Can You Sit Up Nice and Tall For Me?

I’m assessing a gentleman and he’s high as a kite on fentanyl.  This is common, plenty of people are arrested for being under the influence of a controlled substance. “Under the influence,” is a funny term to me. You’re being influenced by this and it's not OK, like it has a spell on you or you’re being manipulated.  I think it’s fitting.

Anyway, he keeps leaning over and closing his eyes and I’m afraid he’s going to fall off the bench. Even if he were to, if he can answer all our questions he’ll go into a normal cell instead of into the sobering cell.  I didn’t understand that when I first started; sobering cells are only for people who are so intoxicated they can’t answer questions. 

When I have a patient like this I ask them to scoot as far as they can to the corner of the bench so they can lean against the walls in the corner instead of toward me and potentially onto the floor while they’re arms stay attached to the back of the bench with handcuffs.  But, this guy keeps leaning to the wrong side.

I say, “Stay with me man, you’re gonna fall.  Sit up nice and tall for me or lean the other way so we can get through these questions.”

He nods his head and opens his eyes halfway with what looks like is requiring an extreme amount of effort before letting them close and leaning to the wrong side again.

The deputy is watching him shaking his head. I take a deep breath and skim his previous screening from his last arrest six months ago to see if the nurse found any areas of concern I need to make sure to ask about. I see nothing besides daily fentanyl use. This guy is in his early 20’s and reminds me of guys I went to high school with.

I’ve never had a patient who doesn’t just lean into the corner and doze off between questions after I instruct them to move to the other side and suddenly it occurs to me, maybe he can’t.  Maybe he’s hurt. 

“Is your back ok?” I ask him. It takes more prompting before he finally says, “Uh, uh-uh.”

“I’m going to pull your shirt up, OK?” I say.  He’s leaning forward anyway and doesn’t seem to notice or mind so I put gloves on and pull his shirt up to his neck.

His spine is curved in a U-shape, right to left, from a few inches below his neck to around where his rib cage ends.  It looks similar to scoliosis. High or not, he’s not capable of sitting up without leaning because of the shape of his back. 

“Did something happen?” I ask.

“I got hit by a car,” he mumbles.

“Did you go to the hospital?” I ask, and my stomach turns as I consider that he may not have.

He tells me he did, that it was a hit-and-run and someone saw and called 911.

“And they discharged you?” I ask, “ They didn’t tell you you need surgery?”

“They did, but I don’t have insurance,” he says, eyes still closed.

“They let you leave the hospital though?” I ask, trying to get the story straight. Usually, they would give a person a surgery like this even without insurance if they needed it. 

“They said it won’t kill me, it’s just dislocated," he says.

I imagine the pain this guy must be in sober. I feel my blood pressure go up as I start to digest how our medical system has set up this already struggling man up for failure. 

When I picture communities that allow members to live with severe orthopedic deformities, I picture developing countries. Places where the resources simply don’t exist to connect people with the treatment they would need to restore basic physical function to their bodies.  I don’t picture it here, in my community.  I feel ashamed, and my eyes sting looking at this 22-year-old, who is such a Goddamn mess, and needs so much help.

In nursing school, we’re taught to assess for readiness-to-learn before trying to provide any teaching to patients.  This guy is in no state to receive teaching, but I can’t help myself.

“We don’t have resources to help you with this while you’re in here,” I say, “But when you get out of here, go to a library, you can use the internet for free there, and have someone help you enroll in Covered California.  Just Google, ‘Covered California’ and it will pop right up.” I keep going even though he’s half asleep, “And there’s a methadone clinic on the avenue.  They can help you get off of fentanyl and manage a little bit of the pain.”

He gives me a little moan in acknowledgment that I’m saying words at him.

I set up an appointment for him to see the doctor and mental health the next day, but he will probably be released from custody by then. Not that they would be able to do much of anything anyway, just like I couldn’t do much of anything, beyond watch this young man nod off.

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Review

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This story is heart-wrenching, deeply empathetic, and quietly devastating, offering a stark reflection on the intersection of poverty, addiction, and systemic neglect within healthcare and the criminal justice system. Through compassionate observations, the narrative critiques the failures of societal safety nets that leave vulnerable individuals—especially those struggling with addiction and poverty—without the support they need.

At its core, the story speaks to the quiet tragedy of being abandoned by the systems meant to protect and heal. The role as a caregiver becomes emotionally complicated, as they’re forced to confront how powerless they are to offer real solutions within a broken framework.

The reflection that this kind of suffering seems more fitting for a “developing country” challenges the myth that wealthier nations inherently care for their citizens more effectively. The feeling of futile hope is reflected in the offering of information and resources, knowing full well he's unlikely to remember or act on it in his state. This highlights the moral and emotional burden of caregiving where even the most compassionate efforts often feel meaningless.

The story humanizes individuals often dismissed by society, showing the complex realities of addiction, pain, and poverty beyond surface-level judgments.