Aspiring alcoholics

I’ve had more than enough teenage girls show up in my emergency via ambulance wasted and out of their minds after a weekend (or school-day) binge. Alcohol abolishes their inhibitions and exaggerates their underlying borderline personality disorder unleashing the terror of uncontrolled and unedited adolescent angst. I have had them screaming “f$#k you stupid f%#king f$#kers, I f$#king hate your f$#king guts!” at the top of their lungs while crying hysterically with their – always black- eyeliner streaking down their faces. It’s fantastic for morale in an over-crowded ER often filled with sick children and elderly patients. On more than one occasion I’ve had multiple teenaged offenders performing duets of profanity – as soon as one would start screaming how her life sucks and she hates everyone another drunk in another part of the ED would wake up and add her opinions of how her life sucks worse and she hates everyone in the entire universe. As each one attempts to outdo the other it escalates into a deafening stereo performance of anger, frustration, and hate - juvenile anguish in surround sound. What’s not to love? These potty-mouthed princesses must surely be a source of pride and joy for their families – too bad it’s against the law to you-tube their behavior to the world, or better yet post a little video on their facebook profile for all their friends to enjoy.
Occasionally I have been a little slow with chemical sedation thinking we could keep them calm and complacent as they sleep off all the alcohol they had consumed. Unfortunately I had a soft spot for the wasted teenagers, and I was somewhat optimistic they would behave themselves– a naïve and dangerous perspective for an EM doctor. It never works. You can’t reason with a drunken adult, and it’s even worse a drunken teenager who already believes that anyone over the age of 18 can’t know anything about anything. Now I just sedate them at the first sign of belligerence and let them metabolize their indulgences without any drama. Chemically –induced complacency helps to avoid all kinds of unpleasantness. These teenaged drunks are labile powder kegs that can explode with no observable trigger. In 1 second they can go from resting comfortably oblivious to the world, and the next second they are screaming epitaphs, ripping out their IV catheters, and jumping out of their gurneys to sprint down the hall ass to the wind flinging blood all over the place while threatening bodily injury to everyone who is risking their own health and well-being to get them back under control. You may think it isn’t hard to subdue a 16year-old girl, and theoretically it isn’t, but try it with an uninhibited drunk who is bleeding all over you and who isn’t afraid to use her fingernails and teeth. Not fun. And to top it all off, you have to subdue them without hurting them while they are kicking and screaming and trying their best to hurt you. It’s not an easy task.
Once I get my drunken teenagers chemically or physically restrained – often both- I like to put them in the room with the dirtiest, smelliest, crunchiest drunk that is sleeping it off in the ED. I want these aspiring adolescent alcoholics to get a glimpse of their future if they continue on their paths of self-destruction. I don’t think they often get it, but once in awhile one of them will wake up sober with a killer hangover ready to be discharged to home. As they put on their cold clammy pissed-in hip-hugging jeans, they get to witness their decrepit, disheveled, malodorous roommate who has also soiled themselves. Sometimes they make the connection – this smelly, crusty lady is an adult version of them and one day that will be passed-out in their filth while another “innocent” teen-ager gapes at them with horror. You can lecture a teenager for hours, and, unfortunately, due to normal human development they all insist nothing wrong could ever happen to them. But a picture is worth a thousand words, and occasionally one of my patients will take note and recognize the scary possibility that their life could become that of the filthy, toothless, tragedy of reality that is sleeping in the next bed.