You know, writing about poor old Boomerang Bill made me think of another notorious alcoholic we used to see on a regular basis when I was a resident. I seem to think that I've written about this guy before, but I can't find him in a quick scan of my archives.
This fellow was another who was frequently found by EMS slumped on the ground under a bar stool. We knew him well. He was surprisingly high-functioning, though, in that he managed to maintain some semblance of a job and a stable social situation. He even had family that would sometimes come and get him from the ER, which is pretty rare for a hard-core alcoholic. He didn't talk much (a welcome trait in an alcoholic frequent flyer) so he got nicknamed "Silent Bob," after the character in Clerks.
Like many heavy drinkers, Silent Bob was tough, and near indestructible. Something about really pickling yourself over many years can for some people give them the ability to survive the lethal insults of physiology. I've seen the same phenomenon at VA hospitals as well. But this guy took the cake.
- Perforated gastric ulcer: Survived
- Necrotizing pancreatitis: Survived
- Subdural hematoma: Survived
Nothing could touch him, and he kept coming back, over and over.
One memorable week, he was brought in by the same EMS crew three times in a row. The first time they found him passed out on the sidewalk outside a bar. The next day he was trespassed in the public library but was too drunk for jail. A couple of days later he was found passed out in the firehouse underneath the fire engine! He had crawled in there when the door was open and fallen asleep under the fire truck itself. They nearly ran him over heading out on a call, but someone noticed his legs sticking out before they drove away. Fortunate for him.
So a few days later, when the same EMS crew was called out and found Silent Bob passed out under the railroad viaduct, they weren't too surprised, and just bundled him up and brought him back in. They did not notice that he was not moving his arms or legs, because, well, he was passed out and not expected to be moving much of anything. It turned out that Silent Bob had fallen off the viaduct and had a horrible C4-5 fracture/dislocation. I used to have the images somewhere — they were impressive.
So once we figured out that he wasn't "just drunk," which is incidentally the most dangerous diagnosis it is possible to have in an ER, we got him admitted to neurosurgery. They did some sort of procedure; I wasn't clear on the details. What was memorable was that a few days later, word filtered through the ER that Silent Bob had walked out of the hospital against medical advice. First of all, how shocking is it that he was walking at all? Second, who the hell leaves the hospital AMA with a broken neck? He apparently had some residual weakness in his lower extremities and still had a halo in place, but he was not going to hang around the goddamned hospital where they wouldn't let you have a drink, was he?
So, another bullet dodged, another lethal diagnosis to add to the list of things he had survived.
We saw Silent Bob in & out of the ER for the next year or so. He never followed up in neurosurgery clinic, but when he came in we'd call them down to adjust, and eventually remove, his halo. He needed a cane to walk, but otherwise had survived his most recent brush with the reaper very well.
Finally, one day, he was brought in dead by the same medic crew who had seen him so many times before. Apparently, Silent Bob was passed out on a park bench when he was witnessed to have been hit by lightning. Really. EMS did their bit, and we did our bit, but his heart did not restart and that was the end of Silent Bob.
One of my attendings reflected, and eulogized Bob after we had terminated the resuscitation. "You know, this was probably the toughest mother fucker I have ever known. He shrugged off more disease than any of us mere mortals ever will. You want to know how tough this guy was? It took an act of God to kill Silent Bob. We won't see his like again soon."
Nor have we.