Tales From a Night On-Call: Pasta and Black Beans (Alcohol Intoxication and its Effects)
Tales From a Night On-Call: Pasta and Black Beans
Like the vast majority of my nights, it began with a few quiet hours, in which there was little to do other than count the old bloodstains on the floor (and there were few - the work of the hospital's janitors is really commendable). It was a Friday, and I was again with @cibeltoledo, my partner in many struggles and sleepless nights during my internship at the General Surgery service, and her boyfriend, Rodolfo, who although is still in the 3rd year of the career, decided to accompany us to get an idea of how things will be for him next year (suffering and insomnia, basically).
After a while telling him that there was still time to leave the career and dedicate himself to something that would allow him to have a normal social life, the cold of the emergency room made me go urinate for the third time that night, in my private bathroom located in a dark corner of the hospital chapel´s courtyard (because if you thought that public bathrooms in gas stations were in poor condition, it is because you have not seen those of a hospital without running water for months). While I excreted the Coca-Cola that I had drank before leaving my house, I heard the siren of an ambulance approaching, and that meant that the night was finally going to get interesting.
@ cibeltoledo and I, in one of those rare moments without anything to do except take photos
When I reached the corner of the corridor that leads to the emergency room, I saw the orderlies enter with 3 patients. As I crossed the door (figuratively speaking; there is no door, it makes the patient´s entrance much less dramatic), I saw the protagonists of today´s story: 2 male patients; one young, one about 40 years old, and a woman, also young, crying inconsolably and complaining of pain, the 3 victims of an automobile accident. I report to the doctors César and Xavier, the residents in charge of us, who ask me to take care of the wounds of the young man, who was sitting next to the older man on the same stretcher. So, @cibeltoledo and I treated the cuts and scrapes of the young man, while César and Xavier sutured several deep wounds in the face of the patient at our side, and Rodolfo tried to calm the young woman down, who was lying on the stretcher still crying, and seemed to be in better condition than the others, with no visible injuries except for a scratch on her right wrist.
The young man told us that his name was Daniel. He had large but relatively shallow scrapes on his left arm and leg, some more on his face, and a small cut on his left arm as well. Immediately we noticed that a strong smell of alcohol emanated from him, and that his speech was slurred, in short, he was drunk. "There is the cause of the accident ..." we thought, while we applied Silvederma (silver sulfadiazine; an antibiotic cream) to his wounds, I asked him to tell us what had happened...
Well, I was drinking, and I fell off my bike ...
I was silent for a few seconds waiting for his story to continue. When I realized that that was all he was going to say, I inquired for more details:
I understand, but tell me more, were you with the young woman and with the gentleman by your side? How long ago was the accident? What caused it, was it a collision or a fall?
I was drinking with her (points to the girl) in a nightclub, and after a while we went on my motorbike and we fell down, it was around 9...
It should be noted that it was already 11 o'clock at night, and I found it unrealistic that they arrived at the emergency room almost 2 hours after the accident. I continued with my interrogation, trying to find the truth to his story.
What do you mean around 9? Were you lying 2 hours on the ground without asking for help?
Yes doctor, exactly.
He answered firmly. It did not make me believe him, but I realized that he either did not remember what had actually happened, or was hiding it, so I changed the subject, figuring that I would have to discover the reason for the accident later.
All right... So, who is the girl, your girlfriend?
Yes... I mean, No! She is not my girlfriend!
Is she or is she not?
Yes, she is
Ok, so, you were driving and your girlfriend was in the back, right?
She is not my girlfriend doctor!
I realized it was going to be a long night. I sighed, and realizing that the patient next to Daniel did not seem drunk, and that he had not been mentioned in Daniel´s account of the accident, so I began to interrogate him with the hope that he could clear up my doubts.
Sir, were you with them? Do you know what happened?
These% # "$ & hit me!
Everything made sense then. Daniel and the girl, whose relationship was still unclear, left a nightclub after several drinks, and on the way to presumably another club (it was too early to just go home), they ran over the man (whose name I do not remember, let's pretend it was Carlos), and Daniel was trying to cover up the accident with a story that only made sense to someone with more alcohol than blood on his body. I noticed that after Carlos´s accusation, Daniel was exasperated, and exclaimed:
No! That´s not true!
Of course! You do not remember because of drunk you are, who knows what you have drank!
No, no ... I fell from the bike!
You fell after running me over!
It should be noted that the doctors were still stitching Carlos´s forehead, specifically a cut of about 6cm in his eyebrow. @cibeltoledo and I had already finished treating Daniel´s wounds, who at all times was restless and constantly moving, which worsened after finishing applying the cream, and therefore after we stopped holding him. Remember that Carlos and Daniel were sitting on the same stretcher (because even those are scarce in Venezuela), so Daniel's movements made it tremble, while they were suturing Carlos's eyebrow. Obviously, this was quite dangerous. We told him several times to stop moving, but he ignored it, so after several warnings, Carlos shouted:
Stop moving, don´t you see that they are stitching me!
Daniel said, as he continued swinging his legs, shaking the stretcher as if we were in a Chilean earthquake. Carlos pushed the doctors, with the wound still half-sewn, and grabbing Daniel by the neck he said:
Stop fucking moving, damn it!
After taking a second to assimilate what had just happened, we separated Carlos from a confused and terrified (but immobile, at last) Daniel, and the doctors took him to the traumatology area to finish suturing his wounds. Daniel stayed relatively calm after that (although from time to time he tried to remove the cream from his wounds, drunk patients are not exactly obedient), so we turned our attention to his... girlfriend? We were still not very clear about their relationship. Rodolfo already had several minutes trying to calm her down and get her basic data, without much success. We asked her how she was doing, to which she replied that her wrist hurt (where she had a scratch), and she said that her right leg was broken, while she waved it in the air it as if she were pedaling an invisible bicycle (so even if she had some small lacerations, she did not have any fractures).
She denied knowing what had happened to her, and she even told us that she did not know where she was or how she had arrived. We explain her the situation; that she had been in a traffic accident (without giving many details to avoid scaring her further) , we assure her that in spite of the pain, her injuries were minor and she did not have any fracture, and we told her that after taking their data to write it down in the morbidity records, we were going to take her and her boyfriend (to what Daniel said "she´s not my girlfriend!") to undergo some radiographies and confirm that her injuries were superficial. We started by asking Daniel how old he was, to what he told us:
20... No! 21
20 or 21?
By this point we thought that they were just messing with us. Both patients arrived without any identification, so we only had their word to guide us, and by not giving clear answers, it only occurred to us to ask the young man to call his mother from my phone (at least he still remembered his mother´s phone number) and tell her about the accident, so that she would come to look for him and provide us with concise data. We went to question his companion, who, while crying, told us she did not remember her age (to this day I still wonder exactly what they were drinking...) but at least she remembered her name: Eliana. I lent her my phone to also contact her parents, although in the middle of the call I noticed that she was worrying them too much due to the hysterical state she was in, and I asked her to give me the phone to talk to her mother and explain that her condition was not grave at all, and that her daughter was not in danger.
After this, we had no choice but to wait for both sets of parents to arrive. I asked Rodolfo to finish calming down Eliana, who finally seemed to realize that her condition was better than she thought. While he took her hand and assured her with some cliché phrases that everything was going to be fine, what gave name to today's story occurred. She told us she had nausea, so we brought her the trash can. As soon as we placed it by her side, she vomited a surprising amount of fluid for its size (she did not exceed 1.60m), with a smell that years of semi-alcoholism allowed me to identify as beer with rum (I told you that going out to get drunk was going to be useful someday, mom), and that upon closer inspection, it contained pasta and black beans almost whole, un-chewed, and not digested at all. If I had wanted to know what she had eaten that night, I probably would have asked, although that was a valid way to find out, I suppose.
It was something similar to this, so you won´t have to strain your imagination too much.
When she finished vomiting, she began to cry again. @cibeltoledo and I left Rodolfo again to try and calm her (he was the lowest ranking in the chain of command), while we sat with the doctors to wait for the parents to arrive and take them to perform the X-rays. Discussing what the scolding would be like when they arrived, we noticed that Daniel stood up from the stretcher and knelt next to Eliana, attempting to comfort her. I remembered that the young man had not clarified to us if they were a couple or not, but in that moment he cleared my doubts; they began kissing passionately (more in the style of a pornographic film than a romantic comedy), leaving threads of vomit between their lips each time they separated to take a breath, and maybe I saw a small piece of black bean in Daniel´s mouth (I know, I have talent for erotic writings, do not be surprised if some day you see one in my blog). @cibeltoledo asked if we should separate them, to what the doctors and I answered in unison and laughing:
Nah, leave them be.
Rodolfo sat next to us, visibly uncomfortable. Their parents arrived shortly aftherwards, and we took them to the radiology area. Daniel enters after Eliana (who indeed did not have any fracture), and after several minutes in the X-ray room, the radiologist comes out, somewhat sweaty, and tells me that he has to talk to me in private. I assumed that Daniel did have to have a broken bone, but I remembered that he had been in constant motion without complaining about any pain, except for his skin lesions, so I wondered where it could be located. As I stood alone with the radiologist outside the building, he told me, with a serious look on his face:
No more drunks, next time you´ll take the X-rays.
All right... but that was all? He doesn´t have a fracture?
No, but he did not help at all, I was about to leave and tell the father to take care of his son.
I let out a laugh of relief; both patients were free to leave as soon as we gave them the medical indications. Upon entering the building again, I saw that both mothers were talking to their respective children, but I admit that I was a little disappointed to note that they were not being scolded for drinking more alcohol than a heartbroken Russian and running over a man, they were only telling them that soon they would be fine and not to worry about the bike they were riding on, since they had found it without much damage. It is not exactly what I would have told my son if he had been in their place, but I suppose that in the state they were in they were not going to pay much attention anyway.
X-rays of Eliana's leg (left) and Daniel's thorax (right), the very picture of health, except by some damage to the lungs caused by smoking. (Photo taken by the author)
Now, leaving aside the story, let's move on to study the case. If we take note, drunkenness, or ethylic intoxication is responsible for a significant percentage of the injuries of patients who arrive at the emergency room, especially on Fridays and weekends. But, what happens in our body when we drink alcohol, and how should this altered state be treated?
Ethanol, or ethyl alcohol, is the type of alcohol found in liquor. It is a central nervous system depressant, so its excessive consumption can cause serious health problems (It sounds like a high school PSA, I know). The symptoms of alcohol intoxication depend on the amount of alcohol ingested: in the case of mild intoxication (20 to 200 mg of alcohol per dl of blood) there is disorientation, deterioration of cognitive functions and difficulty in movements that require motor precision, difficulty in speech (dysarthria), and an increase in impulsivity. In the moderate intoxication (200-400 mg/dl) more serious manifestations occur such as nausea, vomiting, stupor, drowsiness, difficulty with any type of movement, slow response to stimuli, and increased aggressiveness. Those who suffer from severe intoxication (> 400 mg/dl) normally fall into a coma, their blood pressure drops dangerously, and they may even suffer from seizures or respiratory arrest due to depression of their central nervous system. And above 900 mg/dl is usually the lethal range of intoxication.
The appropriate diagnosis is based primarily on the patient's clinic, taking into account the context in which the symptoms occurred; If the patient began to have difficulty walking and talking during a party and after consuming alcohol, it is much more likely that it is drunkenness than a Guillain-Barré syndrome or an ischemic CVD, for example. In addition, the level of ethanol in blood and/or breath is measured, commonly using the breathalyzer that most of us know. This device measures the percentage of alcohol in blood, being legally determined in most countries that someone with more than 0.8% of alcohol in their blood is in a state of drunkenness.
Finally, ** _treatment _** is mainly symptomatic, and depends on the degree of intoxication: in a mild intoxication therapeutic measures are not usually required, although I personally recommend taking the equivalent in water of the alcohol that was consumed to avoid hangovers (works like a charm, believe me). If it is a moderate intoxication, an ampoule of 100mg of Thiamine (Vitamin B1) can be administered intramuscularly in a single dose, and 300mg daily orally for 3 days. In addition, Haloperidol (an antipsychotic) can be used in cases of seizures or extreme physical agitation, and antiemetics such as Metoclopramide are used to treat the vomiting. Both in these patients as in those with severe intoxication, hydration is extremely important both with saline solution and with glucose solution to avoid hypoglycaemia, and constant monitoring of blood pressure, temperature, and respiratory and cardiac frequency. If necessary, cardiopulmonary resuscitation can be performed, and if the patient suffers a respiratory arrest, he should be intubated and taken to the intensive care unit. A gastric lavage can be performed, but only within the first 2 hours after the intake of alcohol, as it has a rapid absorption.
In summary, alcohol is bad, kids. Seriously, I recognize that I have no moral to tell you not to drink, but if you do, avoid reaching the point where you do not remember your age (according to the parents, Daniel was 22, Eliana 21), and it begins to seem like a good idea to make out with your girlfriend (again, the parents confirmed that they were) who has just vomited her entire dinner, and apparently does not chew her food before swallowing it. Life lesson.