Wednesday, September 7, 2011

just like me. just like you.

55 year old male with a history of alcohol dependence/withdrawal presents to the ED after his partner finds him lying on the floor, lethargic, tremulous, with a pool of blood around his head. patient's alcohol dependence dates back to his early teens, or maybe much earlier, as his mother is reported to have been a heavy drinker.

during his mid 30s, the patient is involved in a major motor vehicle accident and nearly loses his life. he was the driver, and he was intoxicated at the time. patient vows never to drink again.

sobriety ends after 5-6 years when patient begins drinking again, heavily: on average, 1-2 bottles of wine per day.

during his early 40s, the patient is involved in a second major motor vehicle accident and nearly loses his life again. he walked into oncoming traffic; he was intoxicated at the time. patient vows never to drink again.

sobriety ends after 1 year when patient begins drinking again, heavily: on average, 1 bottle of vodka per day.

during his late 40s patient is involved in a third major motor vehicle accident and nearly loses his life. he was the driver and drove straight into the side of a liquor store; he was intoxicated at the time. patient vows never to drink again.

sobriety ends after 1 month.

during his early 50s patient experiences his first withdrawal seizure; this event occurs because patient is unable to sustain infusion of alcohol while asleep. patient seizes in the morning, is brought to the hospital, successfully detoxed, and discharged. patient vows never to drink again.

sobriety ends after 1 month.

patient experiences his second withdrawal seizure; he is brought to the hospital, successfully detoxed, and discharged. patient again vows never to drink again.

sobriety ends after 3 weeks.

patient experiences third withdrawal seizure and presents to the hospital today.

in a few days, he will vow never to drink again.

sobriety will end after __ weeks.

Monday, September 5, 2011

goodbye.

she died today. agonal respirations, hypotension despite fluids wide open, extremities edematous. skin cool, yellow-green. pupils fixed, residual bowel sounds present. heart sounds absent, lung sounds absent. 9:22am.

her body is quickly cleaned, top to bottom, front to back. limbs flop around and slap against surfaces; an eerie slapping sound. tag is placed around big toe, and body is wrapped in clean white linen. you'll never forget her face.

did she feel any of this? did she slip away before her body started failing? and you wonder where she went.

Saturday, September 3, 2011

no one will know she died.

a young patient in the icu is irrevocably, rapidly dying. she's from another country and all of her family is there; she has no family or friends here. despite our best, best efforts, we've been unable to reach her family or friends in her country. now, no one will know she died.