Working as an ER tech in the sunny, friendly city of Camden, NJ can certainly have its ups and downs. To anyone who lives in NJ (or Philadelphia...and perhaps elsewhere), Camden’s reputation as being the armpit of the state resonates from the shore to the Delaware River. Although many cities in North Jersey may give Camden a run for its money in terms of crime rates, few can beat the true, unadulterated poverty is rampant and the nicest cars you’ll see driving around are either on one side or the other of a drug deal.
With such a “nothing to lose” mentality among so many of our patients, it was always our MO to use extra caution when dealing with anyone who presented under the influence. Suffice it to say that when a 30-something year old woman with frequent ER visits for substance abuse presented to our ED with abdominal pain, our radar was fired up immediately. Writhing in the wheelchair through our triage area and into her room, the patient was asking for Dilaudid by name.
She received pain medications, albeit not Dilaudid, and a full abdominal work up with x-rays, CT, and ultrasounds. Nothing was found, yet the patient continued to ask for Dilaudid. Our physician asked that the patient be admitted for further evaluation to find the source of this mysterious pain that migrated throughout the night from one quadrant of her abdomen to the next. When the admission was explained to the patient, she quickly became irate, tossing F bombs all over the ED and calling our doc every name in the book.
The patient decided the best cure for her illness was to leave AMA. Things in her corner of the ED seemed to quiet down for a few moments until it was time to remove her IV and ask her to sign the papers to leave. Sometimes, IVDA’s (intravenous drug abusers) will try to sneak out of the ED with their IV still in place as it gives them easy access for their next hit. It would seem as though this was the patient’s plan, as she had already put her sweatshirt back on and was slipping on her sandals. As myself and a nurse approached with a clipboard, a square of gauze and a roll of tape, the patient flipped out harder than ever.
“Don’t you f***ing touch me!” she screamed, ripping herself away from us and launching herself backwards onto her stretcher.
Security didn’t miss a beat. Before long, four guards along with plenty of backup from our nursing staff were at our side to help pacify the aggressive patient. Our charge nurse explained that her IV would need to be removed before she could leave to prevent the risk of an infection. The patient appeared to comply, and I cautiously approached to remove it. As I took hold of her arm, I began working the clear dressing which secured it to her arm up from one corner. In an instant, the patient grasped my arm with both hands and sunk her teeth right into the muscle.
It hurt. A lot. So much so that I instinctively reacted by driving my arm further into the patient’s face as hard as I could to prompt her to release. Somehow, amidst a body-pile of blue security polo shirts, my arm was freed from its plaque-laden prison. The next few seconds were a blur, but when I regained awareness of my surroundings, the security team could be seen carrying the patient by her limbs out of the ED, her IV and its dressing stuck to the bedsheets where she had just committed a felony assault on a healthcare worker (yours truly).
The next few hours were full of thorough documentation and a wide array of blood tests to make sure nothing nasty had been transferred from our lovely local narcotic-seeker to me. Fortunately, the tests all came back negative, but the lesson to be learned was abundantly clear: this was a close call and could have resulted in the contraction of a life-altering disease from the bite.