When first starting out at Charity as an intern, I was in shock. I had never seen the quantity of patients or the volume of trauma. This was in the 1980s, and New Orleans was at that time, the murder capital of the United States. When the triage nurse has a rubber stamp for GSW, meaning gunshot wound, you know you see some trauma. The Accident Room had a steady stream of injured patients with Fridays and Saturdays going all night. But after a few months, things start becoming routine, at least routine for Charity…. another gunshot injury, another stabbing, another combative patient on drugs, another motor vehicle accident. But if it can happen, it happens at Charity. There were the occasional incidents that were unreal, even for Charity standards. When these happened, I would do the Charity double take. You would look at what was happening and keep walking… then stop and look back in disbelief.
My first Charity double take was during my internship. I was going to the Accident Room to see a consult. I walked by a patient sitting calmly in one of the old wooden Charity wheel chairs, waiting to be treated. As I walked by, I noticed the patient had an ice pick buried to the handle in his eye. He was sitting there blinking around the ice pick coming out of his eye. I did stop and stare. After finishing my consult, I came back for another look, and the on call ophthalmology resident and neurosurgery resident were evaluating the patient. An x-ray was hanging on the view box showing the ice pick tip all the way to the inner cortex of his posterior skull. I could hear the two residents saying, “You pull it out.” “No you pull it out.” I guess the nurses were concerned about his privacy, he was out in the hall. All the treatment rooms were full. A nurse taped a big gulp paper cup over the handle of the ice pick. I had to get back to work, last time I saw the patient he was still sitting there with a big gulp cup taped to his head.
Another double take occurred again in the Accident Room. It was common to have patients come in high on drugs. PCP, or Angel Dust, was routinely seen at Charity. It was either mixed with marijuana and smoked or just snorted by itself. These patients would be violent, hallucinate, and not feel any pain. Some would come in with severe injuries, but would fight against any treatment. A patient came in high on PCP and needed suturing. He was combative, so the Charity security restrained him to a stretcher. This was common practice, usually in a couple of hours they would be more cooperative and you could sew up their wounds. The patient was restrained at both ankles and both wrists laying supine on a rolling stretcher. He somehow flipped the stretcher and stood up walking down the hall of the Accident Room with the stretcher still attached to him. Seeing a patient walking with a stretcher on his back was definitely a double take.
It was not unusual for a patient to leave Charity AMA. This meant the patient was leaving the hospital against medical advice. Patients leaving AMA were supposed to sign a release form that informed them of potential consequences of leaving without treatment. Most patients at Charity just left. I admitted a patient with a femur fracture from a gunshot wound. Treatment for this injury would involve washing out the entrance and exit wounds, putting the patient in traction, and surgically fixing the fracture with a rod down the center hollow part of the femur a few days later. Traction for a femur fracture needed a pin drilled through the tibia below the knee and then with ropes, pulleys, and weights the fracture was reduced and pulled out to length. Traction including drilling the pin through the tibia was done in the Accident Room with local anesthesia. Without the traction, the thigh muscles would spasm around the femur fracture causing lots of pain and shortening of the fracture. In general, femur fractures are very painful, but patients feel better while in traction. After getting this patient in traction, he said he had to leave. He was afraid the “dude who shot me will come back and finish me off.” I explained he had to stay and he would be having surgery in a few days. I had nowhere to send him. For the next couple of days on morning and afternoon rounds he would tell me he had to leave. I would just shrug my shoulders and say “where can I send you.” So the next morning, I’m in checking on all patients before morning rounds with the chief resident. Basically, you made a fast walk through the wards and checked quickly on all your patients. I was walking down the ward spending maybe 30 seconds per patient. I get to the bed of the patient with the femur fracture …. Its empty, just some rope and the weights on the floor by the bed. I pass the bed, stop and look back, where is the femur fracture? I go ask the nurse, she had no idea he was gone. I ask the patients sharing the ward with him, they all say they don’t know. How does a patient with a femur fracture go AMA? How does the nurse on the ward not know anything? Did his friends come get him and take him somewhere? Or did the “dude” that shot him come back? I never saw him again.