Iceberg Right Ahead

Darjuna, the nursing assistant, was going around the unit getting nooner vital signs from all the patients when I heard her yell out for help. When I walked into the patient room she was in the bathroom and the patient was just standing there with a blank stare.

This woman was in her early thirties, slim, attractive, full-lipped, and well-coifed. She was smart and had obtained her master's in literature from Yale. Among her personal items were the keys to her Mercedes. She was also a complete psycho.

She started using cocaine many years ago and she had told me earlier that when she initially tried it she "fell in love instantly."

That stuff can be a little rough on the heart. Whenever I've had a relatively young person such as herself admitted to us as a patient with myocarditis and chest pain my first guess is cocaine.

The scars on her inner forearms looked liked she'd been flayed open from elbow to wrist, leaving fish-shaped marks two inches at their widest and running from her elbows to her wrists. From the years when she used needles.

She pleaded for narcotics for her "chest pain" constantly, but because of her history and so far negative work-up the doctors had forbidden morphine and such. They allowed us to treat her with Percocet tablets, though, and the usual IV fluids, antibiotics, and anti-fungals.

Anyways, she was in the bathroom staring at Darjuna when she closed her eyes and her knees began to buckle. We were right there to catch her as she crumpled. We dragged her to bed and obtained vital signs, which were fine. Systolic blood pressure about 100, and heart rate about 105. Same as she usually was. Another nurse who had happened by had been looking at the heart monitors and came to report no arrhythmias.

Then the patient woke up and asked us "what happened?"

"You passed out in front of us," Darjuna said. The patient just laughed and denied it. "No, she's right, I saw you do it too," I said. "You would've hit your head but we caught you," said Darjuna. The patient insisted that this never happened.

Then we noticed a nearly-empty needleless syringe on the bedside stand. It had a bit of cloudy white fluid left in it.

She had cheeked her Percocets, crushed them up in a plastic one-ounce medicine cup after the nurse left, dissolved this in water, drew it up into a syringe that she dug out of the needle box, and injected this concoction into a port on her intravenous line. Then she went to the bathroom, saw stars, and fell like an over-ripe grapefruit from an old tree.

It doesn't matter if you know better. And she did.

We all congratulated Darjuna for her excellent catch.