Three guys in the Solarium

We used to put drunks in the little anteroom at the ambulance entrance. I lovingly called it “The Solarium.” The word “solarium” comes from the Latin, sol, meaning sun. I think I picked that name with obvious irony, given I only work at night.

Usually, the drunks would just sleep there until they woke up and could walk. One night, three drunks who were parked in the solarium didn’t follow this predictable pattern. I recorded the interesting problems that each presented.

First was a skinny, young guy with scrapes on his knees and elbows. He was brought in by ambulance after he was found on the ground, intoxicated. He was too drunk to safely walk but he kept trying to get out of bed. We were worried he might fall so he had to be restrained for his protection. When his ankles and wrists were tied to the bed, he went ballistic.

It is not unusual for us to have to restrain and sedate intoxicated people for their protection. I ordered a shot of droperidol, a commonly used sedative.

He relaxed a little after the shot but soon got more agitated. I thought he just needed more droperidol. He was given another shot but got even worse after that was given.

I then wondered if he were having what is called an extra-pyramidal reaction, a common side effect from this medication. The antidote for an extra-pyramidal reaction is a shot of Benadryl, which he got.

Rather than settle down, as I had expected, he got worse still. The Benadryl was repeated. He got even worse still. His pulse went up to 190. He was sweaty and agitated and wouldn’t talk. He pulled violently against his leather restraints.

I was then worried he might have some other medical condition, rather than just being drunk. Laboratory tests and a toxicology screen were ordered. His alcohol level was 215. (Remember that 80 is driving limit in our fair state.) That is high but I didn’t think it high enough to explain what was going on. Everything else came back normal.

Eight hours later, he sobered up and said he freaked out because he just hates to be restrained. He got himself dressed and walked out perfectly fine.

Next was a sixty-year-old man with huge belly. He was also brought in by ambulance for intoxication. He was unable to talk clearly.  He was watched until he was perfectly awake but still had unintelligible speech and could not walk. I noted a broken-down wheel chair at his bedside so wondered if he usually was unable to walk. He couldn’t tell me and he had never been to our hospital before so we had no old records on him. I offered him paper and pencil but he was not able to write, either. I then was concerned because I was not able to determine if this condition was from some old problem like a stroke or if he might be having some new, worrisome illness. What a nightmare!

I ordered tests on him that all came back normal. He still was not able to talk. I made a plan to just keep an eye on him over night and see if social services could find out something about him in the morning.

Eight hours later, he was sober enough to communicate. He told me he was fine and walked well enough to be discharged. He left, pushing his wheelchair in front of him.

Finally, I had a man in his 20s who had walked into jail then collapsed, unable to stand or walk. The jail nurse refused to accept him and the arresting officer loaded him into her patrol car and brought him to us.

The officer said he had been walking and talking when she arrested him and she felt he was faking. After I examined him, I was also suspicious he was pretending. He wouldn’t stand or walk but woke up when smelling salts were placed under his nose. When we forced him to stand, he let himself go to ground. We picked him up and put him back in the bed to sleep. Later, the officer called me when he climbed back onto the floor. When instructed to do so, he got up and crawled onto bed without any difficulty but would still not stand or walk.  The poor officer was super frustrated. She wanted to just give him a citation and leave him but, because she didn’t know his name, she was not able to just cite and release him. She had to sit with him all night long until he was sober enough to get up and walk out to the patrol car, still refusing to give his name.