Monday 11 July 2016


I don't tend to ask my drunk patients what they drank to make them drunk, because ultimately it doesn't really matter.  Wine, liquor, beer, absinthe, cough syrup, Listerine (yes, really) . . . no matter what type of alcohol they drink, when it ends up inside them it makes them act like idiots, and that ultimately leads to them to be guests (though uninvited) in my trauma bay.  But regardless what it smelled like going in, when that alcohol ends up on my trauma bay floor it smells like pure, unadulterated evil.  When my children vomit (rarely, thank goodness) I can clean it up without any problem.  Adult vomit is just . . . different.  I can't really say why and you parents out there are surely nodding along with me.  But what I can really say is that it is disgusting.

That all said, my patients' drink of choice seems to be beer.  Sometimes whiskey, rarely vodka, even more rarely wine, and once methanol (yes, really).  A bit of advice for you methanol drinkers: in chemistry (and everything else, for that matter) an "m" on the beginning of a word can make a profound difference.

Anyway, Wes (not his real name™) preferred rum.  I have no idea if he preferred rum because he was a pirate, because I didn't ask him.  Come to think of it, he did say "ARRRR" a lot, but I think that was more a factor of the copious amount rum rather than any buccaneering history.  Nevertheless, the only reason I know that it was rum was because he told me.  Repeatedly.

Wes was a bit of an anomaly that day.  The Call Gods were having a bit of fun at my expense by sending me a series of "found down" patients: folks who are presumed to be trauma patients because they were found on the ground and no one knew how they got there (I always suspect gravity plays a significant role).  These patients are seldom severely injured, and even more seldom do they actually require my acute services.  Usually they just need either fluids and time to sober up (if they are drunk) or a medical doctor (if they have had a stroke).  Fluids I can give.  Medical doctoring . . . not so much.

This particular day none of my Found Downs (Founds Down?) had been injured at all, but I still had to determine that for each of them, and it was taking an inordinate amount of time and effort.  Then amidst the drunk people found on the restroom floor, old people found on the floor next to their beds, and drunk people found on the ground outside the pub, along came Wes.  His mechanism of injury was different.  Not a Found Down!  FINALLY!  Some variety!  The word coming in was that Wes had been in a bicycle accident.

It wasn't anything particularly earth-shattering, but at least it was something else.  On a day like that, anything different was good.  Or so I thought.

When Wes was wheeled through the door, the smell of alcohol and vomit came right in with him, mingling nauseatingly with the pungent odour of alcohol and vomit from the previous five patients.  When the medics started their story, I wanted to scream.

"Hey Doc, this here is Wes.  We found him on the ground . . ."

Really?  REALLY!?  Another Found Down??  God damn you, Call Gods.  GOD DAMN YOU.

"He was riding a bicycle . . ."

Oh, ok.  Whew.

". . . when he crashed into a tree.  He wasn't wearing a helmet."

Of course he wasn't.  But at least he wasn't found fucking down.

When I first looked at Wes, the first thing I noticed was that it looked like he was trying to smuggle a pomegranate in his cheek.  Well, that's not exactly true - that came second.  The first thing I noticed was that odour of ethanol and vomit wafting off him.  Though he was conscious, he was slurring badly.

"Heysre Doc, smthingsong withmfaysh.  Fucknhurtsh."

I had to feed this nonsense through my Idiot-English Translation Engine (which fortunately had just come back from the shop), and what came back was "Good evening, doctor.  Something is wrong with my face.  It really hurts.  Thank you for taking care of me.  I truly appreciate everything you are doing."

Hm . . . I think the Translation Engine is embellishing a bit.  Back to the shop with you, damn it.

My head-to-toe evaluation found no obvious injuries other than fairly impressive swelling of the entire left side of his face, and a CT of his facial bones demonstrated a fracture of his zygomatic arch (cheekbone).  It was pretty badly displaced, so a call to the facial surgeon went out (I still don't do bones).  Based on the fracture pattern, Wes would need surgery to put Humpty Dumpty's formerly beautiful (maybe) face back together again.

The following morning found Wes sober (HUZZAH!) but hungover (aww).  Even my knock on the door aggravated his headache.  He had no complaints other than his face and his massive headache, so after another head-to-toe evaluation (the "tertiary evaluation"), I determined that I hadn't missed anything.  Good.  That's when my coffee-deprived brain decided that asking him what had happened was a good idea.  As usual, I regretted the decision.

"Well Doc (ow), I keep having this pain on the left (ugh) side of my face after I broke my jaw a few weeks back.  I ran out of (ow) pain medicine a few days back, so I've been getting it from my friend.  I took three shots of rum to try to (ah) dull the pain before riding my bike to my buddy's house to get more pills.  I guess I lost (ugh) control and crashed into a tree (ow) or something."

So how stupid was Wes?  Let us count the ways:
  1. Not seeking medical care after breaking your mandible is stupid.
  2. Taking narcotics you acquire "from a friend" is stupid.
  3. Using alcohol as pain medicine is Very Stupid.
  4. Drinking enough alcohol to raise your blood alcohol level to three times the legal limit is Very Very Stupid.
  5. Riding a bicycle a) with no helmet and b) while that drunk is Just Plain Idiotic.
I broke the news that he had broken his cheekbone (since he didn't remember the conversation we had the previous night) and would require surgery later in the day to fix it.  He seemed surprised and tried to correct my error-that-wasn't-an-error.

"No no, Doc, it's my jaw that's broken, not my cheekbone."

I slowly explained that now his mandible and cheekbone were broken, and both required surgery.  The facial surgeon would install a few titanium plates to repair the zygoma, and his jaw would have to be wired shut for 6-8 weeks to allow the mandible to heal.  That means no solid food for nearly 2 months.  He again tried to argue with me that that wouldn't be necessary, but the pain in his mandible not only shut him up but also convinced him that I was right.

He went home the following day in slightly less pain, but still swollen like a chipmunk.  Along with his instructions on eating a liquid diet and other discharge paperwork, he got a prescription for some liquid pain medicine.

NOT rum.


  1. people in my area never have more than "a couple" drinks.

  2. Hope he doesn't drink more rum while his jaw is wired shut! How does a person vomit with this procedure?

    1. They swallow.

    2. Patients in MMF (jaw wired shut) are given a pair of scissors designed to cut the wires in case they start to vomit.

    3. so they don't strain anything?

  3. 3 shots. Was Wes really a 90lb petite woman who had alcohol for the first time in her life on an empty stomach?

    1. No, the three was probably actually 6 or 8.

    2. three doubles... or triples... or fourples...

    3. It's plausible it really was just three normal shots. The other factor would be how long before those shots had he taken the last of the pain pills he had gotten from the friend.

      I've seen people take 2-3 pain pills, feel nothing, up to an hour later take more, then 10 minutes later are so doped out of their minds you'd swear they were part of the walking dead.

  4. It was probably three that he *remembered* before he lost count. And, we don't know what size container he uses at home for a "shotglass."

    1. this is why I tend to ask "did you have more to drink than usual?" to a degree, that's what the medics really want to know, anyway. - at least on a person who is just feeling funny.

  5. Ain't gravity the damndest thang... never fails, no matter how much a bod has had to drink.

  6. Question for you Doc':

    Founds down are clearly one of the dullest reasons for a referral to your ER, but what is your most exciting/dramatic?

    On a scale of "found down" to "thrown from their spacecraft while reentering the atmosphere" what is the most dramatic or unlikely mode of injury, and were you able to patch them up?

    Good work as always!


    1. Can I play?

      an unspecified time in the past we had one of our police officers take two below the vest.
      it was close to a year before he had recovered sufficiently to walk into the school gymnasium and wave to his supporters. another 6 months before he was back in uniform. - I missed that one - fortunately, because I would have been responding from the direction the shooter was fleeing, and would have been at risk.

      the most exciting I was involved in was an armed robbery suspect who was taken down with a police car after aiming his gun at another officer. we extricated the patient behind a thin blue wall between us and the accomplice (who was also armed) the paramedic found the patient's second gun while we were backboarding him.

    2. I think the most unexpected was a woman who was at a stadium when a deer ran through the seats, jumped over her, and kicked her in the head. She was ok and didn't need to be patched up too badly, but that sticks out as one of my most notable "WTF" trauma moments.

    3. That is a seriously WTH moment.
      I would love to have seen the accident report sheet for that little episode.


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