Although I have been on an outpatient rotation, I am still covering the wards and consults for the weekends. It's been a bit more call than I usually do in a month--still not too bad--but seeing everyone on the weekends has allowed me snapshots into their lives.
We have one man who will not stop drinking. He drinks and drinks and drinks and drinks. He has had seizures because his sodium is too low. He is essentially diluting himself, thinning out the concentration of his protoplasm full of saline, which is all of our inner state. He doesn't have a tumor, he doesn't have an imbalance in his kidney, he doesn't have a problem with his sugar. He is just sick.
He is one of "my" people, the mentally ill.
He has no understanding that his drinking is causing him problems, or even that it might be related to him being in the hospital. "I know I had a seizure once, but that was years ago! Why do you have to keep TALKING about it?" On admission, his sodium was 109, when the normal level is around 130. With sodium levels that low, free water flows across membranes to areas of higher concentration--like body tissues. Like the brain. More water means swelling in an organ, and a swollen brain means more pressure inside the head, which means seizure, herniation, death.
I saw him last weekend, carring around a larg, 24 ounce Dunkin Doughnuts cup. "My wife brought it for me!" he bayed. He held onto it and kept wandering into the dayroom to refill it with caffeine free Diet Coke from the machine. He never let it go. The nurses couldn't take it from him.
I checked his sodium. 123. Trending down. I asked the nurses if there was any way for us to steal the cup away. They said they'd try. And they did.
This past weekend, there he was again, standing at the nurses' station, bleating for a doctor. He had been out on a pass the day before, where he had drank the largest bottle of Snapple that he could find. He's not gotten any better in the month that he's been with us. Maybe the meds will eventually gain a foothold. Maybe his irritability and mania will soften, cool down. Maybe he will be able to restrain his thirst.
But somehow, I can't see that happening. His thirst is unending, cannot be quenched. I fear the day he is discharged, and wonder how long it will be before he is brought into the ED, flailing madly, intubated, and scanned...and then gone. His mind destroying his body, in the most essential sense of the phrase.
Meanwhile, he stands at the nurses station, wondering why he is here, posing problems that we cannot solve. And so we wait.
And he drinks.