Suicide, Tantrum or Just Stupid?

Beep, Beep, fuss, beep....... "Hi this is Doctor   ___, what do you have?" "Hey Doc, we have a 22 year old male who od'ed on xanax and drank some liquid dishwasher detergent." "What are his vital signs? Is he alert and protecting his airway?" I ask. "Yes he is stable and protecting his airway. His vitals are HR 98, RR 24 and BP is 134/92, he is alert and oriented x 3." they scream back over the radio. "Great, what is your eta? If he starts to crash let us know." I said. "Thanks Doc, we are 10 minutes out."


It was 2 in the morning and we had 4 sets of paramedics on their way in with a variety of sick and not so sick patients. I continued taking care of the patients I already had and waited for this toxic ingestion to arrive. About 10 minutes later I heard a bunch of yelling and screaming coming from the paramedic bay as my toxic patient arrived, yelling and screaming at everyone. One profanity after another came flying out as he made sure to insult everyone his eyes came in contact with. As the paramedics rolled him by I looked up to see how sick my new patient was and I yelled, "take him to room 3, in case I have to intubate him." They obliged and looked like all they wanted to do was drop off this maniac and get out of the ER as fast as possible.

I made my way over to room 3 and started examining the patient as they hooked him up to all the monitors in room 3 and he started told us the story be he was just yelling and obviously agitated. He told me to F+&*& off and attempted to spit on me. This was not the first nor the last time a patient who I was trying to care for tried to spit on me, so I was prepared and dodged the spit like a champion bull fighter. I quickly assessed the situation and fortunately his much calmer girlfriend was there and could tell us what happened and what she saw.

As it turned out he had been on a bender and had "eaten" (her words) all the xanax in the house, which was not enough to kill him. He was only looking to get high but when he found out they were out of xanax he became irate and decided to drink some Cascade, about 2 cups in her estimation. He immediately started throwing up at home and she thought most of it had come back up. I quickly completed my exam and noted that his throat was irritated and also that his teeth were particularly shiny and had no streaks.

I had one of the medical students call poison control to get any further recommendations for treatment and I started a some treatments and stabilized the patient. I saw a few other patients when I was called back by the nurse because "Mr. Clean" (her words) had started to cough up / vomit blood. I made my way to room 3 prepared to intubate  our patient but he look ok and was ventilating nicely. He looked like he was withdrawing from xanax / other benzos. I gave some medication too help prevent a full fledged withdrawal with seizures and other horrible symptoms.

Finally poison control called back and I was paged to take the call. I explained what I had done so far; which tests I had orders, and the interventions / treatments I had started. The doctor on the other end of the line, said "perfect, you did not even need to call us, great job!" I told him thanks and explained I needed to document his recommendations for liability reasons and he chuckled and replied with "smart, very smart, cover all your bases." He also let me know what to watch for and what to expect.

Fortunately my patient had not consumed enough of Casacade to cause major problems that would be permanent. He did however burn his throat, mouth and esophagus. He also had aspirated some into his lungs. I explained to him and his family and  girlfriend that he would be admitted into the hospital. At this point the patient was calmed down and ready to talk. It sounded like this whole event was a tantrum and not a suicide attempt. I called for a 24 hour sitter anyway just incase. I was able to make some phone calls for social work to see him the next day and talk to him about getting into rehab.

This was 1 patient of the 24 I saw that night. While I was caring for him I had 6 other patients in rooms that I was responsible for as well. What I night. I love what I do, it never gets old and when you think you have seen it all, the doors come flying open and a new adventure begins. You can't make this stuff up, real life better than fiction.

The thing about emergency medicine is that you get to do a little bit of everything. You do some minor surgeries / procedures, OB/GYN, psychiatry, orthopedics, dentistry, urology, neurology, GI, cardiology, ophthalmology, dermatology, pediatrics, toxicology, radiology, anesthesiology, primary care and so much more.  Often you do all of these within the same shift. Perfect for ADD / ADHD.

Good times.