It was Saturday night in the emergency department. Probably about 1am. It always seems to be Saturday night at 1am in the emergency department. This is the time when those who have consumed one too many pints of Tennent’s lager come stumbling in, reeking of Tennent’s, clasping on to that Tennent’s can, with Tennent’s written across their football shirt – and can’t figure out why they’re covered in blood….and Tennnent’s.  That is, of course, until they look in the mirror and realize they can see their skull through that irregular triangular shape torn out of their forehead:

“What the…how the F**K did I do THAT!” is the usual response.

(Oh yah – if you couldn’t gather that this story takes place in Scotland, then, well, this story takes place in Scotland, though I’m sure you could replace the drink with Corona if you’re in LA or Kokanee if you’re in British Columbia).

If the pubs were open a bit longer, this guy might have stayed longer. Inevitably, there are other pubs open later, meaning the flow of people meandering almost synchronously throughout the department continues until about 3 or 4am. As does the lingering smell.

This one night in particular, the middle aged chap who meandered into emergency didn’t have a chunk of skin missing from his forehead, revealing his skull. He did have a small laceration on the back of his head. And, like most patients in this state, was completely unaware that he was covering the white sheets with his blood.  When I propped him forward on the trolley, the blood formed a stream from his occiput to his back, with his shirt revealing an almost perfect red circle – as though he just lay down on a margarita pizza. The black trolley had a shine to it, identical to the area on his back, almost like black ice on a west coast winter day.

Oh – he also had a dislocated index finger.

X-Rays showed there wasn’t any break of the finger – just the result of a really awkward fall – Hmmmm…I wonder how that could have happened. What causes someone to 1) fall, and 2) fall awkwardly…

OK – so you don’t have to be Sherlock Holmes to put the pieces of the puzzle together – though if you’re the intoxicated one, it can be difficult to put the pieces together the next morning:

“Uhhhhh…honey…I’ve got a bit of a sore head….any idea what happened last night…I can remember buying that 12 pack of Tennent’s and then…”

I thought I might as well quickly put in a few stitches. It sounds simple enough – but sometimes the ability to retain instructions in an inebriated state means that just when you, the Doc, go to put the sutures in, the pleasantly clueless patient responds with a slightly comedic:

“ehhhhhhh……wwwwwhaats gooooin oooooon….deed ah hurrrrt ma heeeed?”

(That’s Scottish for ‘head’ by the way…though I might have misspelt it…I must confess…I’m not entirely fluent in Glasgwegian.)

After stitching the head, it was time to sort out the finger. Usually the humane thing to do is to offer someone some sort of agent to help ease the pain when pulling a finger back in place  – something like Entonox gas usually does the trick. I offered this rock solid dude some gas, as though he was a whimpering pregnant woman, to make it a bit easier.

His response?

“I’m f***ing drunk! I don’t need anything!”

Did…that…just…make…sense?!

Did I just get talked down to by a drunkard?!

Yes, yes I did – because drunk patients have this ability to talk to doctors as if they’re ordering a Big Mac after their booze session – in fact that’s probably why they seem so anxious in emergency … they just want that Big Mac….and large fries…and  large coke…

…And 20 nuggets.

It’s almost as if drunk patients…lose inhibitions. Hmmm…

Anyhoo, this chap, who oddly made sense, got what he wanted – absolutely nothing.

His wife, standing in the corner of the room, out of sight from Mr. Patient, seemed to approve. I can’t recall her saying hardly anything, but persistently conveyed that look of:

“you got yourself into this mess you drunken a**hole, you don’t deserve any pain relief…or even to be seen by a doctor…you be quiet and the let doctor get on with it!”

Approaching this crooked index finger, I saw a glimpse of fear and anxiety in the patient’s eyes, masked by an intoxicated drunk face – he talked the talk alright but I was less convinced he was going to walk the walk. If he was to walk the walk, it certainly wouldn’t be a straight one. The apprehension on my part arose from the thought that, perhaps:

“Hey, maybe this massive guy, whose twice my size, and claims he doesn’t want anything to ease the pain while I pull his finger back into place, maybe, just maybe, when I actually DO pull his finger without any anaesthetic, he will just get really, really pissed off and punch me in the face? In which case…I would have to stitch up my own face – if conscious – and then have to re-Xray his hand because he’s probably fractured his fifth metacarpal.  Yah. What if THAT happens?”

I couldn’t help but re-offer some painkillers, as if communicating with this guy would be particularly helpful.

“No – I’m still drunk”.

OK. Fair enough. You got it buddy.

Now, drunk patients also vomit.

Luckily…he didn’t vomit.

I grabbed a hold of his finger, and:

“Ok there sir…done.”

The drunk guy was right – the remaining alcohol in his body acted as a sufficient anaesthetic so that pulling his finger, in the end, was really was no big deal.

The repeat X-Ray showed that the finger was perfectly back into place. No fractures. Perfect ROM, or Range Of Movement for the geeks.  (Thank you, Thank you, honestly, it was nothing…OK it was kinda cool…kinda…only because I was an inexperienced dude).

Believe it or not, the chap had the courtesy to thank me – even shook my hand with a firm grasp from his newly set finger (his ‘anaesthetic’ was still working).

Always lovely to have your work appreciated.

Though I discharged the patient, who meandered out of emergency with his wife, the smell of Tennent’s remained.

Disclaimer No.1: I did NOT get paid by Glasgow’s biggest beer company to write this story. HONESTLY.  If anything, a lacerated scalp and dislocated finger SHOULD deter you from drinking…though I’m sure by reading about beer for about 3 Microsoft Word pages you might oddly enough feel like one…

Disclaimer No.2: In my first Disclaimer, I mentioned Microsoft Word. I also did not get paid by Microsoft. This was actually written on a Macbook Air…