Angels in the ER (30 page)

Twenty minutes later, six young men from the auto accident were crowded into our minor trauma room. Three were on backboards, their heads securely taped in a rigid position. They had complained of neck pain, and the EMS squads were taking no chances. The other three victims were casually sitting in chairs, rubbing various body parts.

As Andy and I walked into the room one of the paramedics pulled me aside.

“Doc, somethin’ suspicious is going on here,” he told me. “This was a one-car accident, in the middle of town. Couldn’t have been going more than 25 miles an hour, and there’s no obvious damage to the car.” He scratched his head and surveyed the congested room. “Good luck with these guys.”

“Thanks,” I said, noticing that Andy was in the far corner, questioning and examining one of the patients who had been secured on one of the backboards.

“Where exactly do you hurt?” I heard him ask.

Lori came up behind me and tapped me on the shoulder. “Dr. Lesslie, I’ve got a seventy-five-year-old in Cardiac with chest pain and a blood pressure of 60.”

I glanced once more at the confusion in minor trauma. No one seemed to be seriously hurt, and Andy should be able to handle this. Anyway, I was needed up front.

“I’m right behind you,” I said to Lori as we headed up the hall.

Two hours and a bunch of X-rays later, Andy had managed to clear all six patients involved in the auto accident. Everyone had checked out okay. No one had any obvious injury, and all the X-rays were normal. He stood beside me at the nurses’ station, writing up the charts of these patients.

“I think they’re going to be okay,” he told me. “I didn’t detect any significant neurological injuries.”

“Well, that’s a good thing,” I responded, suppressing a smile. We had known that from the first moment, “we” meaning everyone other than Andy. But something still wasn’t right here. Things didn’t quite add up. I had been too busy to try to sort this out, but that moment of clarity was fast approaching.

We were still standing at the counter, when a police officer walked up. He was accompanied by a diminutive, bespectacled forty-year-old man. He shuffled along with the officer, looking down at the floor.

“Doc,” the officer said. “I need to talk to you about the auto accident downtown, and about those guys involved. Mr. Grant here has some interesting information for you.”

Andy immediately stopped what he was doing, looked up at the officer, and edged closer to where we were standing.

“What’s going on here, Mr. Grant?” I asked him. “Do you have something to tell us?”

Mr. Grant fidgeted and put his hands in his pockets. Reluctantly, he looked up at me.

“I don’t want to get into any trouble,” he began. “And I don’t want anyone else to get into trouble,” he continued, nervously looking down the hallway. “But there’s something you need to know.”

The police officer was silently nodding his head.

“That accident, the one with all those people…” he began. “It didn’t exactly happen the way they said it did.”

I glanced at Andy. He had a troubled look on his face.

“What exactly do you mean?” I asked him.

“Well, I know they told you they ran into a telephone pole, and they were all thrown around inside the car and everything. And they told you that two of them had been crossing the street when the car knocked ’em down. That’s how they said they got hurt.”

“You’re right, Mr. Grant. That’s what they told us,” Andy excitedly interjected. “They all told us the same story.”

Mr. Grant looked in his direction and then back at me.

“Well,” he started again. “I was there, and I saw what happened.”

“You were in the accident?” I asked him. “You were in the car?”

“No, no. I was walking down the sidewalk when it happened. I saw the whole thing.”

The police officer was nodding his head again, and smiling.

“Yeah, I saw the whole thing,” our volunteer witness continued. “It was like in slow motion. I was walking down the street, and then here comes this car, headed straight for the curb. The driver wasn’t paying attention and the car clipped a couple of parked vehicles and then came to a stop. Barely bumped those cars,” he added, shaking his head. “But the main thing is there were only two guys in the car. The driver and a front-seat passenger. That was it.”

“Wait a minute,” Andy said, becoming a little agitated. “There were six people in the accident. You can go back there and count them.”

“I know what they told you,” Mr. Grant responded. “But there were only two people in that car. The other four were standing on the sidewalk when it happened. They must have known the driver of
the car, ’cause as soon as it happened, two of them ran over and piled in. And the other two just sorta looked around and then fell down on the ground, right in front of the car. Then they all started rubbin’ their necks and rolling around.”

“You’re kidding,” I said, amused by their audacity.

“They did what?” Andy asked angrily. “You mean these guys weren’t even in the accident? They’re committing fraud?”

“That’s exactly right,” Mr. Grant said. “Nobody was hurt in that fender bender, and it’s all a hoax. That’s why I came down here. And that’s why I found this officer and told him the story.” He stood a little straighter now, and a little taller, having told us the truth and assisted in the now-inevitable triumph of justice.

There was a moment of silence as this new revelation registered, and then I addressed the police officer. “What do you plan to do here?” I asked.

“Have you people medically cleared them?” he responded. “Are they free to go?”

“Yes,” Andy said. “They’re medically cleared and ready to be released. You’re going to arrest them, aren’t you?” he asked. “I mean, this must be some sort of a crime, isn’t it?”

“Sure, there’s misrepresentation and all of that. And probably some sort of fraud issues, I suppose,” the officer said. “I dare say the insurance people will be interested in this, and I can assure you we’re going to have a word of prayer with them down at the station.”

“You mean this was all about collecting insurance money?” Andy asked, incredulous. “They’ve wasted our time—and the EMS call… What if someone had truly needed an ambulance and none was available because they were responding to this bogus accident?”

I was going to try to calm Andy, but when I turned to face him, he had already headed off down the hall toward minor trauma.

“Uh-oh,” I said, and followed him. The officer was right behind me.

Andy stood in the doorway of the crowded room with his hands on his hips and began to harangue the miscreants. Freed from their
backboards, they were all huddled in the back left corner of the room, either sitting or standing.

“What were you people thinking?” he began. He then lined out their multiple crimes against humanity and the great risk they had imposed upon the people of this community. He dwelt at length on the possibility of truly needy patients not being able to receive care from the EMS system because they had been inappropriately tied up.

Amazingly, the six gentlemen stayed where they were and calmly took this diatribe. To be sure, there was open hostility on the faces of a few of them, and one or two stared blankly at the ceiling. Then I looked behind me and understood the reason for their acquiescence. The police officer was standing behind us, a good head-and-a-half taller than Andy. The look on his face clearly commanded their silence.

Andy finished, his face red with righteous indignation. Then he turned and walked past us. He didn’t notice the wink the officer gave me.

I understood the anger Andy felt in this situation. Blatant abuse is hard to deal with, under any circumstance. But in this instance I was able to be a spectator, and I was able to analyze what had happened here over the past few hours. Andy was justified in his indignation, but what had this confrontation accomplished? Andy might have felt some sense of relief, having blown off some steam and calling these guys out, but I doubt it. He would still be stewing about this when he drove home at seven in the morning. And the six perpetrators? They had no sense of wrongdoing. Their concern now was the immediate repercussions of their actions, nothing more. Their core values had not been altered by Andy’s admonitions.

So everyone here had really been a loser. Wait—there was the police officer. He might be the only winner. He had gotten a little chuckle out of the happenings in minor trauma.

I was going to remember this.

You have to have a lot of patience to learn patience.

—S
TANISLAW
L
EC (1909–1966)

 14 

On
Crossing
the
Bar

When the perishable has been clothed with the imperishable,
and the mortal with immortality, then the saying that is written
will come true: “Death has been swallowed up in victory.”

—
1
C
ORINTHIANS 15:54-55

F
or those of us in the ER, dealing with death in our own department is difficult enough. But from time to time we are also called upon to deal with a death that has occurred elsewhere in the hospital. When someone dies, a physician is needed to certify and then document that a death has actually occurred. This responsibility clearly falls to the treating physician. However, if it’s late at night or the middle of a weekend and that patient’s physician is not in the hospital, the ER doc on duty might seem a reasonable alternative. After all, he or she is in the hospital, awake, and “available.”

Pronouncing the death of a patient is something we had performed in the past as a courtesy extended to the medical staff. However, as the medical staff and hospital census grew, this practice became onerous for the ER physicians.

It isn’t only that we are pulled out of the department at inopportune times. After all we don’t lock the doors to the ER while we are gone, and patients don’t stop coming in. Imagine the response if we called the involved physician when we returned to the department and asked him to come in and help because we had gotten backed up.

The real objection we have is that on occasion we go upstairs to find the recently deceased surrounded by a room full of family members.
These people are complete strangers to us and they are understandably upset and distraught.

And then come the questions:

“Who are you?”

“Where is his doctor?”

“What caused her to die?”

“Do you think he suffered?”

“What do we do now?”

These are all things we are, in most cases, unprepared to answer. (I can usually handle the first one.) It is always an awkward moment for the family and for us. Our current policy is that we will go upstairs when practicable, document the person’s death, and then note the time on the death certificate and in the patient’s chart. This should only take a few minutes, and then we are able to return to the ER. It is the responsibility of the patient’s physician, coordinating with the unit charge nurse, to be sure the family has been notified and left the patient’s room. This is not a perfect solution, but it is a reasonable compromise.