The Mule

The Mule

It was another day as an Infectious Disease physician. I had received a consult call from the Intensive Care Unit (ICU) at our local hospital. It was for an infection of the abdomen.

The patient had an interesting history. He was a Hispanic man in his forties. He had developed a sudden onset of abdominal pain and then collapsed unconscious. He was rushed to the Emergency Room.


In the hospital, he had a CT scan of his abdomen. The radiologist spotted something unusual. His report said that the abdomen was full of small round objects, which the radiologist thought may contain an illicit substance. One of these objects possibly had ruptured causing the abdominal pain and collapse.


He was rushed to emergency surgery and multiple bags containing a white powdery substance (likely illicit drugs) were removed. One of those bags had ruptured leading to an acute overdose and infection in the abdomen. He had to have a colostomy after those bags were removed. He was smuggling drugs, and was what is known in popular slang as a “Mule”. The Police were also called and they called in the State Bureau of Investigation (SBI).


It transpired that he had just returned from a trip to Colombia. He did not speak English, so a Spanish interpreter had to be used. When I saw him, he was not very co-operative. He had a colostomy in place and was awake and alert. I gave advice on antibiotics and I left.

Two days later the United States government shut down. It was one of those unusual occasions that the congress did not agree with the president and did not approve the funding to keep the government running. At that time, our hospitalist team that was taking care of this patient had asked me to give final antibiotic recommendations as they were planning to discharge the patient.

It was at this point that I got a call from our patient’s nurse. It was a request to speak to me from an SBI agent that was assigned to this patient. I went over to the hospital. The SBI agent was a smartly dressed young man. He was exceedingly polite.

He asked me if the discharge could be postponed. He explained to me that because the patient had a colostomy, they could not take him to a regular prison at discharge. He would have to go to a hospital prison. The nearest one was several hours away, and because the government had shut down, they were not accepting any new inmates. If the patient was discharged into his custody, he had nowhere to take the patient.


I told him that I would speak to the hospitalist team. The hospitalist doctor met me and asked me very directly if there was any indication for continued hospitalization from a medical perspective. I told him that I could think of none. He told me that he had other sick patients waiting for beds and he had no choice but to discharge the patient.


I went back to the SBI agent and told him the news. He was quiet for a while, then said that he would have to release the patient. This information distressed me and in an attempt to reassure me he said - “don’t worry, we are going to keep a very close eye on him”.

Later, I was speaking to one of his nurses, and she told me that she had heard (I am not sure from whom), that the drug lords would be punishing our patient for losing the drugs. Those drugs were several bags of heroin, with a street value of over half a million dollars. What kind of punishment, I asked? Oh they will probably kill him or his family members in Colombia if they can't find him, she replied.

The patient was discharged with his colostomy in place. He never showed up for his follow up appointments. I often wonder as to how he did.

                                                             CT Scan of a drug mule.