I soon overheard our charge nurse mention that a prisoner from a regional correctional facility was in the emergency department (ED) with “really bad sepsis.”
“Ugh,” I muttered in quiet annoyance. In my experience, these patients never fared well. Moreover, my cynical side suspected that more wasteful use of limited health care resources was on the horizon. Perhaps I would have felt differently if the patient were not a prisoner; I have no doubt a large part of my reaction was that part of me assumed that anyone who winds up in prison probably is a “bad person.”
Four heavy-set grizzly men in tan security guard uniforms accompanied the cachectic prisoner into the MICU. I immediately noticed that he was shackled to the hospital bed by numerous cuffs and full-body restraints, all of which seemed unnecessary since he was heavily sedated, intubated, and mechanically ventilated. It seemed as though the excessive correctional paraphernalia were there simply to indicate the misguided and reckless life choices that he presumably chose. They may as well have written on his forehead, “I am deplorable.”
I overheard the signing-off ED nurse say in a monotone voice, “the patient is a 53-year-old male inmate with diffuse large B-cell lymphoma being admitted for presumed septic shock from a necrotic right thigh mass.”
“53? He looks more like 83,” I thought in sheer disbelief. I considered what a grueling life this man must have led to look as feeble as he did.
Once the transfer was complete and the patient was settled in his room, it was obvious that his sepsis was due to a decaying, malodorous mass protruding from his lower extremity, along with a large left pneumonia and empyema. Standard sepsis bundles and protocols were initiated and the patient continued receiving a broad-spectrum of antibiotics, intravenous fluids, and two vasopressors. For source control, general surgery was consulted for debridement of his grossly infected, necrotic thigh mass, and he would require a chest tube to drain the empyema. I immediately cringed at the assuredly onerous process of obtaining informed consent for the invasive procedures. Consent could not be obtained directly from the patient for obvious reasons, and I was dubious that any family members would be reachable. Even if kin could be reached, I knew of the cumbersome hoops that I would need to surmount to obtain the obligatory consent. I had no time for this right now; the patient was now hemodynamically unstable and his respiratory status was deteriorating. I talked with an intern and asked him to tackle the dreaded consent quandary.
Ten minutes later, the intern said to me proudly, “Consents for the procedures are in the chart.” I was flabbergasted and perplexed by the rapidity of the process. Little did I know that the patient was a married man with three children. Also unanticipated was that, despite being incarcerated, the patient was in fairly regular contact with family, which made for an effortless phone conversation between the family and intern, who easily and appropriately obtained consent.