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...

Why Medicine?

One of the more frequently asked questions I face is "Why did you become a doctor?"

Trust me, that's a question I have asked myself on more than one occasion. In fact, I think the last time I asked myself that question, it was 4 a.m. and the obnoxious, drunk guy had just finished puking on my new running shoes. Why exactly did I become a doctor? It certainly wasn't so the kind people at Dick's Sporting Goods would know me on a first name basis.

I come from a large family, both immediate and extended. I am the fifth of seven kids, three of us boys. On my father's side, every male is or was involved in the forestry industry. This includes my father, three paternal uncles, my two brothers, and multiple cousins. Since I was a young boy, around age five, I have strong memories of waking up before the morning darkness dissipated, jumping with my father and brothers into one of the company work trucks, and heading out into the pristine Pennsylvania woods. It was expected that I, like my brothers and cousins, would someday pursue a college education in forestry and then continue in our family's international business.

I always knew, though, that I was made from a different cloth. My paternal grandmother, our family matriarch, encouraged me to pursue my dreams, even if those dreams did not include the forestry business. She knew I had a different calling and I loved her for her easy acceptance of this. As much as I enjoyed the beautiful woods, the fresh air, and hard work that came with my family's business, I needed something different.

So, until then, during summer vacations and on Saturdays during the school year, I could be found in the woods carrying a Stihl chainsaw or steering a John Deere skidder loaded with freshly cut logs down a narrow path to an accessible landing where logging trucks would pick them up. Smiling. And ducking behind the occasional tree, convinced that I had seen Bigfoot yet again.

When, then, did I discover my illuminated path toward medicine?

I'd like to say I had one defining moment where it just popped with me, that I would be a doctor, but that wasn't the case. During my tenth grade year in high school, however, multiple happenings occurred in my life that exposed me to medicine and reinforced my belief that I would be a doctor someday. That year, I lost both of my grandfathers to medical illnesses, and I was a firsthand witness to their struggles. I also witnessed my father's leg, crushed in a freak logging accident, be saved by incredible surgeons who refused to look at amputation as an option.

Personally, before these deaths and my father's injury, I also sustained an injury that reinforced my pursuit of medicine.

Chainsaw lacerations were very common in the forestry business, at least before protective chaps gained widespread use. This injury did not spare me and, as a result, I had my first and only ER experience as a patient when I needed a laceration repair.

Right after lunch on that death-defying summer day, I was trimming some obstructing tree branches to reach a felled log. Suddenly, my saw kicked back and cut into my thigh just above my left knee. At first, I thought the pain was just another tree limb poking at my leg. When I looked down and saw my cut denim pant leg outlined with a circle of red blood, though, I knew that I had just been initiated into the Lacerations Are Us Forestry Club.

Trying not to panic and fighting off the dizzying angst of near-death that accompanies a two-inch superficial laceration, I quickly ran out of the woods and jumped onto the skidder, driving it without abandon (yes, 10 mph on a rocky trail) to find Louie, one of the crew guys. Louie, not known for his strong work ethic, was only too happy to drive me to the local hospital's ER. I still don't know to this day how he could eat his bologna sandwich (with ketchup) and listen to Paul Harvey while I sat beside him in the pickup truck, hemorrhaging. And now, page two. The kid sitting beside you in the truck is bleeding to death, Louie. Put the bologna sandwich down and drive faster.

By the time we arrived at the ER, the bleeding had slowed considerably and thoughts of my family catering to my every whim after such a tragic accident waned. As Louie called my Dad from the waiting room, I was placed in an ER room, given a gown to change into, and waited for my Dad's arrival. When he arrived, he was, of course, sympathetic. His face was a hard read, though, bordering between pride for my initiation and disappointment that it wasn't worse.

What happened next for me was nothing short of a miracle. Within minutes of Dad's arrival, the doctor walked in and repaired my laceration. He was kind. He was normal. He was compassionate. And he was thoughtful enough to ask me if I wanted to watch him repair my cut. Absolutely, I said. He propped a pillow behind my back and lifted my cot upright to 90 degrees.

With precision, the doctor explained every step of my laceration repair, from numbing the wound edges with lidocaine to how he would close the laceration in two layers--the buried, dissolvable stitches that would hold my muscle together followed by the external sutures that would closely approximate my skin. Fifteen stitches later, he was done. The nurse, lacking any dramatic flare, applied a big, bulky dressing and antibiotic ointment and I was discharged to home.

Needless to say, I had seen the light. I had experienced medicine. I had been snatched from the jaws of death by the brilliance of medicine (and fifteen measly stitches). From this experience to how the rest of that year played out, I had no doubts about what I wanted to do with the rest of my life.

Is that enough to explain why I went into medicine? I hope so, although at 4 a.m. with that fresh puke all over me, I sometimes wish my personal revelations to pursue a career in medicine held more flare.

So, if you are in my ER in the middle of the night and I smell like bile, please do me a big favor and ignore the stink. And if you see me rubbing my scar above my left knee, don't pay me any attention. I'm just remembering why I went into medicine. Again.

As always, thanks for reading. I hope everyone is having a great holidays. Thanks for all the kind holiday wishes. Next post will be Wednesday, December 30. Until then...