Getting Out of the "Big" House

The view from the ambulance ramp just after it started snowing. You can't see the trees and houses just across the drive.

I think at some point I might have mentioned that we see a lot of the prison population at ECMC. One of the reasons being that we are the tertiary care center for a number of facilities. The other being that we have a very progressive telemedicine program which is connected to all of the correctional facilities in the state of New York.

We had a severe weather day on Friday when lots of snow (9 - 12 inches) was expected to fall over the course of about 12 hours. All of the schools were closed, and a lot of staff came in prepared to not be able to leave that night. The drive in was easy, but I had to spend about 20 minutes getting snow off my car (especially the 6 inches piled on the windshield) when I made the drive home 13 hours later. Luckily, I have a Jeep with 4 wheel drive and just rode over that foot and a half of snow piled up in front of it.

We kept expecting that it was going to be a light day. The snow started about 0900 and around noon, we were informed that there was a "no drive" directive out. However, we kept getting patients... mostly from the correctional facilities.
The complaints were legitimate enough that they warranted being seen, but not so critical that they needed to be seen "today."

Of course, one of the questions I always get asked when I can't provide a service on demand, such as a referral to a surgeon for an elective procedure, is "Is it because I'm wearing an orange jumpsuit?" I look at them, I look at the corrections' officer who is with them, then I look back at them and answer with a resounding, exasperated, "no!"

We never ask anything about our inmate patients. A lot of times, I am sure I don't want to know. I've treated lots of "accidental" falls that have resulted in broken noses, broken ribs, lot of cuts that need suturing, etc. I've treated STD's that have occurred. We have the frequent flyers who use their prior heart attack, asthma, HIV+ status, or seizure history to get out of jail for a while. We had one inmate with a psych history who was treated "Hannibal Lector" style since he was Hep C, HIV+ and liked to occasional spit and bite, or try to cause a needle stick incident when he was being treated.

Which reminds me: it's hard to get a physical exam on a patient wearing full jumpsuit with wrist and ankle cuffs attached to chains which are also wrapped around their midsection. But, for the most part, the CO's know what to do and start getting the pertinent body part ready for us to examine.

We also get a lot of new arrests. They either have just been arrested and have sudden chest pain or difficulty breathing and need a medical eval prior to being taken to jail. We've had the ones who made it to booking and then suddenly developed symptoms. We've had the hunger strikes, unwitnessed seizures, mysteriously injured jail-bound patients. I even had the patient with two days' nausea and vomiting that I had to now inform that she was pregnant. Bummer.

On Friday, all of the inmates were cleared and sent back to their respective facilities. A few looked disappointed that we couldn't admit them and get them out and into the real world... at least for a few more hours.