You know what they say about brothers? Your bond is sealed in blood! Occasionally people dramatically slice open their palms and clasp as a way to cement that bond but I’ve seen it don’t more “enthusiastically” so to speak.
Two brothers start drinking and end up in a free for all stabbing and slashing each other with broken beer bottles. Blood all over the apartment. Blood spurting all over the ambulance. Blood all over the ER trauma bay. Both lying next to each other in the ER getting blood transfusions. It comes full circle.
Ah, nothing is a sacred as family.

I remember in residency there was a guy who used to come in drunk (and occasionally seizing) about 4-5 times a week. Pretty typical I guess for a drunk. However, one night when it was not too busy, one of the attendings decided to look up in our sister hospitals computer system (which we had remote access to) to see if and how often the guy had been over there.

We did some fiddling around and after setting the parameters for both hospitals, ER visits within the last year we calculated the total number of ER visits by this guy. The total – 405. More than there are days in a year. Thus, he spent EVERY SINGLE DAY in his life in one of two ER’s – and often was there more than once in a 24 hour period.

Holy. Frickin’. Crap.

I remember in residency and at some other hospitals where I worked, drunks would be traiged and sent back out to the waiting room, brought in only if there was obvious trauma or they were severely obtunded. Your typical sleeping, stinky drunk waited out in the lobby until it wore off and then he (or she) left in the morning  – usually never coming into the dept for an evaluation.  This was partially because it was really busy and there were sicker people to see, but also partially because, after all, who wants to deal with them?

Great idea on paper – until one of them seizes or suddenly dies because no one realised they also got kicked in the abdomen and had a ruptured spleen. I could see the headlines, “Man dies of massive internal bleeding while slumped over, ignored in the waiting room of the ER”.  After, all this happened in Brooklyn a few years ago when a psych patient in the psych ER waiting room died from a PE and everyone just went about their business, assuming she was either sleeping or acting out.

No, you have to bring them in as much as it sucks.  Once they are in your dept, they are your problem until they are sober.  Maybe a way to solve this is for police depts and family/friends to just keep an eye on them either at home  (or in jail I guess) and let them sleep it off – but Hell, they don’t want the responsibility any more than we do.

Really no solution exists that I can see. Even in ER’s where drunks can be transferred for “detox” at some other facility are really just passing the buck on to someone else.  Sigh.