Wednesday, January 11, 2012

Positive Predictive Value

When I see a guy come screaming into the ER with a pit bull bleeding from a gun shot wound through something vital, I admit, there is a little bit of profiling that goes on. After all, typically, GSWs and pit bulls go hand in hand with people that generally have little to no money. Add in a neck tattoo and a tattoo indicating you've killed someone in jail and that bumps up the probability that "drug dealer" and "violent" will also be added into the mix.

So, picture this...small dude with a shaved head, neck tattoo, and a tear drop tattooed next to his eye. He looks like a reject from an Irish rap band. As he tears into the hospital with his gasping dog in his arms, he starts yelling for someone to help. The patient is rushed straight to the back, huge bloody GSW, flail chest (trust me, bad news). I assess the patient, give orders for pain medication, oxygen, and an IV catheter. When I go out to speak with him, I am told that he has already swept a tray to the floor, breaking it in anger. I catch the sight of the tattoos and, yes, I call the cops. Sorry, you choose to mark your body in that way and precede our interaction with violence, the cops will be involved.

Once I was in the room, it took all of 2 minutes for him to demand to speak to someone other than a woman, a man specifically. Ok, so my tech grabbed her breasts and says, "I could be a man, these could be fake." Seriously, she said that. After informing small angry dude of the cost of treatment and probability of increased costs due to the chance of increased problems given the severity of the wounds, he freaked out and demanded that I bring him the dog. I told him that I thought that the option of taking home a dog with a wound that severe without treating it would be cruel. I urged that if the range of cost was too great, to euthanize. The amount of suffering without treatment would be too great. I also advised that if he wanted to go ahead with initial treatment, understanding that the costs would increase and that without aggressive treatment, his dog would be more to likely die, then I was willing to do that, as long as I could keep the dog comfortable. He want to just take the poor thing home.

In fact, the guy wanted to take the poor thing home so badly, that he threatened me. He threatened my staff. No matter how reasonable I was, no matter how much his poor girl friend cowered in the corner, he still railed on. He never knew I was recording the whole thing. I mean, it says that when you walk in the door, but maybe he didn't read the sign.

Imagine my surprise when he popped out with the "sir, yes sir" when the cops showed up. Yeah, no surprise he had been in jail before. It was all sweetness and light when the boys in blue made their appearance. Considering all of the canine officers that we see, you bet these guys show up 5 minutes after I call them.

After easing this poor dog's way to the rainbow bridge, what did the cops have to say?

"What'd ya do to piss this guy off, steal his lucky charms?"

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