Friday, July 1, 2011

The Drunk Tank

"Oh ($@*#&, they put me in there again". My last name was written in pencil in the box. I was in the drunk tank again last night. I have been there almost every single shift for a month and I work 5 evenings/week.

The charge nurse saw me- hey, we need you to open the drunk tank now.
"Sure, but I need to make sure it's stocked first. Give me a few minutes."

"Everybody gets their drunk tank initiation," a wizened nurse commented as he watched me grudgingly walk to the isolated room in the back hallway.

It is a dimly lit room smelling of stale air, acid and alcohol, unwashed bodies, and wet socks. There were no gloves, no urinals, no food, stale water, no blankets. As I took this inventory, a nurse brought me my first patient.

"I'm not open yet, will be in 5 minutes. I will pick him up myself," I promised.

The nurse grumbled and informed the charge nurse, who burst in indignantly to ask me if I really sent a patient back, lecturing me on the importance of decongesting the hallway of extra patients.

Once upon a time, I might have apologized, but now I know better. The room is totally isolated; it is difficult to find someone walking by to fetch supplies. The patients must be constantly watched. As drunks, they are fall risks, and almost all of them try to walk around. Many of them are "frequent fliers" who know the system better than me. They press buttons to test the new person; but I'm impervious now. I have been since 2 weeks ago, the first time I cried.

The patients started coming in, regardless of whether I was ready or not, so I took notes:

Patient 1 was on his 148th visit; he laid in his stretcher and barely moved for the hours he was there with me. His BAC (blood alcohol content) was still .266 (legal limit= .080, it generally goes out of the system at about .010-.030/hour) at the 6th hour of his stay in the hospital.

Patient 2 was on his 134th visit; I had seen him many times. He was supposed to be going to detox but kept threatening to leave if they didn't give him ativan/valium immediately. I took his vital signs and he was tachycardic at 125bpm, at a BAC of .278!! He had no other symptoms of withdrawl, but after a few pills from the nurse, he quieted down until he felt like he wanted another pill. Then he raised a fuss again. He sneered at the food and refused to eat it; apparently it wasn't good enough for his homeless palate. The nurse asked me to take his blood sugar. Darn! I forgot the gloves. I looked in the hallway, no one was there. I yelled out desperately, but no one came. I finally just took his glucose, without gloves. The blood poured from his needle prick like water- thinned, no doubt by all that alcohol. I stemmed the flow, but felt horrified I touched his blood. Looking in his chart, I saw that he was contact precautions for VRE (multiple antibiotic-resistant organism). Great. I washed my hands in alcohol 4x.

Patient 3 was on his 72nd visit. In the waiting area, he got up from his stretcher several times and almost fell. Indignant that he wasn't getting any ativan/valium/food on command, he got up when the nurse turned her back and peed on the floor in our main hallway, right as my manager was walking by. This, coupled with his constant attempts at shaky ambulation was means to put him in 4 point restraints. He could still reach his pants, though, and pulled out his penis whenever anybody walked by. Someone threw a blanket over him, and that's how he came in.
He asked me to come over- I took his vital signs- fine. Breathalyzer- .230, blood sugar-149. "I'm diabetic, you know. I need to pee". I gave him a urinal.
He called me again- "I have this thing, it's called something like (thinks hard) spinal tendinitis- I really need medication for my back". he wouldn't have been cleared to come to the drunk tank if the ct scans or xrays showed anything, so I just noted it to the nurse.
He called me again- "can you take these restraints off?" not without doctor's orders. remember you peed on the floor?
He called again- "I'm hungry. Give me a sandwich." "Can you peel this orange for me?"
And again- "I need to pee again."
And again- "take these restraints off."
And again- "when am I going to get that pain medication?"
And again- "where is my nurse?"
And again- "what nationality are you?"
And again- "I'm in so much pain, please, give me meds now."
And again- "Do you have anything else to eat?"

I stopped answering. He was testing me. So he called- louder, and louder, and louder. Finally he yelled "If you don't answer me, I'm gonna pee on this #)($@*U floor." And so he did.

There were more people in line for getting cleared to come to this room before I was relieved by a colleague, one guy who was on his 180th visit. Regardless, it was actually a pretty good night there for me- nobody was spitting, screaming non-stop, or getting up to assault me.

Working this 4th of July weekend will be crazy, I'm sure. Updates and stories to come...

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