Saturday, November 04, 2006

Little Miss Adventure

Last night a "GDFD" (get drunk, fall down) was brought into the Emergency Department by aid car. She arrived, as most drunks do, bellowing obscenities and calling the staff vile names. And this young lady was also a spitter. Nice.

The law allows us to restrain a patient who poses a threat to himself or to staff, and our MD, a particularly excellent one, wasted no time in decreeing that it be made so. Security is always down there, so we summoned them to help us put the leathers and a spit sock on the young lady. We then shifted her over to our bed and unceremoniously strapped her down.

While all this was going on I was getting report from the very beleaguered-looking aid car crew. It seems that the patient was with her friends at a bachelorette party and the patient had a little more than her share of the alcoholic beverages, and when the staff decided that enough was enough about four shots of Jagermeister ago, they cut her off. Little Miss Adventure got up to voice her dismay and wound up on her backside, having struck her head on the way down.

It is interesting to note that although the young woman was maybe only 5 feet 3 inches tall and weighed perhaps a buck-five soaking wet, she fought like a wildcat in a burlap sack with a snake in it. Some people hold their liquor; with others, their liquor holds them. This lady was simply awash in the Nyquil-like stench of Jager.

The staff got Little Miss Adventure settled in (read: strapped down), and I obtained IV access (in this case with a big ol' 18-gauge in her antecubital fossa- that's the inner elbow for you laypersons) and drew blood for lab assays.

Oh, yeah. Little Miss Adventure was also a "biter."

Now, we needed to get a urine toxicology screen as well. Since I am male, obviously I was not the one to go in and do it. But I did inform her that yes, Nurse so-and-so was about to put a catheter down there.

"The f--- she is!" she declared.

So after the catheter was in place and the urine sample was obtained, I sat down do do my charting, a voice from behind me says, "230."

Then I hear, "Naw. She's tiny. 180."

Suddenly, numbers are being called out as if this was the set of The Price is Right.

Now, a brief explanation is called for here. Any time we get a GDFD into the Emergency Department, an informal bet about the blood alcohol content (BAC) immediately forms. It usually starts by someone saying, "249" (or 0.249). So without fail, within thirty seconds the entire front staff of the ED has a number except for me. After some prodding and some quiet consideration, I call out, "310."

"Get out!" says Nurse So-and-So. "She's maybe a hundred pounds soaking wet."

"No," says I, "I will bet you a pizza it's at least 300."

"Okay, Boy Wonder. What makes you so sure?"

"I think she's got a tolerance, that's what. Anyway, 310 is my number and I'm sticking with it."

"Have it your way," says Nurse So-and-So with a dismissive wave.

So all the while, Little Miss Adventure is screaming, kicking, spitting, and offering her pointed and graphic opinions about the lineage and sexual orientation of every staff member she can see, even the poor little housekeeper who came in to change the linen bag in her treatment room. (It's a good thing she doesn't habla the Ingles, or at least much. Still, the darling woman came out of the room shaking her head and muttered, "stupid drunk b----."

About a half hour later, the labs came back. Yes, I was wrong. But we were all shocked. Her BAC was 0.418. What that means is that this little firecracker had herself a helluva tolerance for booze. I've seen worse, but not in a little chicka boom-boom as small as her. Her tox screen also showed THC. That's the groovy stuff found in marijuana.

Also around this time, a couple of the patient's girlfriends filtered sheepishly into the ED. They all seemed genuinely concerned, a little anxious, and shockingly underdressed for the weather. At last, one of them pipes up in a nasal, whiny tone that would have been stereotypically applied to a stripper, "Can we see so-and-so?"

"And you are...?" I asked, looking over my computer screen.

"We're her friends. And we work with her. She was at my bachelorette party," says she.

"I'll tell her you're here. What's your name?"

"It's Nikki. With an I." she says, spelling her name and holding out her hand.

"Charmed," I answer, shaking her hand and stiflng the urge to guffaw. I went into Miss Adventure's room and told her she had some friends here, and asked if she would like to have them in- one at a time.

"Oh, pleeeeeeeeze?" She whined.

"Sure." I exit, motion to Nikki-with-an-I, and tell her to go in alone, and to speak quietly, and that she has only five minutes.

Well, of course, the moment Nikki-with-an-I enters the room, the Boo-Hoo fest begins. Miss Adventure escalates, and we remove Nikki-with-an-I. Miss Adventure calls me more names. Nikki-with-an-I looks a little shaken.

"Wow, she's really plowed, huh?" says Nikki-with-an-I.

"Like Farmer Brown's back forty," says Nurse So-and-So from behind me.

"How long will she be like this?"

"I dunno. Depends on her. It'll be awhile. Can't really tell you much more than that."

Well, do you think she will be able to work Monday?"

"Well, I don't know. What does she do?"

"Oh, we're both kindergarten teachers."

I have never heard the entire staff of my Emergency Department fall completely silent before. It was as if the breath had been sucked out of our lungs. But Nurse So-and-So, bless her, recovered first:

"Thank God I homeschooled."