In the 200 years since José Gaspar held women for ransom on Captiva Island in Florida, things have changed a bit. Pirates don’t stalk the waters any more, but osprey, dolphin, and manatee still make an easy living among the mangroves and bright-green waters. Condos and houses line the beaches and bays, and 100-foot yachts find safe harbor.

My family and I traveled there for spring break this year. We enjoyed the water, the warm temperatures, and the abundant wildlife. I also enjoyed having time to do nothing but sit on the porch and read a novel. I read “The Lincoln Lawyer.”

The main character in this story is a criminal defense attorney, Mickey Haller. I grew to like Mickey as the story moved along – as much as you can like a bottom feeder. He says that the most dangerous client a defense attorney can have is an innocent man. This got me thinking about the parallels between criminal defense and emergency medicine.

Both professions deal with people and matters that are actively avoided by others in their general profession. Often these people are down on their luck, and the doctor or the lawyer is their last stop – death or jail. I can empathize with defense attorneys because, like emergency physicians, their acts and their omissions have life-changing consequences.

Now, a large portion of the folks that come through our criminal justice system are, in fact, guilty. I don’t believe that defense attorneys lose much sleep when a three-time felon gets a

20-year sentence for an armed robbery witnessed by five people. What I imagine keeps them up at night is the person who they believe to be truly innocent but who is convicted of a crime. For them, this is the dangerous client.

For us, I think the most dangerous patient is the one who appears well but who turns out to have something bad. This is your average malpractice case. Maybe the person presented too early, or a significant historical point was missed, or too much emphasis was placed on a particular test. Then the patient returns with something like meningitis, sepsis, or appendicitis.

And then you get to have that fateful conversation that starts with the words, “Remember that patient you sent home?”

We see these well-appearing patients all day long. They look well because the great majority of them are, in fact, well. We see benign viral illnesses and minor injuries galore. We give a strong dose of reassurance and a smile and send them on their way.