Wrote this last moonlighting shift. Tonight, I'm on OB call. We'll see if I have time for another update.
"If I were an underage drunk being detained, and my parents were paying $40K a year for me to go to school, I don't know if I would be asking for them to be called."
The second thing he asked for was a lawyer.
Drunks are fun, O Best Beloved. They're agitated, irrational, and generally very talkative. They forget their medical history and remember their Miranda rights. You discover, in the ED, that a lot of people are aware that they're not fit to consent when they're drunk, but they don't know about EMTALA and they don't know that they're also not necessarily fit to refuse treatment.
Apparently, boy went stage diving at $nightclub, conked his head, woke up fighting the bouncers, the cops, and everyone else. So now he's handcuffed to a bed in the Emergency Department, and he gets a CT scan whether he wants one or not. Not My Patient (TM).
Across the hall, pleasantly drunk and just overage, is my patient. He was standing in the nightclub, allegedly trying to stay out of the way, when he was jostled into a pole by the bouncers. Nice clean laceration on the cheek, nice clean triangular wound on the jaw. He's in that stage of drunkenness where one is articulate and just a little slurred - not sloppy or mean. We debate whether or not I need to stitch him up and eventually I win. He moans with the lidocaine - a drawled 'aw, f* that hurts' that sounds more like an afterthought than a genuine complaint - and then bubbles praise about the effectiveness of my 'sticking needles into people'. I let the nurses scrub and irrigate before I come back in to suture. This, O Best Beloved, is a perk of being a doctor - the nurses will scrub and irrigate and even numb if you ask them to; as a medical student that was my job.
It's 6-0 monocryl: a hair-thin piece of fishing line eighteen inches long. It's impossible to see except for the liquid reflection of my operating light. The rhythm is soothing; I like to sew. Four simple interrupted stitches - I could have closed it with a subcuticular running and made it really pretty, I have enough time, but it's the ER and it'll heal the same either way. He talks the whole time, a commentary on what happened, the TV, current events. It's liberally sprinkled with the sort of obscenity that comes with some people's drunkenness - almost inoffensive in its banality.
I put a corner stitch in the jaw laceration - I'm particularly proud of that bit of artistry as soon as I pull the stitch snug. In the bottom right flap, out the middle of the wound. In the subcuticular space of the top flap, out the other side without breaking the skin. In deep and out the skin on the bottom left flap. Pull gently and the gaping triangular wound suddenly resolves itself into three lines spiking out in a Y, no buckles or gaps. I tie and cut, refrain from clapping gleefully at the pretty pretty stitches that I've put in. His friend leans over and pronounces approval. He moans about having stitches on Easter Sunday. I tell him to stay away from poles, and that you can hardly see them.
I like pleasant drunks. He's effusive about my skills and doesn't argue with my instructions. It's been a good half-hour.
Coming back out to the ER desk, Dr. K waves me off. "Do you think I need to see it?" I tell him it's pretty and I like it. "Get him out of here, then." He's composing e-mail on the ER computer. It's an unusual night, but neither I nor J, on medicine call, nor C, on peds call, are complaining. 0530 AM and my ER log sheet has three stickers on it. Not bad for an ER that gets some 45-50,000 patient visits a year. Tonight, I'm getting paid to spend seven hours updating LiveJournal, cleaning out e-mail, and writing referral letters. Next time - who knows? It evens out.