The patient seemed like a nice enough kid. Really, he did. And I'm sure that before his socializing began the previous evening, he never dreamed that he would end up in the emergency room at 2:30 a.m. But, he did. He started the trend, the first of four college students that would come in during that overnight shift, drunk with a decreased level of responsiveness. And nothing else. No trauma. No assault. Just guilty of drinking too much alcohol.
One of the give-ins, I guess, when you work in an ER in a city that brags of having four colleges.
He was brought to our ER by his concerned, sober roommates. They were having a difficult time trying to wake him, despite their best efforts. And when they finally did wake him, he vomited all over their living room furniture and carpet. "We think he ate taco pizza," the roommate confessed to the triage nurse, painting us all an unfortunate picture.
The nurse and I walked into Room 29 after our triage team escorted this patient back in a wheelchair. His head was slumped to the side and he was sleeping. One roommate was with him, and he appeared quite frustrated with the patient.
Several of us were able to lift this patient from the wheelchair and into a treatment cot. Together, we removed his clothes, looking for any signs of trauma, before dressing him in a hospital gown. No signs of trauma. And no unusual findings.
Well, except for the big chunks of taco meat clinging to this patient's brush-cut. And his clothes. And his roommate's clothing, as well. Obviously, vomitus, by both its smell and look.
"What's going on?" I asked the roommate, on behalf of the nurse and myself. "Was he assaulted?"
"Oh, no, nothing like that," the roommate assured us. "He went to a party at another college and the people he went with dropped him off at our apartment like this. We couldn't wake him up and got scared so, after he puked all over, we drove him straight here." The roommate paused, looking like he wanted to add something else.
"Is that all?" I asked him.
"Well," the roommate spoke, quietly, as he picked some vomitus from his shirt, "I know it doesn't really matter, but he puked all over my car while we were driving here."
He was right. It didn't really matter to us. But still, that sucks.
The patient, breathing comfortably and in no apparent distress, was back to snoring. His vital signs remained stable. I think he simply wanted to sleep and be left alone. But no, I wasn't having any of that, yet.
"Hey," I yelled loudly in his ear while I rubbed his sternum, "wake up, buddy. You need to talk to us." Nothing. I grabbed a couple ammonia capsules, popping one under his nose. That did the trick. Those capsules always seem to come through for me.
He tried to shove my hand and the noxious capsule from under his nose. Purposeful movements--we like that in a patient. "What the..," he muttered, stirring his head from side to side. And suddenly, without warning, he started to dry-heave. Followed by more puking. Lettuce and salsa and orange cheese and hamburger meat. All over his gown. Never mind the looks, the smell was overwhelming.
"Wake up, buddy," I continued, side-stepping his line-of-fire, "you're in the emergency room." That news seemed to unsettle him a little. He looked up, glassy-eyed.
"What? What?" he muttered, wiping off his chin with his bare hand. "I said," I repeated myself, back to yelling in his ear again, "you're in the ER." He stared blindly ahead, before smiling a shit-eating grin. "Yeah, right." He turned his head to the side, closed his eyes, and started snoring almost immediately.
All the while, the roommate stood in the corner, shaking his head. "This isn't like him."
"Does he have a drinking problem?" I asked. "No," the roommate replied, "he's a good guy. He gets great grades. I'm not sure what happened tonight."
Well, the patient got an IV-catheter placed by the nurse. We infused a banana-bag, a liter of fluid that is mixed with multi-vitamins and thiamine. We also gave this patient two anti-nausea medications which seemed to control his barfing. We got control of things pretty quickly.
"What should I do now?" the roommate asked me, after things settled. I recommended to just grab a seat in the corner of the room, watch TV, grab a soda. "We'll have to observe your buddy and repeat his exam a couple times until he sobers up and is able to walk on his own in our hallways," I explained.
"Oh," the roommate said, "I can't do that. I can't leave my buddies to clean up all that puke in our apartment by themselves."
"Are you serious?" I asked, thinking back to my own college days. The basic rule then was that if you puked, you cleaned. It was that simple. I have some great college buds, but I would never expect them to clean up after me that way. Not that I ever got to that point. Really.
"If you could smell our apartment," the roommate said, "there's no way you would leave it until morning." Come to think of it, I guess our college house did stink occasionally.
The roommate left. The patient slept. Every hour, the nurse or I woke this patient to check on him, repeat his vital signs, and perform a stable exam. After three hours, he was much better. Awake and talking, able to walk the hallway and go to the bathroom on his own.
"What the heck happened?" the nurse asked him. The patient explained that there had been a very tasty punch at the party, one that packed a lot more than what he had expected.
"Did you eat taco pizza, too?" the nurse asked him, smiling.
"Yeah," he answered, "how did you know?"
The nurse smiled. "Oh," she said sweetly, looking at his soiled gown, "we have our ways."
The roommate had called twice while the patient had been sleeping. What a good guy, huh? By his second call, he had finished cleaning the apartment and his car, and was wondering how everything was going. "Just fine," the nurse told him, "in fact, you can come down and get him. He's walking around our hallways just fine."
We discharged this patient a half-hour later. Very stable. His alcohol level hadn't returned as high as we expected and, upon asking him, the patient admitted that alcohol wasn't the only thing he had abused at the party. We already knew that, though, from the toxicology screens. Like the nurse said, we have our ways.
The roommate proved himself to be a very cool friend, if you ask me. When he came back for the patient, he was genuinely concerned for his buddy and harbored no resentment to the fact that he had been puked upon, that his car had been soiled, and that his apartment had been messed up because of his roommate's choices. Mature beyond his college years, for sure. Or just knew the value of friendship, maybe. I did hear, though, that he had a taxi deliver them home, just in case the patient decided to spray more taco pizza all over the dashboard.
The good roommate turned out to be a smart roommate, too.
Maybe the patient will learn a thing or two from him. Just maybe...
As always, big thanks for reading. Next post will be Wednesday, March 31. See you then...