Two Patients Who Came Back the Next Night

How to Stay Skinny

Mr. Alvarez was forty-seven. He came in right at the first of my shift with confusion and a history of having used methamphetamines. He was so agitated he had to be restrained with leather straps on all four of his extremities and had to be given a lot of sedatives before he finally fell asleep. All testing done on him was normal except for having methamphetamines in his urine.

He was later more calm but when I tried to get him up to see if he could be discharged, he was paranoid and kept asking me if it was safe and telling me he was going to die.

It took him all night long to clear him enough to be discharged. I started my “Why You Should Not Use Drugs” speech by asking him why he used drugs. I like that question because there is really no good answer to justify drug use. His answer was one I had not heard before and it kind of disarmed me. “I use meth to loose weight,” he replied.

I merely pointed out all the problems he had because of using meth. I gave him my opinion that it was not worth it, even to keep skinny. I provided him with a list of community resources to help him get off meth. Off he went.

The next night, just as the shift was starting, medics rolled in with an agitated patient in four point leather restraints. Who do you think it was but Mr. Alvarez? He was in exactly the same condition he had been in twenty-four hours earlier. He, again, had to be physically and chemically restrained after which he fell asleep and was not ready to be discharged until just before I went home in the morning. He claimed to have no memory of either night’s events.  He also denied that he was a slow learner.

A Man of the World

My patient of the week was in his mid-forties and came in by ambulance, worried about chest pain and a fast heartbeat. He was one of those drunks that make you wonder if he is a jerk who just happens to be drunk or if he is just obnoxious because he is drunk. Either way, he was so rude, he really got under my skin despite my best efforts to prevent it.

He wore a cheesy, “I’m smarter than you are” sort of a smile all the time. He went on and on about how things were so much better in his homeland of Great Brittan. He told me he had been a soldier in England and he “knew better,” whatever that meant. He treated me with contempt when I told him a normal heart rate was up to 100 beats per minute. “Any corpsman in the British Army knows a normal heart rate is between 60 and 80,” he corrected me.

I tried to be as pleasant with him as I could as we went through the necessary steps of getting him feeling better and making sure his complaints wouldn’t require him to be admitted to the hospital. After going over his prescriptions and discharge instructions, I asked, as I try always to do, if there was anything else I could do for him or if he had any questions. “Yes,” he responded. “What’s the deal with the ponytail?”

You can imagine how that affects me. I don’t think there is any “deal with the ponytail.” The question was completely inappropriate and, by then, I was totally fed up with him. My patience exhausted, I said, “You are a sick man,” and walked away. He yelled after me, “Why do you hate the English so much?” I didn’t bother to reply.

The next night, I was starting my shift. As I was taking report from the outgoing doctor, something came up that caused me to tell him the story of my interaction with this man. As luck would have it, just as I was telling the story, who should come in by ambulance but the same guy? This time he was there because he told someone he overdosed on the very same medicine I had prescribed for him the night before.

After we made sure he was not poisoned from any overdose he may have taken, I again had the chance to bid him goodbye. I explained the police had put him on a psychiatric hold so he was going from the medical emergency department to the psychiatric emergency department to get help to keep him from committing suicide. When I told him he had no choice, he asked, “Oh, so this is a police state then?” He went off about not needing to go to emergency psychiatry because he was a “man of the world” and “a soldier.” By then, I was so sick of it, I told him off. “You are just a sad drunk,” I bluntly told him. He went off again about what a wonderful person he was and I repeated, “You are just a sad drunk.”

Off he went to talk to the psychiatrist. Though he told me he was headed back home to England the next week, I somehow had the feeling that would not be the last time I would get to clinically interact with Mr. Smith.