Monday, March 29, 2010

The Good Roommate

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...


coulrophobic agnostic said...

There are many reasons I don't drink. Not wanting to end up in that poor dope's position is pretty high on that list.

Gia's Spot said...

Remind me no eating or drinking while I read your posts! After I stopped my stomach from rolling over, I laughed so hard I snorted my coffee!

Chrysalis Angel said...

You need a warning "graphic descriptions" on your blog. Fireguy wanted to know why I kept saying, "Oh, doc!" I had to explain it wasn't a good thing. ;)

Winking Doll said...

Yup, great roomie alright! Amazing guy with grace. Hope that guy learnt his lesson and didn't get into any trouble with his college over the toxicology report.

So your cleaners did magic with the industrial strength detergent again after the patient was gone? Agreed about being careful to be outside the "line-of-fire", ha ha.

Heather said...

Taco Pizza! :)

Also, I love your tags...tags for both barf and puke! Perfection!

Tanya said...

Perhaps if the roommate recorded the drunken friends behavior-the barfing and such, and shown it to him when he was sober, he would think twice about partaking in a booze laden punch the next time it's offered at a party...

Anonymous said...

"You need a warning "graphic descriptions" on your blog."

Chrysalis, I think it's implied in the "A peek behind the curtain..." description of the blog.

Katie said...

I had one suitemate come back drunk once but I was already asleep so my roommate handled it. My dad, on the other hand, has plenty of drunk stories from his college days. His best was the time he made it to the ER twice in one night (while drunk but neither really due to the intoxication). Although, let's just say the doctor was NOT pleased to see him the second time...
<>< Katie said...

In nursing school I NEVER drank like that ;)

He sure did have a good roommate.

Enjoyed the story.


Chrysalis Angel said...

Geesh, can't even joke with you StorytellER doc.

Chrysalis Angel said...

I should have just said, "Ya don't say."

Cal said...

I cannot imagine being puked on by a friend. It is hard enough to have your children vomit on you, and you still feel disgust even though they are your own little beautiful offspring. Although my daughter took me by surprise by vomiting all over herself and me in a recent zoo trip. She is getting a little too old for random puking, something she used to be exceptionally good at when younger.

Marie said...

Ah, binge drinking, a Varsity sport at our local University.

Sounds like the roommate may grow up to be another you. :)

Aaron.Johnston said...

I really struggle with when to intubate these kids as I think especially in the copiously vomiting the airway is at risk even when they can be woken up by various unpleasantries. With the chronic drinkers I have the same struggle with scanning their head, even when they are relatively awake as not infrequently they seem to have subdurals and other findings more than just alcohol on board.
As an emerg doc it is amazing how alcohol fueled patients both pay off our mortgages and endlessly complicate our shifts all at the same time...

Jabulani said...

;) sq2m

Anonymous said...

Ohhhh that brings back memories of truly horrible hangovers -- and thankfully, from long, long ago.

As an inexperienced 19-year-old I once tried all sorts of different hard liquors, all in the same session. My previous drinking experience was Spanada ... Oh, my. The last thing I can remember drinking was Chivas Regal, straight up in a tall glass.

The result was deep, unforgettable embarrassment -- I told off the director of the local ballet company -- and vomited all over my hosts' bedspread. Then I made my boyfriend drive me home and wake my mother up.

And then there was the 3-day-hangover from hell.

I never did it again. I learned a hard lesson. And I hope that young man did, too, though I'd not wish that hangover on anyone.

Great post, doc.

Anonymous said...

Why would you advise anyone to grab a soda, ever?

Anonymous said...

Philosophical question: why do the comatose drunk guys always eat something like taco pizza? Or macaroni with meat sauce? It's like a Law of the Universe: you get a puker, and they're gonna puke up something especially, exceptionally gross.

Just Curious said...

"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"

So, what was the other substance(s) he abused?

Per Winking Doll:
"Hope that guy learnt his lesson and didn't get into any trouble with his college over the toxicology report"

Do you report tox reports to the colleges for these types of student encounters? Wouldn't that be a HIPPA violation?

Maha said...

That is one great friend. It makes me feel bad at yelling at one of my good friends when she decided to come home drunk as a skunk and puking up chunks.

LOL to torontoemerg's comment!

Cathy said...

hmmmm, my boys are both middle age now and I am wondering if they ever did such a thing while in college. If so, I never heard of it. OMG I just thought of my grandson who is in college. He better not be doing something like this? you think I would ever hear of it if he did?

You're right, this guy had a great roommate and friend. I only clean up puke from kids and grandkids. no one else.

BTW, I just wrote a blog post and thought of you while writing it. I wondered how often you see this in the ER. It is about septic arthritis.

SeaSpray said...

They sound like nice kids and he has a good friend there.

I've never been much of drinker, but in my teenage yrs I did have a couple of times where I could not account for time because I either passed out or was so drunk that I just didn't remember.Both times my drinks were spiked. My guardian angel was busy and fortunately I was alright.

Anonymous said...

I have my own memories of drunk college age kids and corn on the cob.

Anonymous said...

Wow, he certainly is lucky to have such a good roommate! Just discovered your blog. You have quite the gift for writing. I can't stop reading!

Jabulani said...

Paedsnurse: *chuckle* And you have quite a gift for understatement! Does "You have quite the gift for writing." translate somewhere as "You are absolutely fabulous"??!! :D