Mullberry Whine

poured out before bed

Pickled

…remarkably well preserved (Renee Comet’s Pickle)…

His speech is mildly slurred, his perfectly white hair protruding at crazy angles from his oily, bruised head, and he reeks of alcohol and a showerless fortnight.  His toxin muddled brain is markedly atrophied (I know, I’ve seen the rule out acute stroke CT), with evidence of old infarcts, and the ED X-ray series bears countless fractures, old and new.  He sits before me, his arm in a sling, his leg in a cast, swearing “the other guy looks way worse off” in a thick accent I cannot identify.  This scrappy old soul is new to the VA hospital, having recently been told (by the community hospital tired of his frequent flying) he qualified for care here.  He does indeed qualify, but as our EMR is down today (which always seems to happen when I’m on call) and the outside hospital records are giving our fax machine plenty to do for the next hour, I sit down to get as much history as I can from my pleasantly intoxicated friend – before he slides into sweaty, trembly, anxious withdrawal.

We go over the vodka soaked brawl that brought him here and his current symptoms, run through his past medical and his past surgical history (significant for multiple ORIFs of countless broken bones from his drunken and high escapades), his known allergies, his medications (an easy one, as he takes none of them), and an uneventful review of systems.  Estranged for years from his family, he can offer me little information about his family’s health history, is not even sure if any of his kin are still living.  He’s never been married (“Why would I?!”), has no children (“Lord, no!”).  He’s “never worked a day in [his] life, except for the year they whipped [him] into shape in the air force, but [he’s] relaxed enough since then to make up for it.”  Social history is further significant for train hopping “anywhere South in winter, anywhere North in summer,” lack of housing (unless you count the High Street bridge, where he’s been squatting since February and on and off for about 5 years), and his (extensive) substance abuse.  You name it, he’s smoked, snorted, injected, or ingested it.  For over 50 years.  Most recently, yesterday.  He uses because “it feels great,” denies underlying depression or pain syndromes he feels the need to dull.  He has never tried to cut down, gets annoyed when people suggest he try, feels no guilt about using, and uses vodka shots as eye openers each morning (thank you, CAGE questions).  He’s not interested in out or in patient detox programs.  He just wants “a place to dry out until I can walk and get my alcohol again…my buddy had a seizure when he had to stop drinking when he got the flu – I don’t want my brain to get fried like that!”  (Oh, the irony).

I put on gloves and complete as thorough a physical exam as the pain from his injuries will allow, marveling at how perfect his heart sounds and distal pulses, how clear his breath sounds, the benignity of his abdominal exam and absence of any stigmata of liver disease, at his 5/5 strength and lack of focal neurological defects.  Besides his busted up arm and leg, his fractured ribs and stitched up cuts, and some sun-damaged skin bearing quite a few lesions worthy of a dermatology consult, he looks great.  I thank him for his time, explain how we will manage his withdrawal and how PT/OT will come to help him work through his injuries in the coming days.  I introduce him to his nurse, mention that my senior and attending will likely be in to see him soon, and encourage him to let us know if he has questions.  He gives me a toothless grin, adjusts the IV attached to the banana bag started in the ED, and flips on the TV.

As I walk out, my senior stops me in the hall.

“Hey, how’s he look – pretty bad?”

“He actually looks really good, aside from the number the other guy did on him and some actinic keratoses.  Surprisingly good.  Let’s hope he doesn’t go all DT on us, though – he’s a pretty heavy drinker.”

The senior peeks in the door.

“Holy cow!  That can’t be him!  Do you have his social on you?”

I pull out my notes, circle the number, hand it to her.  She compares it to the printed information she’s retrieved from an online database.

“This can’t be possible…” she chews her lip and looks at the grimy white haired man flipping through the menu in the bed.

“What do you mean?”

“Mullberry, that gentleman fought in World War II.”

“What, him?!”

“He was a pilot. He’s 97 years old.”

Later, as I pound out my History and Physical note, I smile as I type “appears younger that stated age” under the general portion of the physical exam.

.

{We did make some inquiries to be sure this gentleman is who he claims to be.  Long story short, it appears he is…  Wow.}

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From the Cellar

Now Fermenting

House Rules

Creative Commons License
Nothing under the table.
***
The views expressed on "Mullberry Whine" are NOT intended to diagnose or treat disease.
***
The med-ed related stories described here are based on real events. Details have been changed in accordance with HIPAA de-identification guidelines to protect confidentiality.
***
Mullberry Whine can be enjoyed daily; there is no unsafe quantity. Real wine, though, should be enjoyed in moderation. At-Risk Drinking for males under 65 is defined as >14 alcoholic beverages per week or >4/day, with >7 drinks a week or >3/day being the cut-off for females under 65 and for anyone, male or female, who has graced this planet for 65 years for more. Drink Mullberry Whine like there are no consequences. But drink alcohol responsibly. Your friends, your family, your health-care provider, and your liver - heck, ALL of the organs in your body - will thank you.
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