All Star Wrestling

Last night I was on call and the craziest thing happened. I got a call from an attending physician in the community and he said that one of his patients with a history of cardiac problems was being admitted for an unexplained hemoglobin. He asked my team to take care of the patient. The patient was a 79 year old male that had a history of 2 open heart surgeries (CABG = bypass). He also had a polyp removed from his colon in 2003. Whenever any male over the age of 60 has a declining hemoglobin we worry about an internal bleed. The bleed usually is coming from the colon and often it turns out to be colon cancer. 

The patient's entire family (1 son, 4 daughters and his wife) were all there. It was like a family reunion. It was way past visiting hours but no one mentioned that to the family. I came into introduce myself and examine the patient at about 10:30 pm. It was like a hornets nest with all the family asking me questions like; what is wrong with our dad? are you going to run this test or that test? why aren't you doing this or that? Everyone has suddenly become an expert and wants to question everything. I spent extra time explaining everything to the family. Once you get beyond the surface level of knowledge the family members quickly became lost and realized we knew what we were doing. 

As I was examining the patient and explaining things to the family I realized that the patient that was sharing the room on the other side of the curtain was becoming agitated. He was not my patient. He looked like he was in his mid thirties and had a rough go at life. I looked like he may be detoxing. As the examination went on he became more distressed and finally while I was listening to my patients heart I was jumped on and punched by the neighboring patient. He had stood up on his bed and lunged / jumped through the curtain and on to me. He was on the other side of the curtain so I did not see this coming. He knocked me onto my patient and I quickly stood up and turned around to see what was going on. The neighboring patient was yelling and swearing and saying he was going to kill me. He was obviously hallucinating and in the middle of severe alcohol withdraw. I tried to calm the patient down and signaled a nurse to get security. My patient's son wanted to fight the alcoholic patient and I had to convince him to back down. The daughter's and wife were hysterical and 2 of them were crying while my patient was yelling at them to calm down. 

I had the nurse call to try and reach the patient's attending who is infamous for not returning pages and not being available. Security arrived and began to wrestle with the patient and try to restrain him. The patient was tough and put up quite a fight. In the mean time the attending never called back and the nurses were panicking because they needed to sedate the patient but without doctor's orders they were not allowed to administer any medications. This wrestling match had been going on for over 30 minutes. We moved my patient and his family to a different room. The nurses came up to me and asked if I would order a medication for sedation for this alcoholic patient. Given the circumstances I said I would help out and I ordered some ativan and the nurses were able to sedate the patient. Before putting the order in I ran it by my senior just to cover all the bases and she was fine with it and thought I made a good choice. 

I finished up with my patient by doing a rectal and finding blood in the rectal vault and then transfusing 2 units of blood as his hemoglobin was dangerously low. I went to my call room and laid down in bed and just started laughing out loud. "What a crazy night!" I said to myself and then realized how happy I was and how much I loved this job.