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The Wheat and The Chaff
by Mary Barry, MD
The first time I saw a broken bone sticking up out of a leg I almost fainted. I was in the ER at old St. Joe’ s, helping a fellow nursing student give a street guy a bath. This old man lived rough, and he was smelly, drunk and grabby. We had not yet determined if he was sick, sane or simply disorderly. An ER aide coming up behind us said,“ Hey! Move!” and when I turned around, I was face-to-face with a femur. Its owner was tied down with leather restraints and gave a distinct impression of despair.
Our instructor came around and told me to go with the femur guy and“ Watch everything they do and the order they do it in. And you are in charge of keeping him still for the doctors.”
I checked that I had a large roll of adhesive tape and hurried to catch up. The femur guy was moaning and cussing with every rattle of his stretcher. I asked his aide if he’ d gotten any pain medicine and the aide rolled his eyes.“ First he has to get X-rayed and then send labs and then the doc’ ll look at him.”
I said,“ You sure you need an X-ray to tell that this here leg is injured?”
The orderly said,“ We got a protocol.”
The leg owner’ s pulse was 140 and thin and he looked pasty, miserable and scared to death. I went back to find a doctor right away. If there is one thing I hate in life, it is the person who hides behind rules and routines, when clearly urgent action is called for. I found the ER moonlighter from General Hospital, told him the story, got an oxygen tank and then commandeered the stretcher. We rolled up to the doc and I said,“ Could he please have some pain meds before I have to bump him over all the doorways to X-ray?”
Three mg of morphine later, his pulse was stronger and slower; on some O2 and fluids, he was beginning to look less shattered. I could try to get some history from the guy. He was pinker and calmer but
32 LOUISVILLE MEDICINE grabbed my arm when we tried to head to X-ray.
We negotiated. If I got two more people to lift him over the bumpy parts, very carefully, he would let us take pictures of his leg.
“ What do people call you?” I asked. He said“ Crutch.”“ You mean you broke your leg before this?”
He said,“ Nope, nickname from Little League.” Apparently, his specialty was bowling into home plate with such abandon that parents shrieked and the catcher backed up into the umpire. It was the fear of crutches that named him.
“ How did this happen?” I asked him.
He said,“ You know those old railroad cars that sit down by the racetrack?” I nodded.“ I fell out of one.”
“ You’ re hanging out in a railroad car?”
He said,“ I live there. I can go over to Holy Name and those nuns, they will feed me and save me leftovers. I lift heavy stuff and do things for‘ em. They help me. Anyway, when it’ s rainy I sleep in the car and I musta just rolled right out. I hit my leg on the rail.”
He’ d had to crawl a long way towards the street and finally somebody heard him yelling. I was feeling faint just imagining this pain.
I asked,“ Are you drinking? Is that why you’ re living rough?”“ No drinking. Korea.”“ Ah,” I said. I knew about the war in Korea.“ Was it the caves?”“ What do you know about that?!”
“ All my aunts and uncles were in the service in World War II, and Uncle Jack was in Korea. So I read about it a bunch – caves and tunnels and trying to dig a foxhole in the snow.”
He turned his face away from me then. I think he was beginning to understand what he’ d have to deal with.
OPINION