The Defenseless Ones

Something I thought about today that isn't usually discussed is the problem of Elder Abuse. Now, while most people think about physical violence when they hear abuse, you don't often think of other ways in which the elderly are taken advantage of. I had a case today that kept me late and which turned into a very disturbing story.

Again, while I cannot discuss the particulars of the case because this will now be a criminal investigation, I can say that a moment of kindness offered by a stranger turned into a break-in and physical abuse on the elder person. To add insult to injury, the attacker portrayed a health care worker "acting concerned" about the elder when they somehow managed to call 911 and police arrived.

The elder was then transported as having Altered Mental Status and ended up in the ED. Meanwhile, the stranger and their accomplices ransacked and stole from this elder person. Luckily, a concerned neighbor was able to get a license plate, and the suspects are being tracked. But this poor person had to suffer some humiliation with no one believing them, not to mention the losses suffered in their home, and probably some loss of faith in humanity. I was in shock as I was told the story. If I get an update I will post it.

Unfortunately, we often see some form or other of elder abuse. Usually neglect, sometimes by families that mean well, but are just not prepared to handle the demands of a frail aging person with multiple medical problems. Or by the hands of those in the nursing homes to which they are entrusted. I haven't written about some of the more horrific stories I've heard and seen. I've had a patient I've called Adult Protective Services for due to concern their fracture was inflicted by a staff member.

As for the rest of the day...

I spent the morning cleaning up from a multivehicle accident that resulted in the death of a Buffalo police officer.

I then had a patient come in with a steak knife sticking out of their belly. The driver and passenger of a motorcycle crash who both needed trauma work-ups. An overdose who needed to be intubated upon arrival. And assorted other crazy patients that each took up their own space of time.

Tomorrow it's back to the fun at the County. What a way to spend the weekend!

p.s. you can link to the National Council on Elder Abuse by clicking on the purple ribbon.

Monday Night Fights, Um, Football

I think at some point I remember mentioning that, as part of our residency training, we learn to work at "mass gathering" events. I had a chance earlier in the year to go to the Bills vs. Raiders game, and yesterday I worked the Bills vs. Browns game where I probably spent about 75% of my time sewing up drunk fans or fans involved in altercations with drunk fans.

It's strange, but I don't mind it. I like to suture. It's almost like artistry. You take something that's torn, or cut or shredded and try to put it back together. Of course, the majority of the suturing occurred on people's faces which leads to the added pressure of making sure that cosmetically suitable results are achieved. And, it doesn't matter that the majority of my patients were so sloshed they wouldn't have noticed if I sewed their top lip to their bottom eyelid; my own pride and perfectionistic attitude wouldn't allow me to accept anything but my best.

Now, having said that, it's a challenge to work on someone who's heavily intoxicated while remembering my Hippocratic oath. If you've never had stitches on your face, or seen someone getting them, it's a pretty intimate situation. Especially when I had two patients needing sutures inside of their mouths because they had cut the inside of their lips.

Beer breath is nauseating. Stale beer breath with cigarette tobacco overtones even worse. Of course, the fun patient of the night was the majorly drunk patient in handcuffs who was jumping and fighting the two sheriff's deputies who had him under arrest. The patient needed just one stitch. On his lip.

Ever try to wash a cat? Yeah, the two sheriffs holding him down looked something like that. To top it off, we didn't have a suture kit, and I was using what I had available... a suture removal kit. So, here I was trying to hold the needle with a pair of scissors and getting a stitch into a moving target.

The sheriffs managed to hold his head but couldn't keep him from talking. I guess I didn't think about the possibility of him spitting or kicking out. He managed to stop talking long enough for me to swoop in, throw the stitch, step back and then take another step forward as I quickly tied my knots and then cut the stitch. No lidocaine for him, but given his blood alcohol level, I don't think he even noticed.

OK, that's it for tonight. I need to write about my last patients at Suburban before starting back at the excitement that is ECMC. Grand Rounds tomorrow, so I should have some time to write... cheers! Of course, always in moderation... :)