I take care of lots of people who are mostly sick because of things they do to themselves. This week has been no exception.
Two days ago, I admitted a guy with belly pain who also drinks a lot of alcohol. He didn't look great yesterday, and was complaining of belly pain which I attributed to stomach irritation from his binge drinking. His heart was beating fast and he also had a low grade temperature, which I attributed to symptoms of withdrawal from his chronic alcohol use.
Today he looked no better. In fact, if anything, he looked worse. Still with a very tender belly, fast heart beat, and low grade temperature. Finally today I decided to do some further investigation. I got an ultrasound and checked his urine for infection. His urine was clear, but the radiologist actually called me because the ultrasound didn't look right. Then it was on to a cat scan to figure out the problem.
Turns out he actually had perforated his bowel somehow. I am kicking myself that I didn't find it sooner. But because he was a drinker, it was so easy for me to just assume all his problems were related to that. But they weren't. It is easy when you take care of so many alcoholics to blow off certain complaints as always being related to drinking or to withdrawal from alcohol. I should have listened better and taken more time with him.
Thankfully we have excellent surgeons and I suspect he will be ok after a trip to the OR. Time will tell. But this was a good reminder to me that everyone deserves my best, most concentrated effort. No matter how they ended up in the hospital or what they've done in the past.