Night Duty Duel with an Alcohol Withdrawal Patient

Night Duty Duel with an Alcohol Withdrawal Patient

Funny things can happen in the night at hospitals which the duty doctor has to attend. I was the doctor on duty that night when the patient suffering from “acute alcohol withdrawals” was causing all kinds of trouble one could possibly imagine. The story goes this way :

When the phone rang, I woke up with a quick jerk, rubbed my eyes and answered the call. It took me 5 seconds to identify the voice at the other end as I was in deep sleep when I woke up. I realised that I was not enjoying the comforts of my cosy bed at home, instead I was the Resident Medical Officer on duty at the hospital that night. The last thing I could recollect was going to the bed in my duty room after attending to a “pain” call from the surgery ward at about 11:30 in the night.

The male nurse’s words sounded meaningless to me and I had to ask him to repeat what he had just told. He calmed down a bit and in a less frantic manner told me that there was a problem at the “Male Orthopaedics Ward” and that my presence there was needed to handle the situation.

I told him that I would be there in a minute and hung up the call. The digital clock in the phone screen had just displayed the time as 02:30 in the morning. I locked the duty room after washing my face and taking the stethoscope in my hands. The Orthopaedics department was 2 storeys down from my room.

There were about 3 men standing and discussing something serious at the doors of the Male Ward. Apparently, they hadn’t seen me coming and I had to ask them to move a bit to make space for the entry. These were not the usual scenes that one would expect at that time in the hospital ward. I could hear the voice in my head warning me that, something bad has happened! My thoughts were confirmed when I heard loud cries and shouting from the ward as I made way through the doors.

Almost all the patients in the ward were up in their bed and staring at the little group of persons dressed up in whites. It seemed that they had given up any hopes of sleeping that night and were eagerly waiting for me to arrive!

There were 3 male nurses (who we call as “brothers”), one nursing assistant, 3 strangers who were by-standers of other patients in the ward and they were all trying hard to restrain a person who was making all the noise. The person was cursing the men who were trying to restrain him and the kind of words he was using would make any one wish for industry quality ear plugs!

One of the brothers came close to me after instructing the others to stay near the problem maker. It was a case of classic “Acute Alcohol Withdrawal” which had reached the stage of “Delirium”. It was a clinical diagnosis to make and I couldn’t resist a smile when I heard how the patient had got admitted in the Orthopaedics Ward in the first place.

It was the month of April in 2011, and the last day of “Vishu” festival holidays. The main attraction of this festival is that all Keralites celebrate this festival by firing crackers, flower pots etc. This person who was apparently drunk at the time when the accident occurred had a bottle of alcohol in his one hand while lighting the cracker with his other hand.. Instead of throwing the lighted cracker, he threw the bottle far and you can guess the rest of the story.

He had sustained a tendon injury in his hand which the Orthopedician had repaired. The patient had been admitted in the ward for 4 days now and every night he had trouble sleeping because of the sudden abstinence from alcohol. The patient had already been sent to the Psychiatrist for consultation and drugs were prescribed to help ease the symptoms of alcohol withdrawal. The drugs were evidently  not enough for this person.

The patient had beaten up a fellow patient’s by-stander, was cursing everyone in the ward, had even tried to jump down from the third storey of the hospital building before I had arrived. After checking the restrained patient’s vital signs, I asked the brother to start an intravenous fluid of 5 percent Dextrose together with thiamine and multivitamins. As the patient was agitative, I had to try giving a shot of Lorazepam in an attempt to sedate the patient. I knew that sedation was the only thing that could be done and that achieving sedation in chronic alcoholics would be difficult. There were no beds with rails at the Ortho ward and thus the brothers and by-standers had to use their muscle power to restrain this man from getting up from his bed and causing more trouble. The shots to sedate the patient were being repeated every 20 minutes and still his aggression was not getting relieved.

We had to shift the patient to the Surgery Intensive Care Unit for more adequate monitoring as the dosage of the drugs was getting higher and higher.The beds in the ICU also made it easy to restrain the patient. The patent in the meantime had bitten his own tongue which was bleeding by the time we shifted him to the ICU. The situation was getting more and more difficult to control. The vitals of the patient was surprisingly normal except for the high pulse rate. We managed to place a removable oral airway device in order to prevent repeated tongue bites and aspiration of blood into the lungs.
It was 5 in the morning when we finally managed to sedate the patient successfully. The tongue injury was fortunately a minor one and the patient’s vitals were in control at that time. It was an unforgettable night in my career. I spent the rest of the time at the ICU sharing similar such experiences with the nursing staff there. I felt like a relieved man when I handed over my duty to the next duty doctor in the morning after which I went home to catch up on the sleep.



Image credit : Brian Evans

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