Predators and Prey

On the night shift in the ER, there are two types of patients: predators and prey. (There are many more types but this combo is a common theme.)

For example, last night I had a female who was the victim of domestic violence. Her husband had choked, punched, and kicked her. She ended up with a fracture of her cheekbone, a ruptured eardrum, and lacerations on her fingers from bite marks. She is prey. She doesn’t leave the ER in the middle of the night unless she is safe. This includes offers for domestic assault nurse evaluation, making a police report, and social work if available to arrange a safe disposition (DV/womens shelter, etc). She has the option to pick and choose what resources are offered, but we do our best to make sure she is offered those things more than once, by myself and nursing. I can’t actually make her choose/do anything.

Just two rooms down from her, a middle aged male presented by EMS after just getting out of jail. He had various complaints about injuries and a possible assault in jail. He had conspiracy theories about how nothing gets reported in jail because the entire system is corrupt. He could not tell me any details about his assault. He had a bruise on his arm, some subacute wounds that did not appear to be consistent with an assault but looked like old cigarette burns or something else. He had a few bruises on his flank, which were very nonspecific. He wanted X-rays of his back just in case something “exploded”. But he had no exam findings or any details about why something in his back may have exploded. He was very unhappy with my offer for acetaminophen and ibuprofen and wanted to file a report, a grievance against the care that he received. Looking at his chart, he has a history of methamphetamine use, and obviously jail time. He’s a predator. That doesn’t mean he’s actually a good predator. He’s not an actual alpha male, but he can handle himself when being discharged from the ER in the middle of the night.

The reason we could discharge my domestic assault victim safely was because her asshole husband was in jail already. She is not inherently safe from all predators but she is at least safe from that one.