"She insisted he come in, but her eyes kept darting to him as if she were seeking approval."

"Are they alone in the exam room?"

"No. Jamie is in the room with them. I figure if the six-foot black belt in Taekwondo can't control the situation, we'd need the Sheriff's HRT."

"What do you want to do?" I asked.

"Call the cops, but I don't have any actual evidence yet. I'm concerned that I won't get truthful answers from her, and I certainly won't with him in the room."

"If he won't leave and she doesn't want him to leave, we try a bit of subterfuge. Perform your exam and say that we want to send her to Radiology for a CAT scan. I'll call Jeannie Wilders or Amelia Clinton and ask them to put on a lab coat and meet us in Radiology. We've used this ploy in the past because no one is allowed in the scanner room or the control room except medical staff. If the patient admits the abuse, the social worker can call the Sheriff. If not, all we can do is treat her injuries."

"That sucks," Mary declared.

"One lesson I had to learn, and with some difficulty, is that we have to leave things outside medicine to other professionals. There were times when I was still a clergyman when I wanted to do clerical things, but that wasn't my job as much as I wanted to do that. Doctor Gibbs made the point starkly — if I wanted to be a chaplain, then I had to be a chaplain and not a physician. It took quite a few whacks on the nose with a rolled-up newspaper for that to sink in, but it finally did. Let me make the call to the social worker now."

I picked up the phone and dialed the number for the on-call social worker, and Jeannie Wilders answered. I explained the situation, and she agreed to my plan and asked me to call when we were ready to go to Radiology.

"All set," I said. "I'll call her when you take your patient to Radiology. Let's go see your patient, and be very careful how you present. We don't want to spook the boyfriend."

"Defib set to 300 to the groin will do it," Mary said.

"Ouch?" I said, shaking my head.

"Never thought about doing that?"

"Only to Residents or Attendings," I chuckled.

Mary laughed, "I promise not to do that to you! Rosenbaum ... never mind."

"Did he act inappropriately towards you?"

"Yes, but before the new rules went into effect."

"Not since?" I asked.

"Not since," Mary confirmed.

"Then, sadly, there is not much I can do. Let's go."

We went to Exam 4, where Mary presented.

"Jill, this is my supervisor, Doctor Mike."

"Hi, Jill," I said.

The boyfriend, who was standing close to the bed, eyed me suspiciously, and I had to admit to myself I had the same vibe Mary had. A quick look with Jamie confirmed he agreed.

"Hi, Doctor," Jill replied.

"Mary?" I prompted.

"Jill Morrison, nineteen. Multiple contusions and abrasions to arms, hands, and temple due to Rollerblade accident. BP 120/70; pulse 70; PO₂ 99% on room air. Reports significant right shoulder pain, and shoulder is tender to the touch, but does not appear dislocated."

"Jill, mostly your injuries don't appear to need more than irrigation – cleaning them with saline — and topical antibiotic. Your forehead scrape doesn't appear to be serious enough to require plastic surgery to prevent a scar. May I listen to your heart and lungs and examine your shoulder?"

"The lady doctor already did that!" the boyfriend protested.

"Mr...?" I prompted.

"Carter. Drew Carter."

"Mr. Carter, Mary is a Sub-Intern, so I'll need to confirm her findings. She believes the shoulder injury is serious enough to require a CAT scan, which will require my signature and approval from the Chief of Emergency Medicine. In order for me to sign off on the test, I need to do an exam. Jill, may I?"

"Yes," she agreed, but only after looking for approval from her boyfriend.

Her heart and lungs were unremarkable on auscultation, but I was actually concerned about the shoulder, given how Jill winced when I touched it. I suspected some kind of deep ligament injury or possibly a ball-and-socket injury of some kind that hadn't resulted in a dislocation.

"She needs an X-ray and very likely a CAT scan," I announced. "Mary, please call Radiology, and I'll have Doctor Wernher sign off on the CAT scan."

"Why does it need three doctors?" Mr. Carter asked.

"The hospital, like the military, thrives on red tape," I replied. "I'll be right back."

Mary went to the phone, and I left the room and walked to Doctor Wernher's office. He wasn't there, so I checked the board and saw he was in Exam 1, so I went there.

"Excuse me, Doctor Wernher, may I interrupt?" I asked.

"What do you need, Doctor?"

"Could you step out for a moment for a private conversation?"

"Two minutes," he replied.

I stepped back into the corridor and waited for him to come out, then explained what I wanted to do.

"Is that the usual protocol here for this kind of thing? In Chicago, we just called in a female police officer and social worker."

"We tend not to call law enforcement until we have some actual evidence, and usually it's left to the social workers to place those calls when we're treating battered women."

"X-ray first, and if it's not sufficient, then a CAT. Unless there's a break, it's most likely going to be treated outpatient, not by admission to Ortho or Surgery. Agreed?"

"Agreed."

"Proceed."

He went back into the room, and I returned to Exam 4.

"All set," I said. "Jill, we'll do an X-ray, you'll wait in Radiology while we wait for the film to be developed, and if it's inconclusive, we'll do an immediate CAT scan."

"OK," she agreed.

"Mr. Carter, because both scans use ionizing radiation, nobody is allowed in the room except medical staff and the patient. There's a waiting room outside Radiology, or you could go to the cafeteria and get some coffee."

"I want to stay with Jill."

"The best we can do is the waiting room outside Radiology. It's simply unsafe for anyone to be in the room. Mary and I aren't allowed in there; only Radiology techs and the Radiologist, and they wear badges to measure the X-rays they receive, despite the protective systems for the equipment."

He looked very unhappy, and I wondered if he'd insist Jill leave AMA.

"My shoulder really hurts, Drew," she said. "Please?"

"OK," he agreed. "I'll stay with you every second until they take the X-rays."

"Mary, go ahead and walk them down to Radiology, please."

They left, and I went to the phone and called Jeannie Wilders, who promised to go straight to Radiology wearing a medical coat.

"That asshole is beating her," Jamie said after I hung up.

"Mary figured that out. Hopefully, she'll talk to Jeannie. If she doesn't, our hands are tied."

"I'm a pacifist like you, Mike, but guys like that who abuse women..."

"Yeah."

We left the exam room and waited for Mary to return, which she did about five minutes later.

"The social worker is with Jill, but I'm not confident Jill is going to talk."

"All we can do is wait. You can get another patient while we wait."

"Mike?" Ellie called out. "EMS three minutes out; GSW to the chest."

"Mary, let's go. Ellie, I need two nurses."

"Jamie and Kellie."

All of us hurried to the ambulance bay for what was guaranteed to be a surgical admission.

"Mary, use the phone just inside the bay doors to call Surgery and let them know we have an inbound GSW."

"Right away, Doctor!"

The EMS squad pulled up, and Randy, a new paramedic, hopped out.

"Male, twenty-six; single gunshot wound to the right chest with no exit wound; BP 90/60; tachy at 110; PO₂ 94% on five litres; IV plasma and saline; 3mg morphine."

When he opened the back of the squad, Deputy Kenseth jumped out first, followed by Julie, the County's lone female paramedic.

"Trauma 1!" I ordered. "Jamie, type and crossmatch; Kellie CBC, Chem-20, ABG surgical stat! Mary, intubation, then 5-lead."

We rushed the patient towards Trauma 1, with Deputy Kenseth following closely.

"Your handiwork, Deputy?"

"He drew on Scott Turner. That never ends well."

When we reached the room, we moved the patient to the treatment table, and I began my assessment. I moved the pressure bandage, observed the wound, then covered it again.