"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.