The Friendly Head-butter

The ambulance call came in shortly after 2 a.m. "We're bringing you a 27 y.o. unresponsive male with a head injury and alcohol on board." Despite the patient's unresponsive state, the prehospital team's vitals for this patient were stable.

We prepared a trauma room for this patient, unsure if we would need to intubate the patient to protect his airway and get an appropriate work-up. Alcohol ingestion with unresponsiveness can mean something very serious and, until we had a chance to thoroughly examine this patient, we would provide him with every cautionary medical measure available. Of course, flipping the coin, alcohol ingestion with unresponsiveness can also simply mean "passing out." And as anyone who has worked in an ER setting can tell you, the majority of patients who come in with these similar symptoms are usually just of the "passing out" variety.

Soon enough, the prehospital crew wheeled this patient through our ambulance bay doors and rushed him to Room 18, where we were waiting to greet them. The patient was disheveled, laying on his back, his head turned over his right shoulder. The smell of vomitus was overwhelming, a mixture of bile, soured alcohol, and undigested food. On closer inspection, that was not a designer graphic t-shirt he was wearing but rather a run-of-the-mill Hanes t-shirt sprinkled with the remnants of his puking. Corn kernals included. His cargo shorts were hanging halfway down his pelvis.

As we moved this patient from the transport cot to our hospital bed, the paramedics filled me in with a little history. "Einstein, here," the one paramedic started, "was out tonight with a bunch of buddies drinking and having a grand ol' time." He paused for a minute, chuckling to himself, before continuing. "Somewhere around his tenth drink, his buddies said he started head-butting anyone who would let him."

"You mean people actually let this guy come up to them and head-butt a 'hello' to them?" I asked, incredulous at the thought.

"They probably didn't see it coming," the paramedic answered. "Supposedly, he's real quick with the gesture," he continued, "like a head-butting champ or something."

How's that title for making your parents proud? "Champion Head-butter, 2010." I don't think I would have a prouder moment than if one of my children came home with that award. Especially if it came with some cash. Throw in a tiara and a sash, too.

"Anyway," the paramedic finished as we began hooking the patient up to our monitors, "he head-butted one too many people. He walked up to another drunk buddy of his, slammed heads with him, and literally dropped. Before he hit the floor, though, somebody standing next to him was able to catch him and ease him down. Witnesses said he was out like a light."

I yelled in this patient's ear and was happy to see him stir. I rubbed his chest and pinched his toes to make sure he was appropriately responsive, and he was, trying to swat away annoying me. I listened to this patient's heart and lungs. All clear. I reviewed his vitals. All stable. I looked closely at his pupils, happy to find them appropriately reactive. I was reassured that he was in no grave danger.

Now I had time to do a closer, more focused exam, starting with his head. Hardly surprising, this patient had a large, erythematous abrasion on his forehead, the skin tense from some localized swelling. I pushed on it to make sure his skull bones were stable underneath, expecting nothing less than a hard-head from this patient. He didn't disappoint. I looked in his ears and nose. No blood. I pushed on his facial bones and found no other abnormalities. The rest of his exam was also unremarkable.

In essence, this patient was a drunk with a big "goomba" on his forehead.

Prior to leaving his room and ordering his CT scans, the patient began stirring. His nurse, fresh out of nursing school, greeted him. "Hello, Mr. Sanders," she said, "I'm Chrissie and this here is Dr. Jim. We'll be taking care of you tonight." I said "hello" to him while I nodded my acknowledgement.

The patient must have liked what he saw in Nurse Chrissie, turning his attention back to her. In an artificially deep voice, slurred slightly, and with a lopsided grin, he said, "How you doin', Chrissie? You can call me Larry." He pulled his hands through his hair, trying to straighten-up a little. Unfortunate for him, though, there is a limit to how appealing you can make yourself when you are drunk, sitting in a hospital cot, covered in a gray, threadbare hospital gown. Oh, with a big "goomba" on your forehead.

"I'm good, Larry," Chrissie answered, enunciating 'Larry', "and how are you doing?" "I got a massive headache," he answered her. Then, turning to look at me, he said, "Hey dude, how about some medicine for this headache. Jesus H. Christ, already." I felt like head-butting him. In a nice, friendly way, of course.

A few minutes later, after this patient returned from the CT scanner and was waiting for his results, a call came back from the waiting room concierge. "Is it okay if Mr. Sanders has a few friends come back and wait with him?" "Are they sober or drunk?" the secretary rightfully asked before giving her permission. "They might have had a few drinks," the concierge said, "but they are really respectful and concerned."

I was walking down the hall, coming back from seeing another patient, when I saw Larry's friends coming from the opposite way. I wasn't aware of the concierge call, but none of that mattered. I knew who these two guys were the minute I saw them. I slowed my walking pace, wishing that the fluorescent hallway lights were just a little more brighter so I could better appreciate their appearances.

Both of the guys were wearing fashionable jeans with flip-flops that clucked with every step, graphic-Ts, and, barring the sprinkles of vomit that covered both of their fronts, looked quite hip. But these weren't the signs of their brotherhood, of best buddies out on a late Friday night having a great time, now bonding in our ER.

No, that sign would be the matching "goombas" they both wore on their foreheads. Bright pink, two inches in diameter, and glaringly obvious under their shaved heads, their warwounds looked almost identical to the injury of our patient, Larry. Their friend.

I stopped them as they walked by. "Hey guys," I said, having a little fun, "what happened to your heads?" The one remained silent, intently watching his pacing feet, while the other spoke. "You don't even want to know," he said, shaking his head in disappointment. "Well," I said, "if you guys want to be seen or get a bad headache, let us know, okay?"

Soon after, Larry's CT reports came back negative for any injury. Outside of a bad headache and a nice-sized contusion/abrasion, he was getting off quite nicely. I went to the room to explain his results to him, and caught my breath as I walked into Room 18. With these three buddies sitting close together with their matching injuries, how could I not think of The Three Muskateers?

Larry, thankful for not having any significant injuries, started crying (the gut-wrenching bawling brought on by a stiff drink) and throwing around his apologies to anyone who would accept one. A tech walking by his room even got one. "I'm so sorry, buddy," Larry said. "For what?" the tech asked. "I just am," he replied. The tech kindly went and got Larry a box of tissues.

Finally, a sober friend came to drive them home. A female. Long brown hair, very sophisticated-appearing, wearing a warm smile. Evidently, she also had a great sense of humor. She exhibited a hearty, genuine, gutteral laugh, I'm told, when she walked into Room 18 to gather her friends. And had a hard time stopping.

At least the patient was a gentleman. She wasn't sporting a matching forehead "goomba"...

As always, big thanks for reading. Trying to keep things light this week. See you Friday...