Jim Dey: Unofficial: Business as usual in Carle's ER
By the time Unofficial St. Patrick's Day celebrants show up in the Carle Foundation Hospital's emergency room, their party is over.
The only question is, "What's next?"
Is it a relatively quick checkup to determine the extent of alcohol intoxication, introduce intravenous fluids to rehydrate bodies dehydrated from excessive vomiting, time to sober up and, finally, discharge with a prescription to minimize nausea?
Or does it involve something more serious, including sophisticated care for extreme intoxication leading to respiratory failure? Patients in that condition are put on a ventilator to keep them alive and admitted to the hospital's intensive care unit.
"It really, truly varies person by person," said Dr. Michael Smith, an emergency room physician at Carle.
Dr. Smith was among on those on duty last weekend when the annual Unofficial binge-drinking fest took place.
He has good news and bad news to report about what the emergency room crew experienced.
The good news is that it was pretty much business as usual in the ER.
"We did not see any volume bump at all versus other weekends. That, to me, was surprising," Dr. Smith said.
Carle's ER, a very busy place, treats an average of 250 patients a day.
The Thursday before Unofficial, Carle's ER treated 258 patients. The Friday of Unofficial, it treated 261, including seven for alcohol intoxication.
"We did not see a public health crisis as far as the number of students coming to the ER," Smith said.
The bad news is that Carle's ER treats victims of alcohol intoxication every weekend, Smith calling Unofficial weekend "relatively mild compared to an average football weekend."
In other words, medical treatment for alcohol intoxication is not an occasional problem, one brought about by unique events like Unofficial, but a constant problem caused by excessive drinking across the community, including on campus.
Whatever the frequency and whoever the patient, providing medical treatment to individuals who've had too much to drink is a nasty business. Patients throw up. They become abusive. They have a hard time following instructions and giving information. Further, they pose a physical threat to themselves, even in the ER.
"They tend to wander. They don't always follow commands. They're a very large fall risk," said Aja Bozarth, a registered nurse who works as a supervisor in the ER.
Bozarth dismissed the unpleasant aspects of dealing with sick drunks, saying they're not any worse than other patients.
"For us, (Unofficial) is a typical day. It's something we get used to," she said. "We just know how to deal with it."
But Dr. Smith is effusive in his praise of their work.
"Some of the cases they have to deal with, our nurses are angels," he said.
Three fatalities have been linked to Unofficial over the years.
One occurred last weekend when a UI student apparently fell over an apartment balcony to his death. The number who've suffered lesser, but still serious, problems is far higher.
Statistics reveal that about 20 Unofficial participants per year are brought to local hospitals for medical treatment. But Dr. Smith said that number reflects only a portion of the problem.
Police and ambulance transport many, but not all, patients. Friends or acquaintances of those needing help sometimes bring them to the ER. Others are admitted for injuries, like a broken wrist sustained during a fall, that may be alcohol-related but are not the direct cause by alcohol.
Intoxicated patients in need of treatment run a familiar gamut.
Upon admission, nurses and doctors seek their identification and try to determine the nature of the problem. Sometimes friends identify the patient, sometimes hospital workers secure the patient's official identification, sometimes hospital officials have to wait until the patient is sober enough to identify himself.
The patient's next stop is with a doctor or nurse, who attempts to secure the patient's medical history and determine the proper treatment. Securing a medical history from an intoxicated person is not easy.
"You try. You put down in your chart what was unobtainable and come back in a few hours to try again," said Dr. Smith.
Finally, the patient receives whatever treatment his condition requires.
Patients sober up over time as alcohol metabolizes in their body, and they can get a shock when they finally become aware of their surroundings.
"They wake up, and they don't know where they are," Bozarth said. "There's a lot of remorse. We hear a lot of 'Did you call my parents?'"
Bozarth said the immediate aftermath of a patient's regaining the ability to think clearly is an opportune time to educate them on the risks of overindulgence. That process includes a description of what the patient has been through but may not remember.
Bozarth said nurses "explain to them the events of the previous night and how they got where they are."
She said that sometimes includes telling the patients about how they behaved in the ER, "how they were unkind to the staff."
The general reaction is that patients "are humbled" by the experience and sometimes write letters of apology. Bozarth said letters of apology usually are sent by patients whose parents became involved.
Jim Dey, a member of The News-Gazette staff, can be reached by email at firstname.lastname@example.org or by phone at 217-351-5369.