“I don’t know why I came here, it was clearly a mistake”: Carceral Trauma in the Trauma Bay
By Arielle Lawson
What do you think of when someone says, “I don’t know why I came here, it was clearly a mistake”? For me, the first thing that comes to mind is a scene from a cheesy romcom or 90’s ballad lyrics. I never thought I would hear those words in the trauma bay coming out of a patient who had just been shot.
The Hospital I was working at is one of the five busiest level 1 trauma centers in the United States and the busiest in the Southeast. It is every bit as chaotic as it sounds. During my trauma surgery rotation, Emergency Medical Services (EMS) brought in several patients injured via gunshot wounds, dog bites, motor vehicle collisions, and more. One patient’s hand was caught in an industrial salad slicer and when he arrived, his fingers were hanging on by a thread of skin with blood squirting out of his severed arteries. Despite all the mayhem and gore of the trauma bay, one interaction stuck with me.
A Black man in his late 30s was brought into the trauma bay after suffering two gunshot wounds to his arm. We did not know much about him, but we were told via EMS that he had some sort of psychiatric history and was currently experiencing homelessness. Hospital policy stated that all non-accidental trauma, including gunshot wounds, are required to be reported. In many instances, such as this one, law enforcement officers are at the hospital to interview the patient as soon as the patient arrives. Once this patient was deemed to be stable by the trauma team, the officers entered the room to ask him some questions.
I was tasked with helping to wash out and dress his wounds. Two other team members and I returned to the patient’s room to find two police officers at his bedside. They were asking him what part of town he stayed in, who his friends were, and how they could get in contact with them. The patient repeatedly declined to answer their questions. Despite his steadfast unwillingness to answer the questions and his obvious discomfort, the officers continued probing. At one point he said, “I’m not trying to be disrespectful, I just don’t trust police.” At this point, the patient began to get more agitated and wanted to leave the hospital. When the police asked him why he came here if he wanted to leave, he said “I don’t know, it was clearly a mistake.”
I asked the officers if they would feel comfortable stepping outside while we cleaned his wounds, given that they were making him increasingly agitated. The officers then began asking me what the patient’s name was, what I knew about the patient, and who they could talk to get more information. They started writing down the name on the patient identification stickers on the table. At this point, the patient was irate. He ripped off his ECG stickers and loudly declared he would like to leave. Unfortunately, after expressing suicidal ideation to one of the physicians he was on a temporary psychiatric hold for further evaluation, known as a 1013, further contributing to his sense of powerlessness. The patient’s agitation was soon heard throughout the trauma bay and he was “chemically restrained”, or injected with heavily sedating medication. This is done frequently in emergency rooms for the supposed purpose of protecting others and the patient from themselves, but can further harm the therapeutic relationship between provider and patient. The next, and last, time I saw him before my shift ended, he was fast asleep. I felt a mix of anger, frustration, and sadness. A patient, who was polite, friendly, and in need of medical attention, became understandably angry after continuous probing by law enforcement.
It was especially upsetting because patients in the hospital are uniquely vulnerable. The officers exploited his need for care to the point where this man had to be sedated, and they got to go about their days. The patient came looking for care, but was met with a carceral environment that did not put his needs first, and was unable to de-escalate without the use of medications.
In discussing this experience with other healthcare workers in the emergency department, I found this was not a unique circumstance. I was told that “standing up for patients’ rights and safety is seen as more abrasive than officers asserting their authority.” One resident physician explicitly noted that there is a “lack of accountability for [law enforcement officers]” and “tremendous accountability for us for things that interfere with their job.” I was told by multiple individuals that the ED has had issues with officers leaving body cameras in the patient’s room after being asked to step out, recording the intimate conversations of the patient and the healthcare provider. One attending told me of cases in which sexual assault victims may get arrested for outstanding warrants after coming to the emergency department to seek care. Who in their right mind would want to go to the hospital to seek care knowing they may get arrested? Seeking healthcare should not be a decision that is weighed on a pros and cons list, with the cons including loss of your freedom, civil liberties, and dignity.
Hospitals are meant to be places of healing. They are sanctuaries for the unwell, where everyone is entitled to care. We must ask ourselves how the task of tending to patients on what is likely one of the worst days of their lives can possibly include law enforcement.
