“Another drug-seeking biker,” I announced to the nurses as the leather-clad man limped into my ER at 2 AM. Sixty-something, gray ponytail, worn Harley vest covered in patches, grease under his fingernails. I’d seen his type a hundred times – tough guys who crashed their bikes doing something stupid, then wanted painkillers for their “10 out of 10” pain.
“Says his chest hurts,” Nurse Williams informed me, handing over the intake form. “Motorcycle accident three days ago. Finally decided to come in.”
I rolled my eyes. Three days later? Classic drug-seeking behavior. Wait until the weekend when they think younger doctors are on duty, more likely to hand out opioids.
“Put him in bay 4,” I said dismissively. “I’ll get to him after the real emergencies.”
The man, William “Tank” Morrison according to his intake form, sat hunched on the exam bed when I finally entered forty minutes later. His face was pale, sweat beading on his forehead despite the cool temperature.
“So, Mr. Morrison,” I said, not bothering to hide my skepticism. “Chest pain from a motorcycle accident three days ago? Why didn’t you come in immediately?”
He looked up at me with gray eyes that held more pain than I was willing to acknowledge. “Couldn’t afford to miss work. Thought it was just bruised ribs. But it’s getting worse.”
“Uh-huh.” I made a show of checking his chart. “And what kind of painkillers are you hoping I’ll prescribe?”
His jaw tightened. “I don’t want pills. I want to know why I can’t breathe right.”
But I’d already made up my mind. The leather vest, the patches marking him as a member of some motorcycle club, the delayed presentation – it all screamed drug seeker to me. In my eight years as an ER physician, I’d become an expert at spotting them. Or so I thought.
What I didn’t see – what I refused to see – was a man genuinely struggling to breathe. A man who’d spent three days trying to tough it out because missing work meant his disabled wife wouldn’t have money for her medications. A man whose motorcycle was his only transportation to the construction job that barely paid their bills.
I performed a cursory exam, deliberately rough as I pressed on his ribs. He winced but didn’t cry out, another mark against him in my prejudiced assessment. Drug seekers always overreacted to pain.
“Looks like bruised ribs to me,” I announced. “Take some ibuprofen. Rest. You’ll be fine.”
“Doc, something’s really wrong,” he insisted, struggling to take a deep breath. “I’ve had broken ribs before. This is different.”
“Mr. Morrison,” I said condescendingly, “I’ve been doing this for eight years. I think I know the difference between drug-seeking and actual injury. You rode here on your motorcycle, walked in under your own power. You’re fine.”
I saw the flash of anger in his eyes, quickly suppressed. “You’re judging me because of how I look. Because I ride. Because I’m blue collar.”
“I’m judging based on medical presentation,” I lied smoothly. “Bruised ribs. Ibuprofen. Rest. Nurse Williams will discharge you.”
I turned to leave, but his hand caught my coat. His grip was weak, which should have been another warning sign.
“Please,” he said quietly. “Just run some tests. I’ll pay cash if insurance is the issue. Something’s wrong. I can feel it.”
I pulled away from his grasp. “Mr. Morrison, emergency rooms are for emergencies. You’ve wasted enough of our time.”
Those were the last words I ever spoke to William “Tank” Morrison.
Two hours later, I was treating a teenager for a skateboarding injury when the trauma alarm went off. Paramedics rushed in with a patient in full cardiac arrest.
“Found collapsed in the parking lot,” the lead paramedic called out. “Witness says he was trying to get on his motorcycle when he went down. No pulse for at least five minutes before we got ROSC.”
It wasn’t until they transferred him to the trauma bed that I saw his face. Tank Morrison. The “drug seeker” I’d dismissed. The man whose pleas I’d ignored.
“Get me ultrasound, stat!” I barked, my hands already moving in the familiar rhythm of emergency medicine. But even as I worked, I knew. The ultrasound confirmed it – massive internal bleeding. Likely a lacerated spleen that had been slowly leaking for days.
A simple CT scan would have caught it. Basic blood work would have shown his dropping hemoglobin. Any test beyond my prejudiced assumptions would have saved his life.
We worked on him for forty minutes. I cracked his chest, manually massaged his heart, pushed unit after unit of blood into his dying body. But it was too late. The man I’d dismissed as a drug-seeking biker died on my trauma table, his leather vest cut away and discarded on the floor like the assumptions I’d made about him.
Dr. Harrison, the trauma surgeon, reviewed the case with barely concealed disgust. “Three days of internal bleeding. He must have been compensating until his body just couldn’t anymore. Why wasn’t this caught when he came in?”
