I recently took care of two interesting cases that came from the jail on the same night. You never know what will come into the emergency department and the jail is a very interesting source of our patients.
Keep Patient Away from Toilet Paper
A 39-year-old man came in from custody for evaluation. He had tried, unsuccessfully, to hang himself with some sort of a plastic ligature. He was found to be uninjured and was sent back to jail… but not for long.
After getting back to his cell, he spent some time twisting toilet paper into a rope of sorts, which he used to try, again, to strangle himself. He was returned to the emergency department and, again, was found to be uninjured.
When I discharged him to go back to jail on a suicide watch, my instructions were, “Keep patient away from toilet paper.”
I wonder if they followed my instructions.
Something Unnatural in the Eye
A 33-year-old woman came in complaining of left eye pain. She told me someone had “put something unnatural” in her eye a year ago and she had been having eye pains, like a knife stabbing into it, every since. She had never seen a doctor about it. The reason she was there that night was that she had been arrested and, during medical screening at jail, mentioned it to the nurse. The nurse sent her straight to the emergency department in the middle of the night for evaluation.
Vision problems are a fairly common complaint in the emergency department. Eye pain can be a symptom of a serious eye problem so we always take this complaint seriously.
As I approached the patient, she was sitting comfortably with a piece of gauze loosely taped over the eye. She had 20/20 vision and my examination of her eye didn’t reveal any abnormality. I could see no reason for her pain.
As I asked her for more details about getting something unnatural in her eye, she replied with vague and unhelpful answers. When I asked if she had any past medical problems, she denied any. Her demeanor made me suspicious she had a psychiatric problem but she denied that as well.
Still wanting to make sure I was not missing anything, I went to the computer to review her past medical history and previous visits to the emergency department. This showed that she did, in deed, have a history of anxiety, bipolar affective disorder and psychosis as well as drug and alcohol abuse.
As I went back to talk with her again, I summed things up in my mind. A vague history of someone putting something unnatural in her eye. Pain for a year without seeking any medical attention. Normal visual acuity and eye examination. Pain that made no sense for any eye disorder of which I was aware. A history of psychiatric problems, though denying so. It was pretty unlikely she had an eye disorder that needed to be identified by me in the middle of the night in the emergency department.
I released her return to jail with a recommendation that they schedule a routine visit with an eye doctor.
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