Walking into our first patient’s room, I am overtaken by the putrid smell of urine. My sense of smell is soon overshadowed by the piercing moans of pain and agony coming from our patient. I glance over a crowd of stoic guards to get a glimpse of the man, curled up and writhing on a dirty, plastic mattress. He lies in a cold, dark room with cement floor and walls, a dungeon. There is a dried puddle of urine next to his bed. The toilet that is four feet away is infested with fecal matter.
As I force myself to look at the patient again, fearing my reaction, I notice he is missing the lower part of his left leg. He is a heroin addict with a grossly unkempt appearance. He wears grimy sweats and has long, uncombed hair and stubble covering his face. There is no wheelchair in sight. My heart starts racing as I absorb the absolute horror of the patient’s situation. I step out of the dingy room when I feel my brain being drained of blood.
As I regain my composure, I watch the physician approach our patient. He winces in pain and anger as five onlookers stare with blank faces. With the compassion and care of a mother, the physician gently places her hand on the patient, who is curled in the fetal position. Without fear, she lowers her head close to his face. She comforts him, and tells him she is here to help. Through clenched teeth, he describes his unbearable pain. He is too physically incapacitated to sit up to be examined.
Yesterday the patient was in a car crash. He sustained a broken femur on his leg that had previously been amputated. After a few short hours of being stabilized in the Emergency Department, he was immediately transported to the Sandoval County Detention Center. Police officers at the scene of the crash determined he has two warrants out for his arrest.
After a long, restless night in his cell, audibly expressing his suffering, the jail nurse attended to the patient this morning. For his severe pain, the nurse administered ibuprofen and acetaminophen. Because of strict laws prohibiting narcotics in jail, the physician could only prescribe Tramadol, a centrally acting analgesic. There was nothing else we could do to help this patient except request an orthopedic follow-up. He will most likely need to have the majority of what was left of his leg amputated. It may take days to weeks for him to see the orthopedist. Until then, he will suffer alone in his cold, gloomy cell.
I do not know what crimes our patient committed. Maybe that would change my opinion of the dark scenario. Irrespective of the fact that he is a criminal, I am able to suspend all judgments, replacing them with empathy, concern, and anger over our patient’s situation. This patient showed me that I live in a country where cruelty and disregard for human rights is acceptable. How can I deliver health care in a rigid system that does not value life?