I half-smiled at him in solidarity.

The curtain to the room was ajar, revealing a wiry white man lying uncomfortably on the stretcher. His full head of dark hair made him look much younger than he was: His chart said fifty-one. There was no sheet on the bed and no blanket. The man was tall, and naked except for the thin white hospital gown embellished with navy blue geometric shapes. He seemed not to notice or care that as he lay on the stretcher, writhing from side to side, his gown splayed open revealing his bare backside. Mike stood on one side of the room, and I stood next to him and leaned against the supply cart; I needed this bracing as well as the distance. Mike and I stared at the patient as he flopped around like a fish on a hook.

I sighed. Making sure to convey that I was a distant authority figure, I said, “Mr. Samuels, I’m Dr. Harper. What brings you in today?” showing a little less enthusiasm than I might have displayed when asking if he had a paper clip I could borrow.

“The pain, the pain,” he moaned. “It happened again!”

“And what might that be, sir?”

“The hernia,” he whispered in anguish.

I recalled the triage note in the record. “Hernia? You didn’t come in for a hemorrhoid?”

“Well, I don’t know what it is. There’s something swollen in my groin. It just started today, and I can’t take it.”

He was curled in the fetal position, his knees bent to his chest. As he spoke, he buried his face in his hands.

“Okay,” I said. “Let’s take a look at this hernia. Lie on your back.”

He tried to relax his legs and attempted to pry them apart. Mike and I regarded him coolly. We didn’t move as we waited for him to adjust and calm himself. When he was more still, I walked toward him. His fists were clenched around waves of pain, and his toes twitched with the throbbing. I began to raise his gown and told him to straighten his legs. His arms started to flex up and move toward me. I quickly dropped the edge of his gown and leaned back.

“Put your arms down,” I commanded. “Keep your arms down by your sides. Stay still. Straighten your legs.”

His thighs were tense as I tapped the side of his right leg. “Okay, open up.”

His legs stayed clamped.

I didn’t attempt to hide my annoyance. “Sir, would you like to be examined or not?” I continued, already knowing the answer. “The only way I can do that is if you show me the area that is bothering you.”

I could sense Mike rolling his eyes, but I was too close to the patient to do anything more than grimace.

The patient lifted his gown and spread his legs enough to reveal a large, firm swelling extending from his right groin to his left scrotum, which was stretched to the size of an eggplant. The skin was so taut that it glistened. Still cautious, but focused, I reached out to palpate his scrotum; I couldn’t identify any anatomic landmark. I tried to follow what I imagined might be a thick cordlike swelling down the inguinal canal, but all I could really discern was a balloon of exquisitely tender human flesh. What should I push back into place and where? What was intestine and what was testicle? Was there a perforation or dead bowel? An infection?

I turned to Mike, who had already started to grab supplies. Our faces softened. This was a surgical emergency. Yes, the man was likely an awful human being, but his pain was real.

“Sir, we will need to put in an IV and check some blood work. We will also need to perform a CAT scan to see what exactly is going on with your hernia. You are right that there is a serious problem here. I have to find out if it’s infected and how it is stuck. I will also call a surgeon because you will certainly need an operation to fix this. While all this is going on, we’ll make sure you’re comfortable. We’ll give you pain medication right away.”

He looked up at me and nodded. “Thank you, ma’am. Thank you, Doctor.”

His eyes were a tremulous, pale gray. I didn’t remember the name of the female physician he had assaulted, only that it had sounded Indian. Was she dark-skinned like me? I wondered if Mr. Samuels saw her when he looked at me.

I tore off my gloves and started to enter the orders into the computer. I asked the clerk to page Surgery so I could give them a heads-up. As I waited for the call back, I stared into my coffee, remembering how slowly I had stirred in the half-and-half as Mr. Samuels’s legs had twisted in pain, how painstakingly I had added the sugar, almost grain by grain, as his intestines pushed against his testicles and his scrotum ballooned. To the patient, those six minutes of procrastination on my part must have felt like an eternity. While he certainly deserved to pay for his past violent behavior, it wasn’t for me to decide when or how. In my mind, this wasn’t the time.

The surgeon, Dr. Castellano, was just leaving a patient’s room on the floor. She said she would swing by to take a look, as the shift might change by the time Mr. Samuels’s test results came back. Five minutes later, she was in and out of the patient’s room.

“Yeah, Dr. Harper, pretty impressive. Please give a call once the labs and CT are done. If I haven’t heard from you before my shift is over, I’ll let Dr. Ritter—she’s the day doc—know to expect your call.”

Fate had delivered this man into the care of three female doctors that evening, each of whom had calmly gazed at his excruciatingly swollen genitals. Women were the ones to inspect him, to touch him, and, ultimately, to slice open his flesh to save his life. Was any of this irony lost on him? From that experience, did he learn how it felt to be vulnerable? I wondered if it might expand his definition of gender, what it meant to be female or male. I wanted to believe that he would never grab a woman again, and I took another moment to stand there trying to convince myself that this could be true. Probably not, but maybe.

I’d update the surgeons with the details of his CT, which would confirm his strangulated hernia, so they could better plan his case for the OR to remove the dead bowel and close up the deficit in his fascia that had allowed the breach so that now his body was busted like his character.

If Mr. Samuels were ever to evolve, it would be due to experiences like this one, where people who didn’t have to care for him chose to do so anyway, regardless of his past actions. And, yes, people who commit the type of violence that Mr. Samuels did should be held accountable by the appropriate people, in the appropriate ways. Still, his life lessons were for him alone to choose to learn from or disregard as he decided.

If I were to evolve, I would have to regard his brokenness genuinely and my own tenderly, and then make the next best decision. My choosing to care about his welfare, my decision to hold in my heart the best intention for another human being no matter who that person is or what they have done, that day in the ER, despite my disgust at his previous behavior and the possible moral decay that had led him to it, was a social action.

Two more patients flashed on the board, a sore throat and eye discharge, but they would wait just a little while longer while I finished with Mr. Samuels.

FIVE

    Dominic: Body of Evidence

“Just make him do it!” A voice rang out, followed by the sound of metal grating on metal.

I leaned past my computer screen toward the triage area to see a young man in handcuffs chafing at the bony prominences of his reddened wrists. Fading charcoal gray lines of graphic tattoos on his left forearm were almost indecipherable against his dark skin.

“I didn’t do nothing!” the prisoner shouted.

“That’s enough out of you!” a police officer commanded.

“Listen, we have to take your vital signs. Put on this gown.” The voice was from Carl, the charge nurse assigned to head the nursing team for the shift.

“I ain’t doin’ nuthin’. I don’t want to be here. I don’t want to put on that gown. I’m not doin’ nuthin’.” The young man looked away—away from the charge nurse who tried to stare at him straight in the face, away from the officer who looked only at the nurse, away from the audience comprising the full ER occupants, who were intently watching the show.