Sugar Mountain

The most unpleasant thing about vomiting is its semblance to a heightened emotional state. The nose runs. The eyes water and flow. The cheeks become flushed and there’s an unpleasantness occurring in the gut.

I’m wiping away the spittle from my chin and splashing cold water when my pager goes off. It’s the ED’s ICU. I blow my nose into my hands and then wash them again. I adjust my tie, unlock the bathroom door and walk over to the phone in the nurses’ station.

I call the ED and the resident tells me about a patient that needs to be admitted: She’s a woman who’s ingested an unknown amount of an unknown drug and washed it down with a generous amount of alcohol. She’s not lethargic, in fact she’s struck one nurse and nearly kicked another in the head. She’s currently in four-point soft-restraints, meaning her wrists and ankles are all tied to the gurney. I can hear her in the background screaming variations on a theme of Fuck You in E minor.

He tells me her MedRec number and name. When I hear the name I say, ‘I think she went to charm school with my sister!’

‘Really?’ the resident asks, surprised.

‘No,’ I say flatly, signaling my intern and heading to the stairwell.



In the ED, our charmer does not disappoint.

When I see her wearing an N95 mask over her face, I know she’s started spitting at people. The ED resident confirms this without my asking. He also tells me they held off on giving her another round of sedation until I could evaluate her.

I approach the patient in veterinarian mode. I use her first name. I speak in soothing tones. I explain how worried we are about her safety and want to make sure she’s okay. I ask her if she has any pain anywhere.

This is all just a stall. She’s going to have it in for me. I’m just trying to keep her calm long enough to make sure she’s not acutely ill. She’s a thin white woman, sitting up, looking at me with only a fair amount of anger. Her pupils are dilated and sluggish but equal, disc margins sharp, no lymphadenopathy, thyromegaly, nuchal rigidity or cervical tenderness.

‘Can you breathe okay?’ I coo.

She takes a few deep breaths and her lungs are clear. I skip ahead because I see she is started to tire of me. Her belly is soft and bowel sounds are normal. I go back to her heart and she is only a bit tachycardic; no murmur, rub, or gallop.

‘I need to go home and take care of my kids,’ she says.

I have already checked her pedal pulses and examined her legs for edema. Her skin is warm and dry.

I walk to her side as I again scan her skin for any rash or evidence of trauma. I take her hand, pretending to sooth her, but really I’m checking her nail beds and palms which are negative for stigmata of disease. She has no track marks.

‘Your husband knows you’re here’ I say, ‘he’s taking good care of them.’

‘I need to leave. Now!’

‘I know, but that isn’t safe.’ I tell her, removing my hand from what is soon to become her grasp. ‘We need to watch you a bit longer and make sure you’re okay.’

She rev’s up rather quickly and before you can say bobs-your-uncle she’s flailing around in the bed. She’s spitting at me. Nonsensically, as the mask is effectively catching it and her saliva rolls down her jaw. I turn and walk away as she begins a reprise of her variations on a theme. This time directed at me.

‘You can sedate her now,’ I say to the nurse as I head into my workroom. Within a few moments, her her screech quiets and I can hear her peaceful snore. I grab her chart and look at the photocopy of her driver’s license. The photo was taken three years ago. She was a beautiful women then. The difference is not unlike the progression seen here and here.


I’m writing the orders to admit her into the hospital. I do not feel nauseous.