Anyway, it seems that in my trauma bay I see more than my fair share of people who are either unwilling or unable to learn from what they've done wrong so that they don't do it again. Everyone makes misteaks (myself included, naturally), but unlike many of my patients I try to refrain from making the same misteak twice. This is a lesson that I beat into my children (NOT LITERALLY) on a daily basis. After all, I tell them, if you don't learn from your mistakes, then what the hell is the point of making mistakes. Right? Of course right.
I have to assume that Lacey (not her real name™) didn't have such caring and knowledgeable parents.
Lacey was brought to me in a bit of a heap one fine late evening, the police trailing just behind. That is, as you have probably guessed, never a good sign. When she was wheeled into the trauma bay, she was completely unresponsive, unable even to open her eyes. When I see such a patient, I think of the three Most Likely Possibilities:
- She has a severe brain injury,
- She is drunk (or otherwise intoxicated) as hell,
- She is faking to avoid talking to the police.
It's my job to differentiate among the three.
"Evening, Doc. Here we have Lacey. She's 29, history of anxiety and depression, allergy to penicillin, takes one medication for anxiety though she doesn't know which one. History of heroin abuse. We found her like this, unresponsive, outside her car on the side of the road. Basically no damage to the car, but, you know, we can't tell if she hit her head or oh-deed or what. She's been unresponsive like this since we found her, though her vitals have been rock stable."
A quick glance at Lacey revealed no outward sign of trauma, not even an abrasion. She literally had not a single scratch on her. I strongly suspected Most Likely Possibility #2. She had a grossly abnormal neurological exam: her pupils were pinpoint and she did not respond to painful stimuli, so I could rule out Most Likely Possibility #3 (though #1 was very much still in play). Her physical exam was otherwise completely normal. X-rays of her chest and pelvis were normal. An ultrasound of her chest and abdomen showed no sign of bleeding around her heart, lungs, liver, spleen, kidneys, or bladder. A full-body CT scan was negative.
This did not seem to be Most Likely Possibility #1 either. Shocking.
A few minutes after seeing her normal scans, her lab work finally came back. Her chemistry and complete blood count were (are you sitting down?) totally normal. Finally I saw what I was looking for: something. Something. Anything that could explain why she was out cold.
Her urine tox screen was positive for heroin. I hate the term "Duh", but really. DUH.
Now clearly no one in the trauma bay was surprised, but as we started to discuss the sheer stupidity of driving after injecting way-too-much heroin (though to be fair, any amount of heroin is way too much if you plan on driving), something occurred to me about the medics' presentation that hopefully occurred to you too. I cocked my head as I thought about it, wondering.
Fortunately the ambulance crew was still milling around the hallway, so I decided to ask them the question that was noodling around my brain: If she was unresponsive when you found her, how the hell did you know her medical history other than heroin use and that she was allergic to penicillin??
The medics turned to each other, laughed, turned back to me, laughed in my face, and then started high-fiving each other. Not really, but that's what it felt like as he chuckled politely and said,
"Oh, because we picked Lacey up for a heroin overdose earlier this morning too."
Wait, you . . . what? Of course you did. Somehow, that made total and complete sense.
Unfortunately for the general public, the police left without arresting her. I have no idea why and no reasonable suspicion other than that the officer got bored of waiting for Lacey to wake up. So instead of going to jail for endangering every single person around her, Lacey got away with it. Again. She woke up, got dressed, asked me for a prescription for narcotics (HA!), and went home.
I can guarantee that she learned absolutely nothing from this episode, and I can further guarantee with near 100% precision that I will see her again. Probably soon.