A Quiet Night in Casualty

A quiet night. Apart from the ten year old who coughs through every winter and the two year old with a cut leg, all our patients wash up on our shores on a tide of intoxicants. Subtract grog from these lives, says the Director, and we could close half our cubicles. Take away drugs and we’d need only a quarter.
We treat the thirty year old whose man – drunk – split open her scalp and broke three of her fingers; we check out the Frequent Flyer with (real) kidney failure disabled for the fourth night in a row by (spurious) chest pain; he seeks opiates and when denied a needle, suddenly invigorated, he walks out. Tall and elegant, the forty-something in the very high heels tripped over her long legs following a fusillade of shots (vodka). She tore her medial collateral ligament. The man snoring down the back treated his epilepsy with a slab in place of his Epilim. The ambos brought him in, fitting. He’ll need observation until morning…

The ward slows, starts to doze. Time to go to the loo. Above the urinal a laminated protocol provides advice on intoxication. The notice is headed:

TOILET PAPER – SEPTEMBER 2014.

Around two in the morning an irruption of large bodies in blue. One, two, three, four police officers, escorting one small man whose pale blue shirt is soaked. Handcuffed to the bedrails, he yet manages to give the cops the finger – two fingers actually – one on each hand. He blows kisses to the cops. The officers remain unprovoked.

The ambo, a non-combatant, provides the story: The pub called the coppers because he was behaving wildly. His friends say he had taken ecstasy, crack and alcohol. And another tablet – they don’t know what. He went crazy in the pub. Security tried to quieten him and he fought them; then he fought the cops. These four are only half the number it took to control him. They cuffed him. Somewhere along the line he vomited.

The man is surprisingly small. His short half shirt is soaked in lumpy vomitus. Between his gallery of tattoos patches of skin are missing from his knuckles. A large abrasion swells and shines dully on his forehead. A dull steel ring decorates his lower lip. Another improves an eyebrow. When a nurse tries to mask him (“You’ve been vomiting, we need you to wear a mask”) he speaks simple words in surprisingly mild tones: Please don’t touch me. Please don’t touch me. The nurse looks too slender, too young to handle this unpredictable person. Her speech is a further surprise. Turning from the patient to the gathering of uniforms congregating around the cubicle, she asks: Do we really need all these people? She draws the curtains, comes close to her patient and asks: Have you taken drugs?
No.
Any alcohol?
No.
Have you been in a fight?
No.
Has your head has been injured?
No.
Have you vomited?
No.
Do you take any regular medications?
No.
Do you have any medical history?
No.
This is a nineteen year old without symptoms, without any reason to be here. Mildly the nurse says, Well then, once we find there’s no reason to detain you will you have any objection if we return you to these officers?
No.
To his denials of all symptoms and concerns the man adds, I don’t believe I have any obligation to answer your questions.
A compact young doctor joins the conversation: Look, Simon, we’re here to help you. We aren’t the police, we’re not charging you, we’re not collecting evidence.
Like her nursing colleague the doctor speaks calmly. She focuses on assessing and helping the patient. Your heart is racing. You’re a bit dry. We’ll put a drip into this vein. Do you mind?
No answer. Eyes closed, resolutely mute, the young man affects a coma rather than concede anything to anyone.

The boy trembles as far as his manacles allow. Is he just scared? Are his drugs making him paranoid or is he frightened by the storm of chemicals that fight each other inside his brain? Or just terrified of the police?

His shirt is wet. The thermometer reads 35 degrees.
Are you cold?
No.
Would you like a blanket?
No.
Do you need to pee?
No.

Taking the nurse aside I confide: With this drip running he will need to urinate eventually. Handcuffed as he is, he’ll need help. How will you handle that?
We’ll give him a bottle.
He won’t be able to unzip. Someone will need to pull his dick out for him.
That will be your job.

An hour later, I find the nurse and ask for the bladder report.
He’s been. He’s voided.
How did you do it?
I took him to the toilet. He did the rest.
In handcuffs?
O no: the cuffs are off. He’s calm now. I walked him there and he managed himself. The cops are leaving.

I check in the cubicle. With no need of coma or bravado or petulance, the young man – or boy – lies on the bed and chats with his girlfriend – another surprise: impeccably presented, she’s a demure young lady.

Domestic violence, drug seeking, a lacerated child, another who coughs; grog, grog, grog, and multi-chemical intoxication…

A quiet night in Casualty.

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