You see them around the hospital everywhere. Hands and feet cuffed together. Two fully equipped guards follow them everywhere, even to the operating room. The hospital has a contract with the county prison, so we see them all. I’m told the ones in orange are protected from the other prisoners. They tend to be child molesters and rapists who would be assaulted by the other prisoners if they were not protected. We usually don’t know what they did, we never ask them, nor do I want to know. Every day, I go with the residents and attendings to tend to their wounds or stitch up lacerations in the emergency department. It’s easier not knowing, it doesn’t create an inner battle.
But when I scrubbed into the arteriovenous fistula case, I noticed the nurses were oddly quiet and looked unsettled. One of them said she didn’t want to do this. I asked what happened. She had recognized the man in the orange suit I saw being rolled into the pre-op room in the morning. He was a viral social media star for violently assaulting women and posting the videos. My stomach instantly started churning.
Why did it suddenly feel so wrong to help someone? I had never felt that before with the other prisoners. I always believed it was not for me to judge and treated them like every other patient, with kindness and my brand of great-to-excellent jokes. But when I went to see this man, his coldness pierced my soul. He didn’t have the look of the others. I could usually tell they felt guilty or remorseful and they were always polite when interacting with me — but this one was different. I don’t know if it’s because I saw the orange suit, if it’s from what the nurse told me or if I was just a good judge of character. It was as if I could see the clinical psychopath within. He was tall, big, and had a calm and self-assured comportment.
I envied the resident and attending surgeons who did not know about him. They were talking, discussing, and laughing at each other’s jokes as usual. But all the women in that room had the same demeanor from beginning to end. All were quiet and would have preferred not to be there; but we all knew and believed that this man deserved quality health care.
That was the first time I confronted conflicting emotions of this nature but not the last. The Monday after, I went to check on the man who had been shot by police the night before because he would not stop stabbing his wife. I had a certain image in my mind of what this domestic abuser looked like; he would have a large stature and be confrontational. But this man was thin, quiet, timid and followed directions well. I found it odd that the chief resident had such charisma when speaking to him because he was the second person that weekend who had stabbed his wife and I could not find the energy within me to strike up a “The weather is nice today, isn’t it?” conversation. I wanted to scream into a pillow, but I made sure he did his daily walks, took his pills and moved on. It’s an uncomfortable feeling to harbor — to want to help someone and demonstrate humanism but in synchrony with profound rage.
It felt surreal living through a medical school ethics interview question. No one had taught me how to cope with this, but I recalled an interaction I had with the neurosurgeon who taught me it was okay to have these conflicting emotions. “Sometimes I think they deserve to live with back pain for the rest of their lives; he did kill a preschooler,” she said. My hands and feet went cold thinking of my preschool age nephew whom I love more than anything in the world. I was angry she told me. I didn’t want to deal with those confusing feelings again, but I just let them exist. My heart felt like it had been wrung out and there was nothing else left to squeeze out, but it never crossed my mind that she would deny him the surgery. I went to the restroom, wiped my tears and moved on. After all, we are human beings and we’re allowed to have conflicting moral compasses at war with one another simultaneously.
At the end of every day, I went home certain every nurse and doctor in the hospital provided the best health care possible to these patients despite what we all felt, including me. I find it to be the most admirable quality of health care workers. We understand that we do not play God.
Email Preny Karamian
