The Thin Blue Line

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As we follow the news in places like Ferguson and New York City – and anywhere else where those maintaining the peace fall into conflict with social norms and expectations – one cannot help but be impressed by the tenuous nature of what we call civil society. In at least half the world’s population death, mayhem and abuse are the norm. Most of the world isn’t like Canada or Denmark. The corruption and violence of the government is commonplace, not the exception. And this blurring of might and right takes place at all levels. It is good to remember that prior to World War II, Pope Pius XII blessed Mussolini’s troops as they bravely went forward to fight Haile Selassie’s Ethiopian horsemen who were still using spears. Hitler had local political and religious support for the 1923 Beer Hall Putsch. All around us we perceive the battle between anarchy and the police state.

Why discuss this in an emergency medicine journal? Simple. We are where the victims come and where much of real violence takes place. To me, if you haven’t treated a shot police officer – or witnessed a legitimate police beating – you’re not really an emergency doctor.

I’m not certain I’ve met an emergency doc who doesn’t owe his health, if not his life, to the police. I was savagely attacked twice in my career. The first time was by a 220-pound, 25-year-old man with a long history of psychiatrically-induced pseudo seizures. While I was bending over him to look into his eyes, an aid lost control of his right arm, which he brought up into my gut. I was sick for four days. For those of you who remember the old oto-opthalmascopes which contain three batteries and were about the weight of an Estwing framing hammer, this is what I immediately used to smack this gentleman in the scrotum. I was much younger and stronger then and the gentleman required a trip to the operating room for repair of the right testicle. I don’t feel the least bit bad about this. As he attempted to retaliate, the police quickly intervened and controlled the situation.


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The next attack was from a 19-year-old mentally impaired belligerent alcoholic woman who was all muscle. As I was escorting her back to her bed and stopping her from going through an 85-year-old woman’s purse, she hit me. She hit me hard and we were on the ground. Now I have no problem with hitting a woman, I just don’t like to lose. And I was losing badly. I had blood on my face – and probably several other bodily fluids – as she proceeded to beat the crap out of me.

In this attack as well I was saved by the police. Coming through the door on the first case, they probably stopped me from an assault charge as they took over the duties of controlling both the patient and the doctor. In the second case, the woman who was beating me turned her attention to the young police officer who had hit her in the head with a spun metal Maglite flashlight. It barely slowed her down. The rest of that fight was worth the price of admission.

I am at all levels a conservative law and order guy who in general supports the police, particularly when I am tasting my own blood in my mouth. In smaller hospitals in small towns where there’s little or no security, we depend on these folks. For those who say I don’t stand behind my nurses; well, I certainly do when there’s violence. Fighting between husbands and boyfriends seemed a weekly event and everyone was better off when the police arrived.


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But this is not the end of the story. I had to stop the police twice in my career from inflicting greater bodily harm than necessary. I didn’t like it but I wasn’t given a choice.

If anyone ever asks if I actually saved anyone’s life during my career, I can say that at least two people continued to live because I acted. In 1975 in Saginaw, Michigan at St. Mary’s Hospital, the police brought in a 19-year-old male who was involved in a convenience store robbery. As a part of that arrest, he received lacerations about the head and face. He probably wasn’t a bad kid, just young and stupid and angry. As I went to numb his facial lacerations, my 27-gauge needle and its Lidocaine gave him a little pain. In anger – more with himself and with his current predicament than with me – he shoved me away and I fell over the stool and into the wall.

In one motion the officer in attendance rose from his chair and drew his gun. In those wild and wooly days the Saginaw police could carry “weapon of choice.” This officer carried the .44 Magnum revolver, which, for those of you who are not familiar with firearms, is the handgun equivalent of a Howitzer. You know, it’s the one Dirty Harry carried. If I shut my eyes I can still hear the clicks of the hammer being pulled back and the look of terror on that young kid’s face.

The officer looked at me and said: “Do you want me to kill him, Doc?” My heart stopped, but somehow I said: “We’re all going to rethink this! You are going to un-cock that gun and you, young man, are going to sit down and behave yourself.” Which is exactly what he did. I’ll never know whether that officer would have actually shot the kid or not. Let’s just say he got my undivided attention. We have so few great outcomes, I’m taking this as not only a save but a personal lesson in bowel and bladder control.


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My second save was tougher. In a small town in the 80s most street cops were men. Most nurses were women. And in most small towns, cops dated emergency department nurses in higher-than-would-be-projected numbers. Our department was no different and we had the best protected coffee machine in existence. Now enters the cast of characters. In this corner a loud, belligerent (Are there any other kinds?) intoxicated, large young man who had been in (any guesses?) a bar fight. The nurse is now placing him in a room for examination. Just at that moment an officer outside the door hears the nurse scream as the patient hits her. He runs in to see the patient hit the nurse a second time. Wouldn’t you know it: The nurse – who was a petite, geniunely kind woman – was that officer’s current girlfriend. I entered the room just in time to watch the cop (an ex-marine and the police department’s hand-to-hand combat instructor) pick up the perp and slam him against a cement column supporting the building. The entire department shook.

“You have the right to remain silent!” BOOM. I could hear this guy’s head hit the post. “In fact, if you don’t remain silent, I’m going to crush your F***ing skull!” BOOM.

Now, this was a real problem. This officer and I were friends. We went to the pistol range together. He had been to parties at my house. He had a right to be mad, but enough was enough. I said to him: “John, that’s enough now.” Now he begins pulling back his arm to throw another punch and I added: “I love you guy but I can’t lie for you. You got two good shots at him and that’s all I’m going to give you.” Now remember his girlfriend/nurse is crying her eyes out. The other officer, his partner, is still in the patrol car. He stopped, put the cuffs on him and walked him to the door. I said: “John, this is the right thing.” He said nothing but put this nitwit kid in the patrol car and drove off. We never went shooting again and he broke up with the nurse two months later.

I’m going to take this one as a save as well. I probably stopped a drunk from getting his last two brain cells obliterated. And I know I stopped a great cop from killing his career. That’s good enough for me.

So what’s the point? Simply this: Emergency doctors and nurses work in inherently dangerous situations. And the smaller, more isolated the emergency department, the more dangerous it is. (There really isn’t as much personal danger in larger urban departments with an active police presence. Detroit Receiving is a numbered Detroit police precinct with sometimes a dozen patients handcuffed to the beds and at least a half dozen police officers in attendance.) The role of emergency personnel is to foster an arena of reasonable societal justice. We need to defend all parties and make an effort to have compassion for all patients and law enforcement personnel. We will accommodate to new social norms but never collaborate with terror or the infliction of unnecessary pain.

A hard job to be sure. Emergency medicine – particularly the brand practiced in smaller facilities – is not for sissies. Standing up for what is right is never easy. We don’t extend our social liberalism to ever put us or anyone else in danger. Our reality says: We need to do what we have to do – but no more than we have to do – in protection of ourselves, the other patients and the law enforcement personnel. We should never let our attachment to calm and our dislike of certain patients to ignore this long term perspective.

Our welfare ghettoes have become dystopian nightmares; we have provided wealth to transform them but nothing has happened. Violence still exists. When they send police officers to act to suppress crime and keep families from ripping each other apart, most of us just shake our heads. Most cops would rather show up at a robbery than a family fight any day. After all, who’s right and who’s wrong becomes a judgment call. An officer only has one good weapon: his caring commitment which is expressed through his words. Just the paperwork involved in pulling out any other weapon makes it almost untenable.

Please define for me the term “the common good.” The emergency department, in my mind, is that spot in the society which represents that common good. It is up to us to make sure that our behavior befits our noble profession.

The emergency department is very much like the police department. Our regular visitors are their regular visitors. Our drug abusers are their petty thieves, breaking and entering artists and thugs. The police are often left to deal with the bottom of the societal birdcage. Sound familiar? We take those patients other doctors don’t want to see and we are the champions of the non-daylight hours. Not unlike the police.

We minister to the bodies of the sick. The police minister to the intellectual deficiencies of our mentally ill, our morally bankrupt and the outright dangerous. Police aren’t sort of like us; they are us. Different uniforms, different weapons but our worlds are the same.

In the end, what those in law enforcement and emergency medicine really have in common is a set of fears. Will we go home tonight? Will we be well? Very few people have to think in these terms. We are outliers. While the rest of society depends more and more on modern technology our job remains low tech, high touch, where ever encounter is face to face, one problem at a time.

Go home and ask your non-medical neighbors how many of them have ever been assaulted on the job. See how many of them live in fear of simply being at work. Trust me, they won’t even understand the questions. They work in comfortable places where their actions and reactions are ruled by logic, discussion and analysis. We don’t live that way. We deal with stupidity, emotional irrationality and behaviors where no amount of logic will prevail.

And yet we proceed, entering each new room with compassion . . . and a quiver of Haldol blow darts and leathers. When things get out of hand, we do what we must to calm the situation. Probably the only people who really empathize with us are the police. Be slow to judge. All emergency personnel know there are no simple answers.

Vox temporus, vox dei
The voice of the times is the voice of God 

Photo from Seattle Municipal Archives

Talk Back: Respond to this column on Twitter (@epmonthly). The EPM staff will inscribe your message on the opening page of The Iliad and leave it on Dr. Henry’s work bench.

ABOUT THE AUTHOR

EXECUTIVE EDITOR
Dr. Henry is the founder and CEO of Medical Practice Risk Assessment, Inc.; past president of ACEP.

6 Comments

  1. Amen! Dr. Henry you write so eloquently what I have thought on this topic. We are warriors as are police officers and we must be ready at any time to defend ourselves. Same patients, different day.

  2. Keith Cornstock on

    ‘Emergency doctors and nurses work in inherently dangerous situations’

    Well said. Similar to ED doctors, cops have to deal with what comes there way and have no choice. Cops however have more rights/leeway and can often do what they want and get away with it.

    If anyone of us had punched a “customer” in the testicle(s), we’d be fired despite the torrents of verbal/physical abuse we sustained. Additionally, our Director wouldn’t allow us to be Sick for four days.

  3. Now because of HCAPS, Value Based Purchasing and other stupid ideas, these “. . . mentally ill, morally bankrupt and outright dangerous” individuals get to determine whether we are “good doctors” and should be paid (or not) for all our hard work.

  4. Jesse Belville, PA-C on

    Have you read gavin DeBecker’s the gift of fear, or LTC Dave Grossman’s ON Killing, or rory Miller’s “Facing Violence..
    Valuable insights to people and violence. I read them and sent copies to All my Children.
    I have confronted violence to my nurse’s and sometimes me In Rural ER’s all my 38 year career
    Drunks, druggies, got jumped only once and he got lifted by his throat and Testicles and slammed onto the Gurney, told to behave. He did and tried to press charges against me. did not work..I go armed with knowledge and Judgement and most will telegraph their intentions. so train and be prepared. We do live in a dangerous world.. Where do most accidents happen? At home, MVA’s within 5 miles of home. No safety. Never was.Vietnam Vet medic, PA-C, old guy, grandpa.. Boy scout. Be prepared.

  5. Dr Henry

    I was listening to your talks back when I was but a mere paramedic, and I continue to read your columns now. I’ve always enjoyed your perspective, and particularly your language. You understand and evince the power of language to work on many levels concurrently.

    So, it pains me to see you toss in the phrase “welfare ghetto.” This is unnecessarily pejorative, and serves to strengthen the false assumption that “people who get welfare” = “people who live in urban areas, usually with pigmented skin.”

    Frankly, I’m sure you could explain my own objections more eloquently than I am doing. Would love to hear your perspective on why that phrase seemed important to use.

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