The overweight middle-aged man was propped up on the EMS gurney and flanked by two police officers as he was being rolled in through the ambulance entrance. He was alert but somber and looking down at his blood-stained white shirt.
“What’s that all about?” I asked the secretary, Dannie.
“EMS called a little while ago and said there was a stabbing victim…”
“Why didn’t they tell us to prepare the bay?!” I shot up to my seat.
“…he’s not the stabbing victim. He’s the killer. She’s dead.”
I followed behind the medics as they entered a room to presumably move him over to the ER bed. One of the police officers was standing guard outside while the other was inside the room assisting the medics. Frequently in the ER we all assume the formal societal role and are addressed accordingly. “Hello, officer,” I started.
“Hello, doctor,” the officer responded.
“What’s the story?” I asked.
“45 year old man, just killed his wife. Stabbed her repeatedly in the belly and chest,” he informed me.
I nodded and took a deep breath and then walked into the room. “Hello guys,” I greeted the medics and grabbed a pair of gloves, “What do we have?”
“50 year old man, multple deep lacerations to his hands and fingers. No other apparent injuries.”
“Hello, sir,” I said, a bit repulsed but trying not to show it. “I hear you got some cuts on your hands. Um, from a, from a knife.”
“Yes sir,” he responded politely, not yet looking up.
“Well, let’s take a look,” I began to unwrap his hands. They were still cuffed to the side rails so it took a bit of effort to even examine him. “Is it OK to remove the cuffs?” I asked the officer in the room.
“We can cuff his leg to the rail,” he said, and proceeded to remove the cuffs and then place one on his right leg and attach it to the rail.
“OK, let’s see,” I resumed. He had multiple deep wounds to both palms and palmar surface of his fingers. I positioned his hands so they were palms up on the table in front, pointed the overhead light down, and continued to examine him. I pulled one of the flaps of skin back from his left index finger, and noted a thin white band that had a very well-demarcated cut through it, like a rubber band that had snapped. A cut flexor tendon. “Bend your index finger,” I commanded, and I noted the portion closest to his wrist moved, but tendon portion closer to the tip did not. I examined his next finger, and the next, and it was the same for all of his left hand fingers. I moved to the other hand, “Multiple cut flexor tendons,” I exhasperated. “You really did a number on your hands. I’m afraid you’re not going to be able to use your hands the same for a while, if ever.”
“Yes sir,” he responded, head still down.
“You’re going to need surgery to fix these…” I trailed off continuing to examine his circulation and nerves. “Thing is, the hand surgeons won’t repair them right away. They are on-call for acutely limb-threatening injuries, and they will put off the stuff that can wait–like these injuries–until later. Like later next week.”
“Uh-huh,” the patient acknowledged with a grunt.
“Our job in the ER is to make sure the blood flow is intact, clean out the wounds and sew them up and get you on your way to see them.”
“OK,” he said. And as he turned his palms over to rest his hands on the table in front of him, I noticed his fingers had a strange puppet-like physics to them. Now that they were effectively unattached from his forearm muscles, they jiggled like sausages. I glanced at the clock, arose and left the room to meet the oncoming doctor. It was almost 7am and I went to the coffee machine and made myself a coffee. Black wasn’t my favorite, but would have to do because the ‘cream’ we were afforded in the lounge was corn solid powder. The morning doctor arrived shortly therafter and I signed out my remaining patients to him. Mr. So-and-So is a 35 year old man here for right lower quadrant abdominal pain and is awaiting his CT scan. Mrs. Room 7 is here for chest pain, we are awaiting her troponin and CXR. And Room 17 is a man that came in a little while ago after killing his wife. He’s got multiple hand lacerations I still have to sew up and then I’m going to call ortho to see if they’ll see him in follow up.”
“Oh, wow, they brought him to our ER?” the other doctor asked out loud. “I just now examined his teenage daughter in the hall bed. He apparently got a few cuts on her leg too before she ran away and hid.”
–DrMedicineMan
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