1. Racially motivated murder by paramedics
2. Paramedics raping patients

I've worked in several different emergency rooms in a variety of settings, and I've learned that some cities have a disproportionate share of people who do strange things. Unless you work in an ER of a town with a high “weirdness quotient” you may have a hard time believing that people can do some of the strange things that are described in my books. If that's true, it is a good sign: it means you are fairly normal and you haven't spent much time around the bizarre fringe element in our society.

In general, I think people are naturally incredulous when they read of incidents that are far outside the behavioral norms they have previously experienced. In this regard I'm just like you, except that I have a higher threshold of incredulousness as a result of being exposed to so many odd things that I once thought would have been impossible. Nevertheless, I can be very skeptical when I read about events that I had never heard of in the past.

It was with this mindset that I initially reacted with skepticism to information sent to me by a paramedic (who I'll call Ed) alleging that some of his co-workers had committed acts that were so extreme they could only be described as savage. However, Ed seemed to be genuinely and passionately repulsed by these acts, and he provided me with extensive documentation to support his allegations. The events that I found most heinous are summarized below. Warning: I will not euphemize the crude and offensive words since I think they are essential to a full and unadulterated appreciation of these acts.

Ed said that his partner Clyde became enraged when they were dispatched to the scene of a motor vehicle accident involving a potential fatality. Clyde was apparently upset that this would not allow him to sleep during the remainder of his shift, hence interfering with his plans for the next day. Clyde allegedly said that if the person were “a nigger” then that person would die because he would not help him. After arriving at the scene of the accident and finding that the injured people were black, Clyde refused to assist them, leaving Ed to care for multiple victims by himself. After one person died Clyde began working, but Ed claimed that it was at such a deliberately slow pace that he was more of a hindrance than a help. Later, as the remaining victims were being transported in the ambulance to the ER, Ed said that Clyde taunted another patient while he was dying, saying that he purposely withheld care to kill him and his friend because they were black.
On another occasion Ed reported that paramedics were summoned to assist a person who collapsed at home as a result of an apparent heart attack. According to Ed, the medic who attended to the patient simply closed the door and did nothing while his partner obtained a history from the patient's spouse, who was told that everything possible was being done. The medic with the patient allegedly waited until the cardiac monitor showed a flat line, then telephoned the patient's doctor to inform him of the death.

Murdering a patient by purposely withholding care (while maintaining a pretense of giving care) is not a rare event. When I was in training the senior residents would often announce that a certain code would be a “slow code” in which we would go through the motions of doing the right things but do them so slowly it would be of no use to the patient. On other occasions the senior residents would tell us to take our sweet time in responding to a code so that the patient would be more likely to have died by the time we arrived.

I think these slow codes are ridiculous. If a person is being coded, then everything possible should be done for that patient. Lollygagging during the course of a code and then telling the patient's family that “we did everything possible” is dishonest and unprofessional. To the best of my recollection, all of these slow codes were ordered on people who were in poor health with a negligible chance of a recovery. Nevertheless, the law does not allow physicians to arbitrarily decide which people should be given a chance to live and which should be doomed to die.

I have had a few patients whose recovery could only be described as miraculous. I would love to take credit for their turnarounds, but I cannot honestly say that the care I delivered directly resulted in their recovery. If nothing else, these miracles underscore the fact that doctors can't always predict if a patient will recover. Hence, healthcare providers should not withhold care (or administer it halfheartedly) except when they are acting in accordance with the expressed wishes of the patient or his family, but halfhearted care is difficult to justify.

One might excuse the slow codes described above as resulting from well-intentioned but illegal physician arrogance, but withholding care from a patient who has a fair chance of being salvable (such as a patient with a heart problem) is totally inexcusable.

Ed asseverated that paramedics from his city felt an obligation to the taxpayers to curb the abuses of the healthcare system perpetrated by black patients who were, they claimed, all on welfare. According to Ed, the paramedics fought this racial war by withholding care or, when that was not sufficient, by injecting patients with the wrong drug or an overdose of the correct drug. Killing a patient in this manner is easy to do and virtually untraceable in a practical sense.
Ed said that he and his partner were dispatched to the scene of an accident and found a young woman unconscious in one of the cars involved in the collision. Ed alleges that his partner began gawking at the victim, commenting on how she was such a “nice piece of ass.” Ed began assisting another patient who was ejected from the vehicle while his partner moved the comatose patient into the ambulance. When Ed later opened the door of the ambulance he found that his partner had removed all of her clothing and was sexually fondling her. Ed resumed working on his patient, who was transferred to a hospital by another ambulance that had been sent to the scene. Ed said that his partner was later bragging that he had intercourse with the patient, and he marveled at her “tight pussy and firm tits.” Ed also reported that his partner stole her bra and panties as a souvenir.

Are paramedics playing God, deciding who lives and who dies? Are they defiling helpless young women? While I think such behavior is extremely rare, it does occur. Paramedics are not, however, the only perpetrators. There have been several well-publicized cases involving nurses, doctors, and dentists. No veterinarians that I know of, but even that wouldn't surprise me.

Several years ago I had a patient whose perversion was in a class by itself—I hope. In case any children are reading this, I'll euphemize this to spare them from being exposed to one of the few deviances that has not yet been covered by the media. This fellow's aberrancy centered on his pastime of sampling the sensory delights of females from different species. After that revelation, I wasn't very surprised when he told me that he wanted to become a veterinarian. I probably should have reported him to the SPCA, but that would have been a breach of patient confidentiality. Instead, I tried to dissuade him from boinking any more animals by telling him about the few cases I'd heard of in which animals, apparently not enjoying such intimate attention, put their molester's organ out of commission by biting it.

OK, enough digression, and back to the matter of paramedic malfeasance. I was particularly unnerved by Ed's assertions because they meshed with some suspicions that I've had about a few paramedics. While almost all paramedics are honorable people who are motivated by the desire to help people (and to pay the bills, of course), for a long time I have had a vague, admittedly inchoate, suspicion that a small percentage of them are not quite right mentally. In some cases my hunches are not just nebulous intuitions but concerns that have at least some basis in fact. A few female patients who were unconscious in the ambulance have subsequently complained that their undergarments were either missing or, in one particularly odd case, put on backwards. (If their blue jeans [or other outer garments] are still on but their underwear is missing or on backwards, something very odd happened!) Two women said they felt as if they'd just had intercourse, yet both denied any recent sexual activity. At the time I didn't know what to make of their remarks since I implicitly trusted the paramedics and it never occurred to me that they could do something so abominable. Whether or not anything did happen is debatable, but the next time I hear such a complaint I won't gloss over it.

In Love & Lust in the ER, I told the story about how I think (but couldn't feasibly prove) that an ER tech raped one of my patients: a gorgeous but comatose young woman.

In my blog, I discussed how my boss stopped working on a young child nearing death. I entered the room at the beginning of my shift to find him and others with their arms crossed standing so far from the patient that one might have thought the kid was radioactive. I knew they were just waiting for the patient to die so they could go lie to his mother how they did everything possible for him. I stepped in and saved the child's life. That was not a difficult “save.” For my boss to give up on that child was simply inexcusable, but he is not the only doc who prematurely pulls the plug on patients. The public would be outraged if they knew the prevalence of half-assed healthcare.

One of the first lessons that all emergency medical personnel (from EMTs and paramedics to ER nurses and doctors) learn is that treating patients rapidly often makes the difference between life and death. Therefore, it is easy to understand how a paramedic could kill a patient by sexually abusing her, because that wastes time. I wouldn't be surprised if a few twisted paramedics kill patients they rape so their crimes are less likely to be discovered; dead women obviously don't give birth, nor do they develop sexually transmitted diseases, nor do they complain about missing underwear, an unexpected discharge, or post-coital sensation.

Murder is also the missing link in understanding why EMTs or paramedics nutty enough to rape patients would risk doing that, knowing the patient might regain consciousness during the assault. If a patient woke up, murder could keep her from talking. Dead women tell no tales.

Can medical examiners detect these depredations?

I spent a month during medical school in the Wayne County Medical Examiner's Office, whose stated mission is to “provide forensic death investigations, autopsy, and toxicological services to the general public and medico-legal community so they can have documented, timely, and accurate cause and manner of death.”

Perhaps, if you're a big shot. Most stiffs on their cold slabs—at least the ones I saw—got only guesses, as in:

Obese male over the age of 40 = MI or “heart attack”

This quick guessing came as quite a shock to me. I'd grown up watching Quincy, M.E., a television series about a very principled county medical examiner (ME) who dug deep to determine the cause of death. That quest led Quincy to peer into things I never imagined anyone would look at, such as going past the anus and into the rectum to search for needle marks in a suspicious death case. Quincy might (a million years after once in a blue moon) examine semen inside the vagina of a woman who died in a car accident and DNA-test it to verify the paramedic who treated her didn't treat himself to a little fun, but in the real world, medical examiners don't have the time or resources ($) to consider every possible contributing factor to death. Consequently, some healthcare personnel can and do get away with murder.

As a doctor, I filled out death certificates listing the cause of death, as if I always knew exactly what it was. Bereft of the requisite crystal ball, I could sometimes only formulate educated guesses on patients whose medical history was unknown to me—patients I'd never spoken to and had perhaps two minutes of contact with after they died—except the patient wasn't officially dead until I, as an MD, did a few quick tests to verify the person was indeed a goner.

Later, as an emergency physician, I'd sometimes speak with medical examiners about dead patients transported to the ER. In every case I recall, my guess about what killed them was accepted by the ME: a dream come true for killers who don't want to get caught. Are you reading this, Casey Anthony?

Caylee Anthony had an assiduous ME, Dr. Jan Garavaglia (a.k.a., “Dr. G”), yet she was still blasted by Dr. Werner Spitz, head of the Wayne County Medical Examiner's Office during my stint there. Dr. Spitz is a living legend as a forensic pathologist and I have enormous respect for him, but I lost a bit of it that day when he criticized Dr. G, saying her work was “shoddy” because she didn't open Caylee's skull.

When I heard that, I wondered if Dr. Spitz knew what his pathologists were doing: treating many dead people—especially young black males—as if they had cooties or something. I stood shoulder-to-shoulder with those forensic pathologists as they guessed at the cause of death, often without autopsies or even touching the bodies. Techs would bring in another stiff, and we'd stand around in our spiffy white coats and guess what killed 'em. The only time I recall seeing an ME touch a young black male was when a pathologist speared a scrotum with a huge needle and ignited the escaping methane gas with a Bic^® lighter to form an instant blowtorch to entertain the impressionable young medical students under his tutelage.

What concerns me is that 99.999% of the time paramedics rape or kill patients, they get away with it. It's under the radar: it isn't detected and almost never reported. Ed is clearly an exception: principled, brave, and willing to devote his time and get involved in solving this problem instead of looking the other way. I genuinely respect Ed for that. If I get rich, I'll give him an award and a pile of cash because he deserves it. We often give adulation to people who don't deserve it, such as hot celebrities or athletes skilled at hitting or catching a ball. Wow. Really helps make the world a better place, doesn't it?

A rapid cure for racism

I've previously written about a simple method I developed to eliminate racism, which I discussed in a Facebook note. Here is a synopsis of it:

Decades ago, my brother and I ridiculed one of our grandfathers who was brimming with racial intolerance. We made fun of him behind his back because he likely would have beaten us to a pulp had he seen the way we pilloried him for being a racist.

Perhaps the primary defect in racists is a lack of empathy. If you can put yourself in the shoes of someone else (that is, see things from his or her point of view), you can easily understand how reprehensible racism is. Even my grandfather and other staunch racists would abhor racism if they were victimized by it after being born into a different race.

If everyone followed my simple remedy for rapidly overcoming racism, I think that racism would be confined to sociopaths, whose lack of a conscience gives them a “couldn't care less” attitude about how they impact others. As I pointed out in a discussion of how I detest racism and those who irresponsibly make accusations of it, racism is a genetic relic present in all humans but expressed only in those who are too intellectually lazy to appreciate that it is counterproductive.