The Boxer


Paramedics had a difficult time with the patient.

Call went out for a patient named Joanne Doroshow that was reportedly “man down” on the city bus. By the time the paramedics arrived, the patient was laying on the sidewalk with a crowd of bystanders around him. He had shallow breathing. His pupils were constricted. Ahhhhh. A sign suggestive of opiate overdose. Paramedics loaded him into the ambulance and tried to get an IV. No luck. One paramedic then mainlined some Narcan. Yup. It was probably a heroin overdose … and the patient wasn’t happy about losing his high. He woke up, then started yelling, cursing, and swinging.

He was a little better by the time he arrived in the emergency department, although he still took a swing at one of the paramedics when being transferred onto the bed.

He wouldn’t answer any of the questions from the ED staff. He just sat there staring at people.
Was he hypoglycemic? Was he drunk? Did he have a brain bleed? Was he just being difficult?
He took a swing at a nurse who did a finger stick for blood sugar. After that, I was putting my money on the “difficult” diagnosis. Enjoy the matching velcro bracelets and anklets, sir.

The resident asked if he could try to talk to the patient to calm him down before he was put into restraints. The resident had a calm voice and steady demeanor. OK, why not?

I watched the resident introduce himself. The patient gave him a head nod.
“What’s bothering you?” the resident asked.
The patient whispered something like “driss bidd diss maka.”
“Excuse me?” the resident said as he leaned forward toward the patient’s face.
Before I could yell, the patient took a roundhouse right hook right at the resident’s face. Fortunately, the resident saw it coming out of the corner of his eye, and turned away from the swing, so he only got grazed in the side of his head.

We didn’t offer the patient milk and cookies, so I’m sure that JCAHO will fine the hospital thousands of dollars for not following approved protocols for restraining patients … if the case happens to be reviewed.

So the patient got put in restraints and got a Foley catheter to prevent him from urinating all over the bed.

After a significant amount of money was spent ruling out other etiologies for the patient’s symptoms, my initial diagnosis ended up being correct.

Instead of being another news story about a patients gone wild, or about someone being arrested for assaulting a health care provider, the patient was discharged with a sammich and a juice. A satisfaction survey will probably be mailed to his last known residence. Hopefully it will be thrown away.

Sometimes working in emergency medicine can be pretty damn frustrating.

This and all posts about patients may be my experiences or may be submitted by readers for publication here. If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail me.


  1. Altered mental status, the paramedics screwed the pooch. Also, I prefer intranasal Narcan – less chances of an accidental lancing.

    • Definitely, though really we need to start treating these instances as criminal cases. Unfortunately you risk losing your job or residency if you actually filed charges but I do think the current legal climate is such that, if you were terminated you’d end up with a pretty nice wrongful dismissal settlement. Nobody should have to put up with this crap.

      • Why on earth would you risk losing your job if you were assaulted at work and filed charges? Doesn’t sound like anywhere I’d want to work. Of course no one should put up with this.

  2. I just almost got my ass beaten by a REALLY big drug seeker. I was so pissed at the guy I actually stood up to him until security wrestled him away from certain boxing victory.

  3. I guess this is why I am not a fan of Narcan in the field, save for cyanosis. Shallow breathing … support resps or tube and transport. I’d rather work up a zombie than a narco-grizzly. Then after the workup he gets the ‘H pack’ … 2 of Narcan, AMA form and earplugs for the staff.

    (yeah I know about Narcan half life, withdrawal and such)

  4. Frustrating ?
    Our hospital has had no OB for several years, yet when a pregnant woman shows up in the ER, no one is allowed to tell them this until AFTER they check into the ER. Our administration says to check them in, check them out and then “transfer them” ! To where ? Who will take a woman possibly in labor ? We already only have ultrasound during banker/administrative hours. When I asked if we had a fetal monitor still around , I was told “Yes, but we are not allowed to use it in the ER”!!!!!!
    Our job has become a nightmare.

  5. I stayed in the cardiac unit of my local hospital for a couple of days last week and was shocked when my roommate smacked the nurse and told her she wanted to kill her. I was ready to go over there and smack her myself, but everyone – nurses, doctors, porters – was unfailingly patient and kind.

    You guys put up with a hell of a lot.

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