AN ADULT woman without health insurance presented to the emergency department of a private, not-for-profit, university hospital. A male acquaintance had assaulted her and had fractured her forearm. After the assault, she impulsively took an overdose of an anticonvulsant, phenytoin. A friend brought her to the emergency department. Because a history of intravenous drug abuse had scarred the patient's peripheral veins, peripheral intravenous access was not possible. An attempt to place a catheter in her subclavian vein led to a pneumothorax and a chest tube. Intravenous access was then obtained through a jugular vein. As the overdose was an emergency, the arm was splinted and she was admitted to the medicine service on which I was the attending physician.
Two days later, she was medically stabilized. The overdose was resolved, the chest tube was pulled. A psychiatrist concluded that the overdose was in response to the stress of the assault
Miles SH. What Are We Teaching About Indigent Patients?. JAMA. 1992;268(18):2561-2562. doi:10.1001/jama.1992.03490180093032