The Things That Medical School Won't Teach You (8): "Dealing with Drunk Patients"

After a short stint of dealing with inebriated patients within the casualty department lately, I guess this is as good a time as ever to highlight one of the mainstays (and frustrations) of the healthcare experience; and there can be no better way of showing this than to indulge you in a very sordid experience from my internship.

So there I was working in Casualty, and having an average kind of day. Then there's a bit of a ruckus as a group from a county referral hospital that will remain unnamed (including Medical Officer interns) brings a patient into the Casualty area. The patient's dramatic story goes a little something like this:

He had been drinking at a local tavern, and once he had consumed his fill, he decided that he was not going to pay the bill. He was most clear in communicating this to the bar owner, who happened to be a woman, and on this day she was not going to settle for this level of belligerence. She therefore proceeded to take a Fanta bottle and smash it against the left side of the bloke's neck.

So he's literally been hand delivered to us - a referral - because it has been determined that he's ended up with a laceration to his jugular vein. Without even staying to answer any more questions, the whole group disappears, leaving us to mull over the fate of this unfortunate soul. This was certainly a task that might have been better handled by a Vascular Surgeon (heck, even a General Surgeon), so I relayed the message to my Medical Officer (MO) and he told me to take a "peek under the hood", and make my assessment.

So I take him into the minor theater with two assistants in tow to help me cope with any eventualities...and that's when things get interesting: the patient who appeared almost lifeless up until this point suddenly starts drunkenkly flailing his limbs all over the place, you'd think he was reliving some vividly joyous moment in the pub. Not only do I face the risk of perhaps dealing with a gusher of a leaking blood vessel, I have the added pressure of dealing with an uncooperative idiot. So I do the only thing I can do: ask for more people to hold this person down, which ended up being 3 more people (his relatives).

So, with the idiot well secured, I have one of my assistants peel off the heavy layer of compression dressing from his neck, with me standing with the needle holder and suture ready to start suturing. Luckily, there was a laceration, but the bleeding was minimal and definitely not from the jugular vein. After placing enough sutures and getting an adequate level of hemostasis, I sent him to the ward for observation and to sober up. Lord knows I wanted to rap his head with my knuckles, but I just held back the urge and walked away.       

No matter your attitude towards alcohol usage, I guarantee that you will without a doubt be irritated about dealing with an inebriated patient. Now, technically, people can drink alcohol at any time of day on any day of the week, you are more likely to be overwhelmed by such patients at night time and the weekend; but as in the experience I quoted above, that patient showed up around 3 pm, so if you're from a drinking nation you'll have to be prepared whenever.

There really is no way of telling what kind of inebriated patient you'll get; alcohol elicits many different responses from its consumers. Some people might just be happy and might even get more courageous (even awkwardly flirtatious), while others become a chaotic storm of anger and rudeness; then you also have the person who'll drink themself into such a stupor that they become like the living dead, practically comatose. I have also encountered the emotional wreck (more often a woman than a man) who becomes so overcome by emotion and just breaks down crying.

Come what may, it usually comes in handy to have a calm demeanour. Bear in my mind that there are a myriad of ways to effectively deal with the situation:

1. If the patient gets belligerent and violent, security has your back. If they refuse to get something like a wound looked at, allow them to go home and calm down. Soon as the numbing effects of alcohol wear off, they will make a beeline for the hospital to apologetically get their wounds treated.
2. The emotional lot can usually just be allowed to cry away their sorrows. They'll come to their senses once the alcohol has worn off, and there will usually be a relative on hand to console them.
3. If the flirtatious weirdos can't take a hint, use security to put them in their place.
4. The living dead will pose something of a difficulty: make your assessments and decide whether it's the alcohol that has put him under or possibly the effect of an as yet undetected head injury. If you have a CT scanner on hand, take a look at his brain and clear yourself of any doubt. If aforementioned patient lacks the capacity to pay for such imaging, weigh out the pros-and-cons of keeping that patient around for observation versus sending them out to a place with an ICU. It's remarkable how someone with a GCS of 3, can suddenly return to the land of the living once the alcohol has had some time to work its way through their system.

The experience might be rather annoying at the time you undergo it, but truth be said, these experiences are comedic gold that infinitely sharable among your colleagues; if you're going to deal with these folks, you might as well come away with a good story to tell.

God Bless