Last night was magical in the ED. I went to a dinner party with the Biscuit and then to work at 10pm. I managed to feel pretty good through the whole night. Not bad on 4-5 hours sleep the night before. The key is pacing: enough work to keep time moving, but not so much that it's oppresive. I was ready to go home only 15 minutes late. 22 patients in 10 hours on the high acuity side. Oh, and I harpooned a peritonsilar abscess! The highlight of the night was a drunken college student. Some poor young guy who was found naked in a shower in one of the local colleges and brought in by paramedics stone drunk and smelly. I have a special fondness for this demographic: I went to those same colleges and can't help but feel a certain avuncular warmth towards these wayward youth. This guy reported having had 17 tequila shots. I believe it--and the fact he had lost bowel continence and was covered in his own vomit and feces attested to some heavy imbibing. His alcohol level was only 242--a lightweight, new to this exciting world of binge drinking, stupefaction and laying shivering and crying in one's soiled clothing. Every now and again over the course of two or three hours he would vomit and gag on his puke---I'd rush over and roll him over and scoop his mouth out and he'd start breathing again after probably aspirating only a little stomach contents. Finally I decided to just tape him up so he was permanently leaned over to one side, a thin trail of pinkish liquid dribbling from his mouth. This "taping" of patients is ILLEGAL, but damn handy and a cheap alternative to the JACHO approved method of...well, just watching him choke on his own vomitus. By 5 am he was awake and said "Exxcuse me, sir, I think I'm feeling okay, now." Polite son of a gun. His friend came to pick him up. As the guy got out of bed to get dressed our entire department had the chance to witness this patient and his friend simultaneously realizing that he was wearing diapers. That's a life highlight!--having your good friend come to the hospital and see you in diapers. Because you shit yourself. Repeatedly. Really, between the ages of 3 and 93 that's not a good memory to have. His friend, of course, thouht this was screamingly funny and immediately got on the cell phone. Our staff--we're only human--we couldn't help laughing. But it was fond "Those were the days" laughter, not "Ha,ha--Mister Poopy Pants is going to die of liver failure" laughter. As the guy left he thanked all the staff and thanked me for not calling his parents. Of course not--illegal and, while funny, not really appropriate. U-561