An Ethical Tool

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A few years ago, I met a Westchester man in his late twenties. "Charles" had learned how to jimmy open the back doors of the houses in his urban low-income neighborhood. He would go in and help himself to what valuables he could find. His general intent was burglary; he picked houses with no one home and took just what he could use or sell. He was apparently good at this and had been doing it for quite some time, until one night when there happened to be someone sitting quietly in the next room. A phone call brought the full force of the city police department down on Charles. Remarkably athletic, he ran — though the backyards and over fences. Then he turned a corner around a brick building and a police cruiser spotted him. As he ran along the wall the cop in the car tried to block his escape by driving right up to the bricks. Charles didn't quite make it past as the car hit the wall; his upper leg was crushed against the bricks by the cruiser's bumper. I met Charles because I was on call.

Dr. Scott Haig is an Assistant Clinical Professor of Orthopedic Surgery at Columbia University College of Physicians and Surgeons. He has a private practice in the New York City area

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Eyes swung up from charts as I walked into the quiet but always brightly lit emergency room, "Hey Scott, he's still in X-ray." Large men in blue were outside the X-ray room, still sporting Kevlar vests and talking on their cell phones. Their faces said they had a lot of paperwork ahead of them. In the X-ray room, the tech, a tiny woman, was alone with my new patient. She was, in fact, single-handedly moving him back off the X-ray table onto his stretcher. The films were up. They showed what you would expect; a shin bone smashed to splinters. The formica top of the X-ray table had trauma debris all over it — bits of asphalt, dirt and, of course, blood, with scraps of that useless white roll paper they put on exam tables. I stabilized the leg while she slid him over. The door opened, the cops saw the situation and flooded in. They helped roll him back out — pretty quickly — and I was left alone for a moment in the X-ray room. A metal object glinted from under the table paper. It was a Leatherman Wave — a multipurpose tool that held a small knife along with a dozen other implements. Did I want to make a big deal of our tech being left alone with a possible weapon? They had the guy, she was safe and there was enough trouble around here tonight. I slipped the Leatherman into the pocket of my white coat.

"This yours?" I asked Charles when I got through examining him and explaining that he needed surgery if he hoped to keep his leg. "Oh no, doc, not mine," he said. "I don't even know what they use those for." His eyes rolled toward the crowd of blue uniforms just outside the door. The Leatherman did have a knife in it and burglars with weapons do get in more trouble than burglars without them. He probably only used it as a jimmy though — and I couldn't quite live with the idea of keeping him in Sing Sing an extra five years on my account. A patient advocacy dilemma resolved itself rapidly in my head. So I kept my mouth shut and I kept the knife.

'Pretty cool for a nerdy physics major' is all I could think on my way home, very late that night. 'Yeah, I copped the shiv for my man Charles.' I was in league with a guy behind bars. Just a little, but I was sure I could have some actual street cred for this. And I had this nifty multipurpose tool that had actually been used to commit a crime — my one real tie to an accused felon's world. What a great souvenir.

Even after the emergency operation we did that night, Charles' leg was a punishment itself — pins sticking out, huge open wounds, skin grafts, almost certain to get a bone infection that would take more surgeries and lots of medicine to fix. We had a long talk when I made rounds the next morning. Then he was arraigned and taken away to the county hospital lock-up. They sent me an update: Charles had kept his leg. There was, of course, not the remotest chance I would ever get paid for those six or so hours of work in the middle of the night. I still have the Leatherman though, and the thoughts that wrap themselves around it every time I use it.

Did I do a good thing or bad? Charles, the cops and I all crossed a line; it was a little bit of a rush for me. How about for them? Orthopedic surgeons are a practical lot. In fact, practical considerations probably "justified" swiping the knife. But couldn't one easily justify everything that night, including a ghetto kid's making a living as a burglar, or the tired cops leaving a potential weapon on him at the hospital, or even ramming him in a dangerous chase in the first place?

The horror of Charles' leg did seem most unfair of all. Most of us think of fairness as a kind of symmetry; equal treatment on both sides of the line. But is there really any symmetry between my world and his? Would one of my surgical tools, or a shackle from my sailboat be for Charles what that the Leatherman is for me? Would he value a souvenir from my life?

Most educated, well-off folks in my doctors' world think our "cosmopolitan" viewpoint subsumes Charles'. We hardly think of other worlds or of the enormous complexity of medical ethics until we are forced to — as I am, every time I use that knife.