‘I’m calling from the emergency department. I’m one of the nursing staff. Everything is okay, but we have your son here with us.’
Any leftover sleep-induced confusion evaporated from his voice. ‘What’s happened? Is he okay? What’s going on?’
‘Peter had a bit too much to drink tonight—’ I never got a chance to finish.
‘The bloody idiot, how bad is he? Was he in a fight?’
‘He’s okay, he hasn’t been hurt, but he did pass out. He’s awake now, and the doctor said he’s well enough to go home. Can you come and collect him?’
Dad said he’d be here in 20 minutes.
‘He’s going to kill me.’ Peter had sobered up enough to appreciate the seriousness of the situation. ‘Hell, I’m so sorry. What have I done?’
I felt sympathetic to his cause. We all make mistakes (especially when we’re teenagers) and as bad as he felt now, it really wasn’t the end of the world.
‘Think of this as a lesson. You got lucky. There’s been no permanent harm done. It’s a good sign you feel bad about your actions. Not everyone does. Oh, and as for your parents, well, they might be angry, but they’ll be even more relieved that you’re okay.’
Peter was lucky, because his dad seemed really nice. He didn’t yell, he was calm, and once he realised his son was fine, he even managed a brief chuckle about the whole situation. I could see that wasn’t the reaction Peter had expected. Thankfully, I’ve seen a lot of teenagers surprised, in a good way, by the unexpected responses of their parents.
Sadly, though, not everyone has parents to pick them up when they get drunk. Some people live their lives around alcohol, and usually end up paying the price.
The regular drunk
‘Where’s Mr Finnerty?’ asked Tracey, looking around anxiously, ‘He’s supposed to be in cubicle 4 but he’s gone missing.’
This was not the first time we’d lost this particular patient. He was notorious for getting lost trying to find the toilet.
Mr Finnerty was a homeless, 60-year-old Irish alcoholic who was brought in every couple of months, because he had drunk himself unconscious and a Good Samaritan had decided to call an ambulance after tripping over him on the street.
‘Check the toilets, then the kitchen. He either needs a pee or he’s woken up hungry,’ I suggested.
The kitchen was empty, as were the toilets.
‘He won’t have left,’ said Tracey, as we reconvened. ‘He must be around the ward somewhere.’
Mr Finnerty always slept until morning and left after coffee and toast. For people like Mr Finnerty it must be a bit like Christmas to sleep in a bed and have a hot drink.
Mr Finnerty’s treatment differed slightly to less hardened drinkers; he would be given an infusion of vitamins, including vitamin B, which alcoholics generally lack, and some diazepam tablets, which help the body relax and cope with the stress of going without alcohol for a night.
Tracey continued to pace around the emergency room, peering into every nook and cranny, but she needn’t have bothered; a nasty trauma was wheeled into the resuscitation bed and Mr Finnerty seemed to materialise out of thin air.
‘Need any help? I’ve got a spare kidney if anyone needs one.’
Of course, Mr Finnerty was only trying to help, but it really wasn’t the sort of help that the doctor needed. Tracey firmly, but gently, grasped his arm and marched him back to his cubicle. Mr Finnerty glanced over his shoulder and winked at me, obviously enjoying the attention.
The sight of a gorgeous, petite blonde telling off a 60-year-old, bearded, intoxicated Irishman who was pretending to act remorseful was rather memorable. It was almost cute.
When morning came around, there was no one to call to come and pick up Mr Finnerty. He was discharged home, which happened to be under a nearby bridge.
The unconscious drunk
The unconscious drunk is a valuable sub-category of the nice drunk. They count as nice, because they can’t do anything to offend you (although they can be the hardest work as patients; an unprotected airway is such a nuisance). A truly unconscious drunk cannot complain, cannot be violent, and doesn’t need assistance walking to the toilet as they’ve already been doubly incontinent in their bed. Best of all they don’t need anaesthetic when suturing up lacerations or manipulating broken bones.
Thankfully, with experience comes the ability to spot an unconscious drunk, as opposed to someone simply asleep. An experienced nurse uses modern medical technology alongside their highly developed skills when assessing an unconscious patient. In the case of the unconscious drunk, we use pain.
Yes, you read right, we administer different levels of pain to see exactly how unconscious a patient is. There are different levels of unconsciousness and it’s important that we know exactly how serious the situation may be. We need to know exactly how much stimulus is needed to rouse someone.
1. Sound: do they respond to noise? They may open their eyes briefly when you call their name, or make a slurred sound.
2. Movement: maybe a gentle shake of the shoulder is enough to get a response, as is often the case when someone is simply asleep.
3. Fingernails: there are a number of ways a patient can respond to us squeezing their fingernails against a solid object. They might open their eyes and shout. They might pull away their hand, moan, but keep their eyes shut, or open them just briefly then fall immediately back to sleep. In the worst cases, they don’t flinch, don’t even flicker their eyes, don’t make a noise. Alternatively, they might wake up and try to punch you.
4. Sternum: after the fingernails, comes rubbing of the knuckles across the patient’s sternum. This works rather well, and I’ve woken up a number of deeply-under patients this way.
5. Eyes: the final option is to press a point on the inside of the eye socket. I haven’t had to use this option often, but I know it to be effective.
If none of these methods get you the desired response from the patient, then the situation becomes much more serious. Usually an anaesthetist is called to decide exactly what to do.
It is not uncommon for these patients to be intubated. This means a tube is stuck down the throat, and the patient is placed on a ventilator.
Most of us will know how to look after our friends when they’ve had too much to drink; to roll them on their side to protect their airway. In the case of the truly unconscious, the risk is the same, but there is no knowing when they may rouse, or even what they’ve consumed, so drastic measures are taken to protect the airway.
The lucky drunk
‘Now don’t be hard on yourself, but I told you so. You wasted your time, and mine.’
Mr Riley was sitting on the edge of his bed, waving his finger in the face of the paramedic who had brought him in.
‘And to think you could be helping someone really in need, and instead you’re here with me. I’m flattered, really, but you shouldn’t have.’
‘You fell from the first floor of your house on to your front lawn. You’re lucky you didn’t break something. Hell, you’re lucky you’re still alive,’ I said as I continued cleaning up the mixture of dried and fresh blood from Mr Riley’s forehead. I’d been busy cleaning him for the last ten minutes. The paramedic had stayed with us as he had wanted to see how badly Mr Riley was injured, especially since he’d refused a neck brace and insisted on being wheeled in on a chair instead of a bed.
Aside from 12 fresh sutures in his head, Mr Riley had no other signs of injury. His friends insisted he wasn’t knocked out, and the only reason they called the ambulance was because he was bleeding all over the carpet. In the end, Mr Riley went home, against medical advice, and back to enjoy the party.
Mr Riley was fortunate, because being drunk enabled him to survive an accident that would otherwise kill, or at least seriously injure, most sober people.
Take Mrs Reese, who was occupying the bed next to Mr Riley. Mrs Reese was an elderly lady who had fallen off her chair. She broke her hip.
Part of the reas
on for this seeming injustice is to do with being relaxed. When you’re sober and fall, you are aware of what is going on, and you tense. Ironically, tensing is what increases the likelihood of damage.
Of course, I very much doubt Mr Riley would have fallen from his balcony if he had not been drinking.
The mean drunk
And now we come to the other main category of drunk, the mean drunk, also known as the pain in the arse drunk. These are particularly easy to spot.
‘Come on, Rick; open your eyes,’ I said to Rick. But apparently Rick wasn’t interested in waking up as he continued to lie on the bed unmoving.
‘He was asleep when we found him; he was rousable to voice,’ said the paramedic who had brought him in. ‘He’s only been like this since we wheeled him through the hospital doors. I suspect he’s acting.’
I watched as the doctor assessed the patient. Dr Wilson began to do the usual tests to assess level of consciousness. Pinching, poking, rubbing, all to no effect.
‘Well, either he’s a good actor, or he’s really unconscious,’ he said.
‘Let me have a go, just to be sure,’ I volunteered. I prided myself on being able to wake up most cases that presented in the emergency room.
Dr Wilson stood aside as I went about the job of administering medicinal pain.
I had no success either.
‘We’d better get him undressed and put on a monitor quickly then,’ said Dr Wilson.
‘It looks like he might be unconscious after all,’ I added, but I wasn’t entirely convinced.
I took some scissors and went in to cautiously cut off his shirt.
At the first snip, Rick sat up suddenly and swung a fist in my general direction.
‘You’ve cut my fucking shirt. What the fuck you do that for?’
I had been ready for it and dodged easily out of the way.
‘That cost 50 fucking quid. You gonna pay for that?’
I shrugged my shoulders. ‘You’re supposed to be unconscious. Just following hospital protocol,’ I replied.
Rick leapt up off the bed, ripping out his IV line in the process. With blood dripping down his arm, he lunged towards me, but Dr Wilson and the paramedic were ready and wrestled him back on to the bed.
Rick could see he was outnumbered and stayed down, but not without sharing his knowledge of the English language.
‘Now, we’ll let you go as long as you promise not to try to hit any of us,’ Dr Wilson explained. ‘If you try anything else, you’ll be spending time with some friendly police officers.’
Bare chest heaving from anger, Rick wrapped his £50 shirt around his bleeding arm and stormed out of the department.
Rick was a fine example of a mean drunk: obnoxious, loud, violent, and a complete pain in the arse. Rick was not the first person to feign unconsciousness and was only one of God knows how many to become violent.
Of course, in some ways, an aggressive drunk patient makes our job much easier – anyone able to stand up and make violent threats is well enough to be forcibly removed from the department.
The changed drunk
‘This is bullshit,’ James exclaimed while glancing around the relatively empty waiting room. ‘I’m a lawyer and I know my rights. You can’t keep me waiting. You’re fucking with me, that’s what you’re doing.’
James took a step towards me, his fists clenching and unclenching. Thankfully, his friend, Steven, grabbed him around the shoulders. ‘Hey, James, calm down, mate; they’re only trying to help.’
‘I’ve never seen him like this. I’m really sorry. He’s not the aggressive type,’ Steven said, turning from me, and firmly pushing James back down on to his seat. ‘I’ve known him all my life; he’s not a trouble maker.’
There is one exception to the dichotomy of nasty and nice drunks – one which all nurses must watch out for: the mean drunk who has experienced a knock to the head.
With James’s hair covered in blood, and his left eye nearly swollen shut, Steven’s words sparked off alarm bells. ‘Follow me.’
‘Thank fuck for that,’ said James, as I laid him down on a bed.
‘Tell me what happened?’ I asked.
James looked up at me, not bothering to brush aside the blood-matted hair that covered his good eye.
‘What the fuck do you think happened? I got assaulted, that’s what the fuck happened.’
Steven held up his hand, motioning for James to be silent.
‘We were having a night out on the town, you know; had a bit too much to drink and all—’ Steven began.
I interrupted.
‘How much is “too much”? I need a rough estimate,’ I said.
‘Well, we finished off a bottle of vodka; maybe half a dozen beers each,’ he said.
‘That’s a lot of booze for two people,’ I offered.
Steven responded with a mirthless laugh. ‘That was before we went to the pub.’
James made a moaning sound and promptly vomited a litre or two of alcohol over himself. I offered Steven a pair of latex gloves.
‘I need you to help. Let’s get him undressed while you finish your story. I just want to know how he got hurt.’
Steven looked at the gloves like they were diseased, but slowly put them on.
‘Well, some guy kicked up a fight. James got hit a few times in the head. The security guys broke it up and threw the guy who started it out. We left the pub about half an hour later and he was waiting for us and hit James over the head with a brick. Security caught him and called the police.’
‘Did James lose consciousness?’ I asked.
‘No. I mean, he fell to the ground, but he was awake, on his hands and knees. Took a few minutes to stand up, but he got up. Cops said we should get him checked out. So here we are.’
As we began to undress James he pushed away my hands.
‘Let me sleep,’ he mumbled, his eyes closed.
Steven looked, his eyebrows raised, seeking direction.
‘Keep going, we need to get him in a gown,’ I instructed.
James didn’t try to resist this time and two minutes later he was in a white hospital robe. I gently wrapped a bandage around his head to stop the sluggish thread of blood still trickling down his face.
‘James, can you hear me?’ I asked.
No response.
I rubbed my knuckles over his chest. His eyes opened briefly and his arms came up and tried to push me away.
‘Fuck off,’ he mumbled, then instantly went back to sleep.
‘He can normally handle his booze. I’m so sorry,’ Steven began to apologise.
‘Don’t apologise; I think it’s the knock to the head. I need to get the doctor now. Don’t go anywhere,’ I instructed. ‘The doctor will want to ask you some questions, probably the same ones I’ve already asked you.’
The only response Dr Wilson could get from James was an automatic, brief but wild lashing out of his arms to deep pain stimuli.
‘How long has he been like this?’ Dr Wilson demanded.
‘He was awake five minutes ago; he only arrived about 15 minutes ago. He’s deteriorated within that time.’
Defensively, my voice rose an octave or two. Dr Wilson gave me a brief smile.
‘Good job,’ he said as we began wheeling James through to the resuscitation area.
The problem with alcohol is that it can very easily disguise the signs of more serious damage. The two most dangerous symptoms of a head injury happen to be two of the more common consequences of alcohol consumption: altered levels of consciousness and aggressive, abusive behaviour.
With James, I could so easily have got it wrong and it sometimes knots my stomach. I could have made the abusive, obnoxious drunk sit and wait in the waiting room; it was certainly tempting. He would have fallen asleep, or at least that is what it would have seemed like. He might have been dead by the time someone went to wake him up. Perhaps having vomited and choked to death, or from the bruise in his head continuing to bleed.
Because of the potential to get it wrong with a simple head injury where alcohol is involved, staff will often put up with some pretty bad behaviour.
In James’s case he was intubated, and taken for a CT scan of his head, which showed a bruise inside the skull. Only after 24 hours in the intensive care unit was he awake, taken off a ventilator and transferred to a regular ward. He made a full recovery.
The final draught
So there you are. If you ever find yourself on a Friday night in your local emergency room, and you’ve had a bit to drink, there are two things I want you to remember: be nice, and be honest.
You see, being a nice drunk isn’t about making my life easier (although that’s nice too), it’s about making your recovery that much quicker. If you listen to our advice, don’t fight against us, and let us do our job, you’ll get the care you need.
Be honest about how much you’ve had and how you got hurt. We’re not here to judge. It’s about helping us to make the right diagnosis, and helping us to give you the treatment you need.
Epilogue:
Reflections on a life of nursing
The dos and don’ts of being a patient
It’s been a long time since I began my career as a naïve, young, outnumbered male nurse. Some days I wonder how I’ve lasted so long, other times I ask myself why I chose to stay so long. The answer is simple, it’s because of you.
Now don’t get soppy on me, what I’m trying to say is that you keep my job interesting. You can make me laugh, cry, tear my hair out in frustration, shudder in disgust, beam with pride, or even make me lose my cool. This job is never boring, and it is rarely easy. Sometimes, every day can be a challenge. But there are some things patients can do to make my job easier. And, by making my life easier, you will ultimately make your hospital stay easier.
Confessions of a Male Nurse Page 21
