Island Med Student

Yesterday was an uncharacteristically eventful morning. I awoke to the sounds of my doggies whining and I immediately knew that the only way to shut them up was to take them for a walk. I woke up my partner, Micah, and we hooked their leashes to their collars and headed down the stairwell of our apartment building. Halfway down, we saw a young man sitting beside a slumped over female on one of the stairs. While he looked distressed, it seemed like he had everything under control, so we just continued walking.

After taking the dogs to the park to do their business, we returned to our apartment building. Before we even got inside, the young man from the stairwell rushed out of the front door with a frantic look on his face. “Please, can you help me?!” he screamed anxiously. “Yes, what is it?” I replied. “My friend, I can’t get her up…please help!”

As soon as I heard those words, I spontaneously switched gears from doggy walking to emergency mode. When I opened the door to the apartment building and saw the young girl sprawled on the floor in front of the stairs, I immediately began creating a differential diagnosis. Could she have fallen and fractured her skull? What if she had become severely hypoglycemic and had a syncopal episode? Could she have just experienced a tonic clonic seizure? Perhaps she had a myocardial infarction secondary to a cocaine overdose? And of course, the most immediate possibility that came to my mind was that she was simply very drunk.

I was suddenly acutely aware of the details surrounding me. I noticed that the young man had a fairly heavy smell of alcohol on his breath and that his clothes were stained with paint and dirt. I surveyed the area and checked for any sharp or otherwise dangerous objects and saw none. I observed the position of her body and deduced that she most likely had not fallen down the stairs.

I leaned down to her and asked her loudly if she was okay. “No, he won’t leave me alone!” she replied. I asked her if she’d been drinking and/or done any other drugs and she admitted to drinking but denied using anything else. She was obviously agitated and as I leaned towards her I could detect alcohol on her breath. We went back and forth for a few minutes and she became increasingly belligerent and verbally abusive. She started screaming profanities at me and the young man, who I discovered was her boyfriend.

To make a long story short, I eventually realized that she was just very drunk and upset with her boyfriend. He was trying to get her to the car, and she kept physically attacking him and screaming. She made threats to attack me and called me some very unpleasant names. By this point, I had switched gears yet again into more of a psychiatric emergency mode. I tried using some techniques to calm her down and diffuse the situation. Luckily, having been called every name in the book already, her comments failed to offend or upset me.

After over an hour of failed attempts, I realized that I had no other choice but to call the police. So I dialed 911 and waited for the cops to arrive. They showed up just a few minutes later and I gave them a full report, including my information in case they needed to question me again. The police also failed to reason with the girl, so they eventually handcuffed her and hauled her off in a van to the police station for booking.

For the rest of the morning, I thought about the sequence of events surrounding the girl. I wondered if I would have responded to the situation the same way before going to med school. I guess most of it was really just common sense. But on the other hand, things could have turned out differently. She could have had no pulse, or been in the middle of having a seizure, and things would have been more serious. I don’t know if I would have responded as calmly or even remembered what to do. At the very least, I guess I gained some practice that I can use with actual patients in the future.

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