WhiteCoat

Acute Incarceritis Revisited

Monopoly Get Out Of Jail FreeIt has happened a few times recently. Just had another case of acute incarceritis.

A man was brought in by police after drinking a little too much and then beating the heck out of his girlfriend.

Police were called to the scene and the man was arrested for domestic battery.

While riding handcuffed in the back of the police car, it happened.

Loud wailing. His bad back just gave out on him again.

A state trooper brought him to the emergency department.

“I’ve got a bunch of slipped disks in my back and the pain is about a 15 out of 10 right now.”
His back looked fine and he had a normal neurologic exam.
When his back pain didn’t seem to make the impression he desired, he added “and I’ve got diverticulosis so bad that the surgeon wanted to take out my entire colon – but I wouldn’t let him.”A rectal exam showed good tone, normal sensation to the area, and no blood or mucous.
“And my blood pressure isn’t very well controlled, so it’s making my head hurt.”
“Your blood pressure is 137/66.”
“Well it shoots up unexpectedly and I haven’t been taking my medications. I almost hit 300 one time, you know.”
“Fortunately, it’s normal now.”
“And my chest is killing me. My heart is beating out of my chest.”
“The workup is still pending, but your EKG looks fine.
“Oh, and I have a bum knee. That’s bugging me too. I can barely walk.”
“You looked like you were walking pretty well when you came into the emergency department.”
“And what about this rash?”
“Wait a minute. You mean to tell me that just after you were picked up by police for beating up your girlfriend, you simultaneously developed the worst back pain, chest pain, knee pain, and abdominal pain you’ve ever had in your life – in addition to palpitations, high blood pressure, and a rash?”

At that point the state trooper interrupted.
“Doc, he was just going to spend the night in jail here, but as long as you tell me he’s not going to die on me in the car, my captain said that I can take him to South Metro State Prison where they have a medical ward.”
The patient quickly changed his mind. “I’m OK. The pain’s better.”
The trooper responded back “Naaaah. Can’t be too careful. You’re going to South Metro.”
“But I’m feeling better now! What the f***?!?”
At that point you could tell that the patient was trying to decide whether to come up with more symptoms in a last ditch effort to get admitted or whether he would plead some more so that he wouldn’t have to go to South Metro.

I walked out of the room.

As he was being discharged, and being led out the back doors in handcuffs, it sounded like the patient was taking the latter approach.

“I was just anxious, OK? Can’t a guy get anxious?”

The trooper just walked behind him with a grin.
“Just because you play the get out of jail free card, it doesn’t mean that you’re going home.”
And the patient just had to be thinking “now you tell me ….”

Monopoly Community Chest Go To Jail

———————–

This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail me.

 

 

6 Responses to “Acute Incarceritis Revisited”

  1. TH says:

    I wish our officers and deputies were so inclined. Mostly, they just ‘cite and release’ because of jail overcrowding, leaving a very angry, usually hostile person in the ED.

  2. hashmd says:

    You could have given him the option of going to the Pscyh hold unit due to his obvious Munchausen’s…

  3. TH says:

    Nah. Then he’d be our problem all night because we don’t have a psych unit and we’d have to hold him until the county worker could get out the next day.

    And the hospitalists don’t want him, either.

  4. Txpharmguy says:

    Perhaps you could use a robot to see through his bullshit, although not necessary in this case. http://abcnews.go.com/blogs/technology/2014/04/man-vs-computer-which-can-best-spot-pain-fakers/

  5. ThorMD says:

    I always love the ones who complain of SI. Um, OK, you can go back to jail under suicide precautions now. Once they realize they are going back, they no longer want to kill themselves….

  6. David F. Guerrieri says:

    Here’s a great idea. Just practice medicine! WOW! I can usually get the POS out of the ER in about ten minutes with an H&P and thirty-five years of experience.

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