Intubating Alcoholics
The first one was 39 years old. He arrived to the emergency department by EMS unconscious with almost no blood pressure. I placed my ultrasound probe on his heart and saw it was beating alright, just very little blood was entering his ventricles. This is because he was bleeding to death. When I intubated him I saw pooled blood in the back of his throat. His liver was so far gone, so cirrhotic, that blood could not easily pass through it, and the backup and created high vein pressures on sensitive areas like his esophagus and stomach, whose linings themselves were eroded from the caustic effects of constant boozing. He was literally hemorrhaging internally, and it took many units of blood to even get a pressure back. He made it to the ICU, and later that night, died. We later learned from family that he had moved back to town "to get sober."
Case two was a 53 year old chronic alcoholic who came to me confused. He had been a long-time traumatic brain injury patient (from a severe fall ten years prior), disabled and living with family. His sister told me they had found vodka bottles stashed all over the house (Sound familiar??) and they had initially chalked up his bizarre behavior to intoxication, until that night when he collapsed in the kitchen. When he came in to us, arms flailing and combative, his blood pressure was through the roof...until it reversed course and bottomed out. I intubated him and placed a central line- a large IV to use for critical drug infusions- into his neck's jugular vein. The telltale lab test was hi lactic acid level, indicating he was dying of sepsis (germs overwhelming his bloodstream), and despite out best team effort, we lost him within hours. His blood alcohol level was 0.16.
My third patient was "found down" outside a local popular ice cream shop. We all knew him well; he was an old ER "frequent flyer" and known alcoholic. Nobody saw what happened; he was just noticed by pedestrians lying curbside, a large gash on his scalp. The rescue squad said he was actually talking at the scene but became unresponsive en route. When I saw his vital signs- high blood pressure, slow heart rate, and agonal respirations ("Cushing's Triad") I knew he had a massive internal head bleed. It was one of the largest I had ever seen on a CT scan. Despite the grave prognosis I tubed him, called for the helicopter, and transferred him to the trauma center where the neurosurgeons could hopefully work their magic.
None of these men had COVID. The oldest was in his early sixties. All had detectable alcohol levels. Their pathologies were the end-manifestations of a ruthless disease that NEVER lets up. I reflect back to my own experience as an active alcoholic. How near was I to a fate similar to these men? How close did I come to a life-ending head injury, overwhelming infection, or intestinal hemorrhage? Why has my Higher Power placed on the "other side" of the endotracheal tube?
I stopped asking these questions, pray, and accept my good fortunes, all the while reminded of where I could have gone, where this disease, now 3 1/2 years in remission,
could have taken me...
Same for me 30 years with a few one time slip up but for the grace of God. I told mykids that the govenor left the package store open because severe alcoholics would overwhelm our icus we needed for covid patients. Thank you for all you do to try to save lives.
ReplyDeleteWhen I quit cold turkey in Dec 2009, I seriously thought It would be a few months break as always, and then back to the numb of the drug of booze. But something happened. For the first few weeks, I was scratching my skin like it was an allergic reaction. My stress levels were insane, and although I loved counting the sober days, I was seeking another crutch. Praise for not drinking. Forward to March 2010. I find out my daughter, who was 18 at the time, not only dropped out of school, but never really went even though she had a full scholarship. Let's just say, I told my boss I needed a shot. So he poured me one. With a stipulation. If you think this shot will change anything drink it. It sat there on my desk downtown Chicago for three hours until I told him I would not drink it. And he came over and slammed it down. LOL! It was only at that moment did I realize it was never a crutch to get through hard times. Just pretend.
ReplyDeleteJust beginning your book, and am amazed at your ability to be real, in spite of your intellect and positions...I became an alcoholic as a pastor in the late 90's. To this day, I am baffled by the blatant disgust society still shows more prevently than any other reaction to addiction. Thank you for your wisdom and words, sincerely!
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