As most ED’s were designed, mine functions as a kitchen sink for the unfortunate, the lonely and the ones who never win. Now to be quiet honest, there is some beauty in this. For how many men and woman can honestly say they are open to each and everyone. And hospitals are placed in cities, that by default may not all be places of friendship, warmth and kindness. It is the harbour towns that still stand out. For centuries these places have have been important for sailors, drunks, and lost ones in general. Genoa, Amsterdam, Hamburg, Seattle, Signapore etc.
Needless to say, with the disappearance of actual sailors one would expect these towns to change character but of course, they didn’t. The hospitals still find the same men and sometimes woman on their shores. Drunk, unresponsive, Alone. Why you ask me? Well, as irony goes – Stag parties found their ways to the cities that have been catering drunk men all along. And as these young men roam the streets of our cities, dressed up as sailors, they recreate history somewhat.
And then the old question never fades: “what shall we do with the drunken sailor”. And how much we would want to answer this one with “Put him in the brick until he is sober”.. We are more likely inclined to intubate and do a CAT Scan just to be sure.
And where does this leave us now. As my residents approach me with ECG’s, arterial bloodgasses, and heaven forbid chest X-rays of these poor people, I find myself more and more inclined to comment. For what, essentially do drunken sailors need? I will state here that what they need is Sugar, spice and everything nice
- Sugar
Its the stuff we are supposed to check for. A blood glucose. Someone at some point will have to have checked this. Will I double check? Of course not. Whatever the sailor has been up to, it wasn’t OD on his insuline. And, you will say, can alcohol not cause hypoglycaemia? Sure it can, but it won’t.
2. Spice
As seasoned emergency physician you have long time ago learned the hard way that in every case, boring, sad or faul smelling, you have to ask yourself the same question over andover again: What Spicy stuff could potentially be going on, and how sure am I it is not that? So I urge you, take 10 seconds on every sailor: what stands out, what is different? Is there a bruise on his head? Think of trauma. Is there a weird position of his eyes? think Brain stam stuff. Is he too old to be drunk? Think infection and electrolytes. I he actually wearing a sailormen’s costume? Think HIV induced cryptococcal meningitis. But, as I said before – think about it. Don’t routinely test for it.
3. Everything nice
If they are in your house, then why not: Keep them warm and dry for a bit, pour some coffee, some soup and some thiamine while you are at it. Most of all, they need a kind nurse to take care of them, check their vitals every once in a while and speak tender words. Now do not be mistaken that these need be female nurses as in many harbour cities, sailors tend to have alternative sexual preferences
Finally:
If this doesn’t make sense enough there are many more interesting acronyms that will fill your cup. “love eat pray” will work, so will “faith love hope”. As long as you are consistent and never forget: It is the sailors that give colour to this world, to this city, to this ED.
Dr. Gerard Rover MD 