Friends

My wife is my best friend.  She has been since we met 15 years ago.  Whenever I have news, I want her to be the first to know, I care deeply for her, I trust her implicitly, and I tell her everything.  That's what friendship is all about - caring for other people - right?

I guess some people didn't get that memo.

"Oh great, another great bastion of humanity just washed up in trauma bay #2." 

This is what I said when this next patient rolled through the door.  He was a young healthy man, clearly heavily intoxicated, reeking of alcohol, and acting as obnoxious as humanly possible.  It would have been very easy to dismiss him as just another belligerent drunk guy, because at the time we had no idea what happened.  The guy was "found down" with bruising around his face, so he was either A) acting obnoxious while drunk and got beaten up, B) acting obnoxious while drunk and  fell flat on his face, or C) he was abducted by aliens, subjected to untold torture, and then went home and got drunk to try to forget the pain.  I had a feeling this guy was going to land solidly in category A.

Boy was I right...sort of.

The problem with severely inebriated patients is that we can not rely on their physical examination.  The term "feeling no pain" is not an exaggeration - people can have broken limbs, lacerations, and all sorts of injuries of which they are unaware because of their intoxication.  So after doing a complete physical exam (remember the A-B-Cs?), I had a suspicion that something else was going on, even mentioning to one of the nurses that I recently had had a drunk patient who also turned out to have bleeding on his brain.  So I decided to get a CT scan of his brain, spine, chest, abdomen, and pelvis just to make sure I didn't miss anything.  And I'm glad I did, because he also happened to have bleeding in his brain.

Now the fact that I caught this isn't the point of this post.  The reason I'm posting this is because unlike with most of these patients, I found out why he was "found down".  It turns out he was at a pickup basketball game at night and was drinking heavily with his buddies.  He made some stupid, obnoxious comment (I know, I know - shocking!), and one of the players suspended the game to beat the shit out of him.  After he crumpled into a puddle in the middle of the basketball court, his friends pushed him to the side of the court and continued playing until someone called for a medic.  

How's that for friendship?