The Night Shift: Real life in the heart of the ER, an excerpt

Fear and Loathing

12:47 a.m.

Two police detectives were waiting for me near the main triage desk; one was a tall male in a sleek black suit, probably in his early forties. He was ruggedly handsome in the manner of Jean-Paul Belmondo, the French actor who played a slew of cops and criminals during his long film career. His partner was a decade or so younger, thin and pretty with long blond hair. Her crisp blouse and grey skirt suggested a TV reporter more than a cop.

They introduced themselves and told me they were investigating two incidents that had taken place a few hours earlier in a trendy part of the city. One of the victims was a fifteen-year-old white male who had been swarmed by a gang of South Asian teenagers in what the police thought might be a racially motivated crime. The boy’s father, after being called by his injured son on his cellphone, had brought him to Mount Sinai. The other victim, around the same age, had been injured and was being treated at another hospital in the north end of the city. The detectives wanted me to examine the boy right away so they could interview him when I was finished.

“We think the attacks are related,” the female detective said. “This gang has a history of going down to the area and picking fights with the white kids down there. It’s been happening for a while.”

I agreed to see the young man next. He was big for his age, as so many are these days. At almost six feet tall and close to 200 pounds, he looked older than his years. He had a bad laceration about three centimetres long on the back of his leg, and some minor bruises on his face. I asked him what had happened.

“I was with my cousin out on the street near a coffee shop where we hang out when a fight broke out not far from us,” he said. “I didn’t want any part of it because I was with her so we started to walk away. A few minutes later a whole bunch of them ran at us. They were punching me and I curled up to protect myself and then someone hit me on the back of the leg with something. Maybe a bat or an iron bar. I don’t know.”

Our focus as doctors is on the injuries themselves and on the mechanism of the injuries, not on the “he said, she said.” My primary purpose was to get the boy talking so I could establish his mental alertness and (of course) so I could check his leg.

He was lucid and calm and able to follow the movement of my finger as I passed it vertically and horizontally in front of him. I assessed him as 15 on the Glasgow Coma Scale. There was a faint smell of ethanol on his breath.

“Why do you think they attacked you?”

“I don’t know,” he said. “Maybe they think we’re all rich snobs or something. Because of where we live.”

“We’re not rich, I can tell you that, and we got no prejudice,” his father interjected. “Maybe some other kids ain’t nice to them.”

The boy wanted me to patch him up so he could go home. I was fine to do that—a few sutures would do the trick.

I asked if they were okay to talk to the detectives; they consented. I left the room and let the police know they could come in.

“What did he tell you?” the male detective asked.

“That he was willing to talk to you,” I said. I tried to look pleasant and hoped he’d get the implicit message: ask the patient what you like, but don’t pressure me to divulge anything a patient has told me. On a busy emergency shift, when I’m running from patient to patient, it’s all I can do to keep focused on patient care. Anything beyond that often feels like it’s taking me from my main duty. The last thing I want to do is have an argument with a detective about what I can and cannot reveal.

A little slit of a smile creased his face as he led his partner into the patient’s room. He knew all too well I was under no obligation to reveal anything whatsoever to him, but he had tried nonetheless. I didn’t blame him, and he accepted my response in a polite and professional way. It was his job to ask and mine to refuse. The two detectives had been around for a while and understood the rules. Some of the younger officers, however, can be more aggressive about pressing for information. Either they are ignorant of the boundaries or they just don’t care.

Hospital workers are not agents of the police. We are legally obligated to inform them if someone comes in with a gunshot wound, but not if it’s a knife wound or a beating from a fight. We don’t have to tell them any details of a case, especially the results of a tox screen that could contain alcohol or drug levels. If they want that information they need to get a warrant—or in the case of alcohol, do their own breath test.

On the other hand, if we suspect a child has been abused we must inform the Children’s Aid Society. However, if we suspect a woman has suffered a domestic assault (or a man, for that matter), we are not required to report it. If victims wish to press charges, that’s their right. But we’re far more concerned with the patient’s personal welfare than with a possible police complaint. We ask a social worker to see the patients so that they know their options. Even if they decide it’s safe to go home, we counsel them to have an emergency plan of escape that includes at least a packed overnight bag and a few dollars hidden away in case they have to leave home abruptly.

There was one instance, however, when I decided I had to intervene whether the victim wanted me to or not. Many years ago at another hospital, paramedics wheeled in a twenty-two-year-old woman who was in a semi-conscious state, accompanied by her husband. She had a broken nose and bruised ribs. A CT scan of her head revealed a subdural hematoma that required a neurosurgical operation to remove a clot.

It was obvious she had been beaten, and I had a pretty good idea her husband was responsible. He was short, and I sensed from the way he tried to puff out his chest that he tried to overcompensate for his lack of height. His physique was wiry, and he had a menacing air that made me uncomfortable. This was not someone you’d like to cross.

He acted solicitous and feigned concern for his wife, but it didn’t seem genuine. I asked him how she became injured, and he said she had slipped on something in the kitchen. After each of my questions he glared at me in a manner I found intimidating. He seemed coiled, ready to spring at the slightest provocation.

After the paramedics came to transfer the woman to the hospital where she would be seen by a neurosurgeon, I called the police and told them my suspicions. I was worried that she might not survive the next beating: in these types of relationships another assault is usually a given. The police said someone would go to the hospital and investigate. I never knew the outcome, but I hope she had the courage to press charges. However, having just tasted a small dose of the intimidation she probably lived under all the time, I would have understood whatever decision she made.

Brian Goldman is an emergency physician and author of The Night Shift: Real Life In The Heart of The E.R.

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