Crie de cour (and liver, and various other organs)

Well, I'm going to be scanning the newspapers tomorrow hoping not to see my face. Listen to this ongoing concatenation of fuckups.

At around about two in the morning the police notice some guy blundering shirtless down the road. They pull him over, breathalyse him and discover him to be spectacularly, almost incoherently drunk. Blood alcohol was 0.39, which is pretty damn high for a skinny little guy.

From what I can work out they arrested him and dumped him at the ED.

He was not pleased about this turn of events (although to be honest, the scars and the slogans and images tattooed on his body suggested he was the type of man who was frequently and violently displeased). In fact, when the nurse went in to assess him he threatened to punch her.

The nurse went and got Dr Jihad (not his real name, but apparently his brother's), who inflamed the situation by trying to take blood from someone who didn't like needles, blood tests, hospitals, doctors, Arabs, "stuck up ****s", or men with moustaches.

At this time it became apparent that the ED security guards were not in the building, since they had been called away to another displeased person elsewhere. By this time the man was parading around the room with fists raised threatening mass fatalities. Dr Jihad went and sought the advice of the senior registrar - i.e.; me.

Things then worsened. I managed to calm the guy down (there should be some kind of international scale of drunkenness, and when someone weighing thirty kilos less than me and standing six inches shorter threatens to take "all of y'on", it's not a goood sign), when the one security guard that could be spared from dealing with 'kickboxing bikie with the head injury' arrived - which enraged our guy more.

He was eventually escorted outside to have a cigarette while I worked out what to do with him.

He didn't want to be here.

He couldn't be detained. He did not have a "treatable mental illness", and did not require the services of a consultant psychiatrist.

He could not be kept in the hospital under 'duty of care', because our security guards were under express instruction that it was illegal for them to prevent anyone leaving the hospital unless they were detained.

He could not leave, because he was stumbling around the room and was clearly intoxicated to the point where he could not look after himself. If he leaves the hospital and gets run over, it's our fault: we have a duty of care.

By this time he was shouting at a fifty eight year old woman with kidney stones in the aiting room and asking her "what she was fucken staring at".

I asked him if he had any friends or family who would come and pick him up from the ED at four in the morning. He suggested that this was unlikely.

I rang the police and they said that they had no further plans for him. I asked if he was still in police custody, and they said no, and I asked why they thought he needed to be brought to a hospital and lie in a six hundred dollar a night bed that was intended for the use of sick people. The police said he was too drunk for the cells.

I pointed out that they had driven past this man's house on the way to get here, since he lived five hundred metres down the road.

By this time I was beginning to be aware of the other sick people in the ED who needed my attention, and who needed protection from a hostile, drunken, partially clothed man.

I went outside where he was standing with the security guard and raging about being locked up and told him that my medical advice was that he stay in hospital until he was sober.

I said we were willing to order a cab and that we would pay for it to drive him home - I admitted that a taxi in this area could take several hours at this time of night.
I also said that there was no way me or the security guard could stop him if he wanted to walk home, which would be straight down the road, first left then probably only one or two houses along on the right.

I told him I was going to call the taxi, went and got a coffee and then checked two minutes later to find he had, indeed, left the hospital against medical advice.

I feel this was bad medicine.

The whole thing was a lose-lose situation. I think it is very likely that he got home without getting run over. But a few years ago in Queensland there was some guy who presented to the ED as clearly agitated, left a few minutes later and subsequently that day commited suicide. The judge found the hospital responsible.

See, if that guy died on the way home, I'm responsible. If I had detained him, I would have been responsible for the "bad detention", which is obviously a much lesser burden - although it does involve getting called up in front of the boss and told about what you've done wrong.

But I don't like detaining people at the best of times, and detaining him means the psychiatrist has to come and see the man when he's sober, and it's a big thing to do to someone, and this guy didn't have a treatable mental illness, because being drunk and stupid and aggro and unable to hold your drink aren't treatable mental illnesses.

Anyway, not that exciting today, just pissed off. Hopefully back sson with more (and able to reply to comments tonight).

Thanks for listening,
John