THE COMPLEXITY OF ALCOHOL
ANY GIVEN SUNDAY
AUTHORS Martin Huecker, MD, & Eric Yazel, MD
S
aturday overnight shift in the Emer-
gency Department is a different an-
imal. You walk in and almost im-
mediately face a barrage of medical
issues. Just as you catch up (around
4am), the second wave arrives as
the bars close. After weathering the
storm, you sometimes get a chance to come
up for air. The patient flow slows to a trickle, and you may witness
an odd moment of peace. This is the time to take stock of what is
left on the board:
» »
An intoxicated middle-aged male, crying uncontrollably. He
states he threw up a baby bird. He is scared because he does
not remember swallowing it and is upset he hurt the bird. Per
bystanders, we were able to ascertain he vomited on the side-
walk, his emesis splattering on a dead baby bird.
» » Two beds down, an elderly female is intubated. She was playing
cards with friends, drinking some wine. She fell down the stairs,
now has a large subdural hematoma. She is on warfarin, not a
surgical candidate. Waiting on family to arrive to withdraw care.
» » Hallway beds across from that room hold two teenage kids.
They drank a few beers and decided to joust each other on
motocross bikes, using 2x4’s and trashcan lids duct-taped to
their forearms. They are awaiting consultation for multiple
orthopedic injuries.
» » Over by the coffee machine, one of our well-known patients
with multiple alcohol related visits is attempting to sell used
dentures that he found in a funeral home dumpster.
» » The back corner holds a 60-year-old male, out at the bar with
some friends. He received a message that his daughter was in
labor with his first grandchild. Speeding to the hospital and
under the influence, he was in a high impact motor vehicle
accident. Now he is hypotensive, unstable and awaiting the
OR with the trauma team.
» » On the far side, there is a 16-year-old girl. She snuck out of her
house to go on a date with her much older boyfriend. He took
her to a party, drank and drove, hitting a telephone pole. She
is paralyzed from the waist down, being evaluated by neuro-
surgery, unlikely to walk again.
» » As you pass by the next room, the family thanks you for sending
the chaplain in to pray with them. Upon further questioning,
you realize it was the fellow selling the dentures posing as chap-
lain. You aren’t sure whether to be mad or a little proud of him.
» » The next bed has a college kid, snoring, but minimally re-
sponsive. His mother states that he called her to pick him up
from the bars. He was so intoxicated he got in the backseat of
her car, thinking it was an Uber, and began giving his mother
directions to their home.
» » The last bed has a 35-year-old female. She was out with some
friends at a bachelorette party before going to pick up her young
child. She has a head injury, numerous broken ribs, and other
traumatic injuries. She will survive. However, when she wakes
up, she will find out that her child did not.
» » As you walk past the work stations back to your desk, you hear
some of the providers, staff and first responders talking about
going out for drinks after the shift to blow off some steam.
Obviously, these patients did not all come to the ED on the same
shift, but we saw them all, in devastation and in wry amusement.
Drinking leads to behaviors that tie together a lot of ED visits. It is
also a thread that unravels a lot of lives. We laugh with our alcoholic
patients, cry with them, and hopefully maintain balance in our own
lives to avoid alcohol dependence ourselves.
Dr. Huecker is a practicing UofL Emergency Medicine Physician and Faculty Member.
Dr. Yazel is a practicing UofL Emergency Medicine Physician. (non-member)
OCTOBER 2019
23