I had a career affirming patient today. Guy comes in with a blow to his head when he dropped a brick on it. He's pale as a sheet, almost passes out in triage and can barely keep his feet under him. I'm worried and pull out all the stops to get him a STAT CT Head. THe cut on his head is trivial, but the story is pretty dramatic: he was outside working on some sort of wall when a cinder block dropped about four feet and clocked him in the head. He spent an hour trying to control the bleeding and then drove in to the ER. CT is negative. I staple up his head and then his alcohol level comes back. 248. Over three times the legal limit! I hardly know what to say: I barely have the energy to do household projects cold sober. And....he drove himself in to the ER. I gave him a pretty good talking to and told him he would have to have someone pick him up for the ride home. Good, fine, okay....and three minutes later he was gone. I was sure he was driving home (and he lives about three blocks from me) so I called the local PD and gave them the story and his address. I thought they might be able to nail him for DUI on the way home. I usually don't get crazy about this sort of thing (incidental DUI discoveries) but come on!--248? That's not in the "one to many" range. About an hour and half later the guy calls me. His very sheepish and wants to explain. His wife was out of town so he was spending the day at his girlfirends when he dropped the brick on his head. His girlfriend drove him in, but he just wanted to keep it hush-hush. I'm sure the reason he's calling is because the cops knocked on his door and gave him a good scare. At least I can sleep tonight knowing that as long as guys like this exist I'll always have a job. U-561