The Cavalry


A young girl was brought in by ambulance after being involved in an argument with her boyfriend and attempting to cut her throat with a knife. Yet another of the many suicidal patients we have seen lately.
When her father arrived, he told her to get her things together because they were leaving.

“Ummmm … sir … you can’t do that. She’s going to require admission for psychiatric evaluation.”
“The hell she is. Not in this place.”
“She needs to be hospitalized.”
“Listen. You waited on my wife last year. You diagnosed her with a throat infection and gave her antibiotics. Two days later the side of her face swolled up like this (cupping his hand against the side of his face as if holding a softball against his cheek). We went to the chiropractor and he said that you damn near killed her. He had to give her a stronger antibiotic to cure her [I know, chiropractors can’t prescribe medications – it didn’t make sense to me, either]. So you’ll have to excuse me if I just don’t trust your judgment.”
“Sir, it is beyond me what this has to do with a determination as to whether your homicidal daughter requires hospitalization for psychiatric evaluation when she has Exacto knife lacerations mere millimeters from her internal carotid arteries.”
“You just don’t get it, do you?”

I was going to answer him, but I was hitting the rewind and play buttons in my brain to see if I missed something. I wanted to “get it.” I just must have missed something. What did I miss?

“We are never coming to this hospital again. You hear me? Never.”
“Oh come now. I wish you’d reconsider.”
“Honey, call the lawyer … now.”

Dammit. My logic circuits – they appear to be jammed. Now I’m going to get a patient complaint and get sued? What did I do? Ah, nevermind.

“Sue, can you call the police and have them come down here?”
“Fine … she’ll stay. But we’re still calling the lawyer. We have rights, you know.”

Two minutes later a couple of officers walk into the room.
The patient’s father sat in a chair and got a short lecture from the po po.
“He shouldn’t give you any more problems, doc,” said one of the officers as they walked back out of the ED. “If he does, just give us a call.”

Did I mention how much easier the police make things for us in our department? Those packages of Christmas cookies are worth every penny.

Our police force rocks.


  1. Pingback: Don Salva (donsalva) 's status on Saturday, 05-Sep-09 14:17:09 UTC -

  2. A missing fact here is whether the guy wanted to go to a different hospital or just wanted to leave the hospital.

    With limited information, I can sympathize a little even though this guy is obviously nuts.

    There are several hospitals in my area that I wouldn’t want a family member admitted to for any reason and if taken by ambulance to one of them I would want a transfer out faster than ASAP.

  3. Sigh. Our greatest national problem isn’t health care or poverty or evil CEOs or Afghanistan. It is the general lack of abiity of most people to assemble a coherent thought process. About anything.

    My own mother, after smoking for 50 years, poor diet and no exercise has just been diagnosed with diabetes. When my sister pointed out to her some of the causes of diabetes, like smoking and poor diet and lack of exercise, Mom looked at her and said, “Do you really think so?” And then got mad and hung up the phone.

    Cause and effect, Mom, cause and effect.

  4. This is an example of similar situations, (however strange)especially at community hospitals, where most of us work. There is an undue, almost mystical emphasis on Press-Ganey scores, and patient complaints however unfounded (there is selection bias,of course; people complain because they can). 40 “attaboys” are negated by one “oh-__hit!” When will we unionize??!

  5. My favorite complaint was from a patient’s family member who complained that the tube feeding tasted horrible and how could we be so cruel as to give it to the patients to save money!

  6. The po po? Do they know you call them that? I thought they hated being called that. Crazy Americans, with your very strange nicknames for the police.

  7. A-freaking-men to that. I came from the U of U ER in SLC where we had police every night for a set number of hours in addition to security. They were awesome. Totally worth cookies, pizza, snacks, and holiday meals.
    This is part of why now that we live in a small town without even security in the hospital, I am not returning to ER nursing at the moment!

  8. At the hospital where I worked (Grady/Atlanta, GA) the security staff actually had arrest powers.

    Draw your own conclusions from *that*.

  9. WWWebb – Mayberry RFD town?

    WC – “rewind and play buttons in my brain” ..Funny!

    Bad enough when they act like jerks but even worse when you know they are lying… although he doesn’t sound like the brightest bulb either.

    * I’m still chuckling at the drunk woman’s comments in your previous post. 🙂

  10. @SeaSpray says:

    Mayberry RFD town?

    Quite the opposite.

    At the time, it was the third busiest ED in the country behind Cook County and L.A. General and the second busiest ambulance service behind Dade County.

    • WWWeb-I thought you meant some little sleepy town that has one sheriff and hardly any police and so they empowered the locals.

      So… why did security have arrest powers? I can see where that would work out well for a hospital if the public knows that. I would think that knowledge would keep *some* patients in line.

      • Among many other things, Grady is Atlanta’s charity hospital. It serves most of the city’s homeless population, all of the local jails, a large chunk of the working (and sometimes nonworking) poor, and a good many people from the surrounding area who mistakenly think that just anyone can get free care there. Often you find visitors to one of the hospital’s five emergency clinics (medical, surgical, OB, psychiatric and pediatric) who are not, shall we say, on their very best behavior. They are, in fact, drunk, high on drugs, psychotic or just plain mean. That’s when they come in the building. Afterwards, as they sit around waiting perhaps more than 24 hours to be seen, they are increasingly indignant, resentful, loud and generally not in the mood to cooperate.

        I volunteered in the surgical emergency room for several years in the late ’80s and early ’90s. I was the nice person going from room to room bringing blankets, pillows, urinals and sandwiches (not all at the same time), and yet I had one patient throw a tray at me and another punch me in the chest and knock me into a wall. (To be fair, the puncher had just had a shot of Demerol and may not have been thinking clearly.) The security force not only needed arrest powers but sometimes whips and chairs.

        Grady does a lot of good. My hat is off to most of the staff there.

  11. Pod A said “The chiropractor probably shined that red dot on her and cured her. Don’t disrepect the dot.”

    The police can also shine a red dot on him, and most people get religion at that point.

  12. Brighid – and restraints! Sounds like they all have tough jobs there..beyond the normal stresses of the ED environment. Hopefully their pay compensates them for the additional risks and aggravation.

    And hopefully it’s not at risk for closing because of lack of funds as it apparently is a huge benefit to the community.

    • Sadly, Grady is in constant financial crisis. Most of its patients are Medicare, Medicaid or uninsured. The deficit is made up by the county governments of just two counties — DeKalb and Fulton — although the patient census at any given moment probably reflects 20-30 counties. The state government resolutely refuses to help, although Grady trains a huge percentage of Georgia’s physicians. It has contracts with both Emory and Morehouse, and virtually all the students of those two schools rotate through Grady at some point.

      Grady’s burn unit treats pretty much anyone with serious burns in northwest Georgia. Babies come to its NICU from as far north as Rome and as far south as Columbus. The diabetes unit by itself could fill a small community hospital. The trauma unit ranks high nationally, and it gets plenty of practice from the shootings and stabbings that go on all over Atlanta and from the carnage on the city’s highways. Grady is the default hospital for trauma; if you’re so seriously injured you’re unable to insist on some other hospital, you’ll probably wind up at Grady (luckily). Grady is where they’d bring the president (any president) if he needed emergency medical care while he was in Atlanta. It’s not just a huge benefit to the community, it’s a huge benefit to the whole state.

      Unfortunately, Grady’s image suffers from the part of its population for whom the whips and chairs are needed. Although they are by far a minority — most patients are decent, mannerly and cooperative — the disruptive, maybe even dangerous people are always present. The emergency department of the community hospital I generally use is as calm and quiet as a library. Grady is loud, chaotic, messy and foul-smelling, the last environment you’d want to be in if you were feeling sick. White collar, insured people around Atlanta tell each other, “If my leg got torn off, I’d somehow manage to whisper to the paramedics, ‘This is important: take me anywhere but Grady!'” I always tell them, “No, that’s what you say when your leg is BROKEN. When your leg is torn off, you say, ‘This is important: get me straight to Grady!'” But the academic story of Grady’s greatness isn’t nearly as persuasive to people as the evidence of their own senses when they go in Grady’s doors.

      • Again, brighid, you shoot, you score.

        The best three-paragraph description I’ve ever read about GMH.

        Do you have your own blog?

  13. @seaspray:

    “So… why did security have arrest powers?”

    Because they NEEDED them– and this despite being two blocks from Atlanta Police Department headquarters.

    @brighid: Thanks for your vivid and accurate description of “The Grady’s”.

    I understand they combined the MEC (Medical Emergency Clinic) and SEC (Surgical Emergency Clinic) sometime around 2002.

    • I didn’t know the medical and surgical clinics had merged, but it makes sense. Having them separated was always an artificial construct. It stemmed from Georgia’s Jim Crow past, when the hospital was divided into separate portions for black and white patients (thus, “The Gradys”). When that ended, the hospital was left with two separate emergency rooms, neither one of which was big enough for the whole population. Since the hospital could no longer divide the population by color, it tried to do it by service instead. That thinking was so deeply institutionalized that it even made its way into the design when the new emergency area was constructed!

  14. Minister of Silly Walks on

    As much as I hate to say it, and really chaps my rear, I do hope that he wasn’t thinking about an osteopathic physician when he said chiropractor.

    That is still a common misconception, even though they are physicians none the less.

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