The police approached a middle-aged man for being intoxicated in public. His lack of cooperation resulted in a scuffle during which he suffered a cut on the bridge of his nose. After being handcuffed, the police noted he was too drunk to walk so, rather than take him to jail, they called an ambulance and sent him to the emergency department.
When I asked him why he was there, he either didn’t remember anything or pretended not to. He said he had not been drinking and didn’t have an injury on his nose. He was fine and just wanted to go home.
I cast my eye over him from head to toe, giving myself a chance to consider that maybe he might not just be drunk but might be suffering from some other medical problem causing him to be confused. This habit of asking myself if I might be mistaken is a good thing for an emergency physician.
What I saw was an overweight man in a sweatshirt and jeans. He was untidy though not dirty except for a brown streak on the front of his right ankle, right above his sock-less shoe. The streak led down to a walnut-sized ball of poop caught behind the tongue of his shoe.
I pressed the patient about drinking, which he again denied. To counter his insistence that he was not drunk, I asked him why a sober man had pooped his pants. He looked at me and said he had not done any such thing. I pointed to the smear on his ankle and the blob on his shoe and encouraged him to reconsider.
He looked down and offhandedly said, “That’s chicken.”
“No, that used to be chicken,” I replied.
Trying to focus, he looked at his shoe, then reached down and took a pinch out of the ball. Sitting back, he slowly smeared it between his thumb and fingers, evaluating the appearance and texture. He then lifted it to his nose and sniffed. A little smile came over his face and he looked up at me with an impish expression as if to acknowledge I had been right.
Once we were agreed about the nature of the blob on his shoe, he looked around, as if wondering what to do with the mess now spread over all the fingers of his right hand. I handed him a box of tissues and, while we continued our conversation about his medical history, he tried to use the dry tissues to get the sticky stool off his fingers. In his drunken state, he only succeeded in spreading it around until he had poop on all of his fingers as well as the wad of tissues. As we talked, his attention drifted from the mess. His hands sat motionless with the dirty tissues in his lap until his nose started to run. Then, he reflexively lifted the tissue to wipe snot off his nose, leaving a smear of stool in its place.
We got a warm, wet towel and cleaned him up. Then, he rolled over and went to sleep. A few hours later, he woke up, again refused to try to call for a ride, and walked out.
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