I work at a state prison and a county detention center... this weekend I was at the detention center.
I had something happen this past weekend that was quite interesting... I had a man come up c/o lightheadedness, nausea and vomiting blood. Ok... I didn't see it but it did warrant an assessment. I pulled his chart. He was on motrin 800mg tid for a shoulder injury. No significat history except he was an alcoholic prior to being incarcerated. I spoke with the inmate and he states he has a history of ulcers. He was clearly pale, clammy and his color was a little yellow to me. I took his vitals... bp 99/50, pulse 100, temp 96 (I took it 3 times). He said that he had been lightheaded as well. I told him to stop the motrin. I asked him what he had eaten and what he had to drink and he said lots of pepperoni and pizza. I thought well, maybe it was sauce that he saw. He started to feel a little better. He said he had Tums and would take those and lay down. I told him to tell an officer if he vomited again or if anything got worse or if he developed new symptoms. Well an hour later I get a call. I told them to bring him up. He stated that he had vomited again and he said he could taste blood. He kept saying "I feel like something busted." His looks spoke for itself. You have so many manipulaters its hard to tell sometimes who is valid and who's not. My gut and assessment said send him out. It was 10:30pm. I called the doc on call and his voice mail picked up. I left a message about my assessment and said I was sending him out. I told security and they were ticked because it was 1) 10:30pm and they were changing shifts soon and 2) the doctor hadn't called back yet. I said "Look, he is clearly sick and I am not risking his health or my license." Sounded mean maybe but I just had a gut feeling. The doc called back and said go ahead and send him... he was already gone. Well I called the day after and found they admitted him. I found out today that he had emergency surgery (he was bleeding internally) and is in ICU... I don't know the diagnosis though. Security actually went to my boss and told them that I made a decision without doctor consent, but I didn't. Well, thats my job late at night with no doctor... My objective opinion was something is wrong. I called the doctor like I was suppose to. The doc didn't pick up so I left a message and he called right back. The doc of course will say yes send them out because they depend on us and we are the ones there, they aren't. Clearly security has no training to make any decisions pertaining to medcial. My boss told them that it was fine that I made the decision that I made... if not, he might have died. I mean sometimes we have to make on the spot decisions based on our knowledge.
Sorry for the book... its just I didn't like the way security acted. They feel like the inmates always lie and sometimes they do. This inmate was a trustee... no history of frequent visits and states he hasn't been sick since being in there (over a year).
When I told them I wanted to send him out... one officer looked at his watch and said "Its almost time to go home." I said "well he needs to go and can't wait." The sargeant comes over to me and says is the doctor aware... I said I called and left a message and she'll call back any minute. I didn't back down because she acted like she wanted to wait. I told her that he had to go asap and that he could be bleeding internally... the other officer said "yeah right" I said, "His objective symptoms clearly say something is wrong..."
