A few weeks ago I responded to the result of a brawl at a seedy bar. The story I was given was that two patrons had a disagreement about something – I am sure it was something very important and academic, warranting violence to settle the discrete differences of intellectual opinion. But the reason for the fight doesn’t really involve me. The patient I was called to see was a fifty-five year old male patient who had suffered the indignity of having a glass beer bottle broken over his head. It was unopened, which makes the impact heavier if nothing else. I asked what kind of beer. Corona. Full bottles of anything hurt, so that sucked for my patient.
|Corona Extra, the thinking man's makeshift club. By N-Lange.de via Wikimedia Commons Source|
I examined the fellow and chatted with him while I checked him out. He had no complaints, denied medical history, and said he just wanted to go home. Bystanders reported that the man had been knocked to the ground by the blow, but did not appear to lose consciousness. He had consumed several beers, but appeared generally sober to me. The whole bar smelled of stale beer, so I couldn’t assess dude’s breath, but his speech was clear and he did not exhibit ataxia. My opinion was that he possessed decision-making capacity at that time. The man appeared to be uninjured, except for a large, complex, full-thickness laceration to the apex of his scalp. Bleeding had been controlled prior to my arrival, and his skull and facial bony structures were stable to palpation.
The patient and I had different opinions of the best thing for him to do. To me, it was an obviously suturable laceration; he needed to come with me to the hospital. If he had a ride easily available, we could discuss it but him going with me would make everything easier. That was my opinion. His opinion was that he had been hit much harder at previous times in his life and it probably wasn’t as bad as I was saying. He just wanted to go home (which probably meant to a different bar). I was having a hard time convincing him about the gory nature of his laceration. “Buddy, your skull is visible. You need to get that cleaned out and stitched closed…”
In the end, it was his decision to make. I didn’t feel like I should chicken-wing the man and drag him off to an ED, kicking and screaming. He was sober and had decision-making capacity. But I didn’t feel like he was making an informed decision. The conversation I was having with the patient felt like he wasn’t absorbing the information I was giving him. I felt like he didn’t understand the severity of his wound.
I asked the patient for his cell phone, which he gave to me. I used it to take a picture of his scalp lac, which he couldn’t see (it being on the top of his head). I actually took a short video, so I could pull the lac apart a little and make it look like it was chewing food. I made a growling “blah blah blah” noise when I pulled the lac apart. I showed the nasty video to him.
“Oh, hell,” he said. “I had no idea it was that bad! I thought you were overreacting!”
“That’s what I’ve been saying!” He went to the hospital with me and got some stitches. By transporting him, I didn't need to worry about whether his sobriety fell on which side of which line, or anything else. He went to the hospital and got stitched up. Simple. (I actually think he may have gotten stapled, though. Whatever. Same thing...)
Camera phones make for good mirrors. They are even better than mirrors, in a lot of ways. You don’t have to align two mirrors to see the back of your head. You don't have to look like you are preening. You can see the same thing a patient does. Also, a mirror can't post a funny story to Facebook. I prefer cell phones to actual mirrors in most cases, as a matter of fact, because the view is better than a patient gets in a side-view mirror at the side of a highway.
When you do this, try to use the patient’s phone for the pictures. It is easier to explain, you don’t have privacy concerns, and there isn’t a need to clear your deleted pictures. I don’t want my phone involved in calls, unless absolutely necessary.
But cell phones can definitely be handy as mirrors.