Ending it All
In summer, the passions of the young run strong. To the young and inexperienced, breaking up with a lover can seem like the end of the world. Teenagers and those in their twenties, have yet to acquire the experience to realize that if the sun still rises and you are there to see it, then life is good. Like Woody Allen said, 80% of life is just showing up. If your girlfriend dumps you, the sun will still rise the next morning. And you know what? When you stumble outside to get the newspaper, more than likely there'll be another young gal walking by, and you can say something intelligent and suave like "Hey." And she will smile back at you and say "Good Morning!"
You get the idea.
The problem is that when you're 16 to 25 years old you have no perspective on life. Being dumped by a girlfriend can seem quite literally like the end of the world, and why wait around for the final moments? Why not just end it all now? And if you happen to live through the suicide attempt, maybe your old lover will find out and come to the hospital and......
Saturday night, July, hot. Call from the suburban ER. Twenty-something male went into his parent's garage and drank a lot of windshield wiper fluid and antifreeze. I know. This sounds totally gross. I'm told that windshield wiper fluid is actually pretty tasty. Tart and tangy with a subtle nose. He was clinically okay but the labs showed mild acute renal failure and metabolic acidosis, both signs of a serious, potentially lethal ingestion. I talked to the ER doc and we started fomepizole, an inhibitor of alcohol metabolism that prevents the metabolism of the methanol and ethylene glycol he ingested into toxic metabolites that can cause severe metabolic derangement, acute renal failure and, worst of all, blindness. We used to give them enough booze to keep them legally drunk, which would competitively inhibit methanol and ethylene glycol metabolism and prevent generation of toxic metabolites. Now we use the antidote, fomepizole. We had a few doses sent down from the county hospital by taxi and got the boy loaded up.
Six hours later he was doing okay clinically, but the methanol levels were still sky high. After wringing my hands for a while I called in the troops and organized treatment with acute hemodialysis, the artificial kidney. This type of treatment removes the abnormal alcohols from the bloodstream and in conjunction with the antidote can save the patient's sorry life.
To do dialysis acutely you have to place vascular access. This means placing a big, thick, long iv tube into a major vessel. Since we only needed one treatment I chose the femoral vein, due to ease of placement. The nurses gathered all the equipment and I started setting things up. Of course there had to be some nurse-beaurocrat who wanted a op permit signed to place the line, something I rarely bother with. Do you really need to ask permission to save someone's life. Anyway, I went through talk, expecting a quick signature and getting on with it. Unfortunately, this guy had a bunch of questions, on the order of "Do I really need to do this? "
To which I answered "No, unless you have a problem with hanging out with seeing-eye dogs."
We finally went forward and I harpooned the femoral vein with great alacrity. Soon we had the dialysis machine spinning and humming, filtering the poisons out of the blood. The kid's parents came by and had a bunch of questions, but were mostly relieved that the child they had put so much time and effort into raising was not going to die tonight.
I wrote some orders for Psychiatry to see the patient in the morning (psychs don't do night work) and headed for home. I thought about my own kids (four at last count) and shuddered at the thought of one of them taking his or her own life. You just have to get them through the phase of teenage asshole narcissism and selfishness, bring them to the point of appreciating the intrinsic beauty and worthiness of life for it's own sake. I got home to the darkened house and walked through the kid's rooms, listening to them breath, before heading for bed and sleep. Waiting for the next call.
You get the idea.
The problem is that when you're 16 to 25 years old you have no perspective on life. Being dumped by a girlfriend can seem quite literally like the end of the world, and why wait around for the final moments? Why not just end it all now? And if you happen to live through the suicide attempt, maybe your old lover will find out and come to the hospital and......
Saturday night, July, hot. Call from the suburban ER. Twenty-something male went into his parent's garage and drank a lot of windshield wiper fluid and antifreeze. I know. This sounds totally gross. I'm told that windshield wiper fluid is actually pretty tasty. Tart and tangy with a subtle nose. He was clinically okay but the labs showed mild acute renal failure and metabolic acidosis, both signs of a serious, potentially lethal ingestion. I talked to the ER doc and we started fomepizole, an inhibitor of alcohol metabolism that prevents the metabolism of the methanol and ethylene glycol he ingested into toxic metabolites that can cause severe metabolic derangement, acute renal failure and, worst of all, blindness. We used to give them enough booze to keep them legally drunk, which would competitively inhibit methanol and ethylene glycol metabolism and prevent generation of toxic metabolites. Now we use the antidote, fomepizole. We had a few doses sent down from the county hospital by taxi and got the boy loaded up.
Six hours later he was doing okay clinically, but the methanol levels were still sky high. After wringing my hands for a while I called in the troops and organized treatment with acute hemodialysis, the artificial kidney. This type of treatment removes the abnormal alcohols from the bloodstream and in conjunction with the antidote can save the patient's sorry life.
To do dialysis acutely you have to place vascular access. This means placing a big, thick, long iv tube into a major vessel. Since we only needed one treatment I chose the femoral vein, due to ease of placement. The nurses gathered all the equipment and I started setting things up. Of course there had to be some nurse-beaurocrat who wanted a op permit signed to place the line, something I rarely bother with. Do you really need to ask permission to save someone's life. Anyway, I went through talk, expecting a quick signature and getting on with it. Unfortunately, this guy had a bunch of questions, on the order of "Do I really need to do this? "
To which I answered "No, unless you have a problem with hanging out with seeing-eye dogs."
We finally went forward and I harpooned the femoral vein with great alacrity. Soon we had the dialysis machine spinning and humming, filtering the poisons out of the blood. The kid's parents came by and had a bunch of questions, but were mostly relieved that the child they had put so much time and effort into raising was not going to die tonight.
I wrote some orders for Psychiatry to see the patient in the morning (psychs don't do night work) and headed for home. I thought about my own kids (four at last count) and shuddered at the thought of one of them taking his or her own life. You just have to get them through the phase of teenage asshole narcissism and selfishness, bring them to the point of appreciating the intrinsic beauty and worthiness of life for it's own sake. I got home to the darkened house and walked through the kid's rooms, listening to them breath, before heading for bed and sleep. Waiting for the next call.
posted by ICUDOC at 8:07 PM
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