Caffeine I

This is based on a patient I saw back in May. I have been meaning for a while to write this into a short story.

She was inconsolable. Normally, inconsolable is a word we use in pediatrics, a "red flag" to note a child who simply won't stop crying. Inconsolable is a foreboding adjective, triggering a reflex that tells me something's wrong, this child is sick. But instead, this patient was 35, in a gurney in Zone 1 of the emergency department.

She was loud. Huddled in the fetal position, she writhed and cried out, clutching her bald head and convulsing. Nobody paid any attention. Nurses with blood pressure machines walked past, volunteers pushed patients along in wheelchairs, doctors hurried by to write orders. Only medical students, in unease and fear, glanced at her. The atmosphere was palpable.

Her clothing surprised me. She was disheveled, with a large brown stain in her cream colored blouse and a hole at the knees of her jeans, but her shoes were fancy. Black and shiny with two inch heels, they registered as dressy causal. She wore a black leather choker. She held her face in a pillow, wailing.

I introduced myself, and when she didn't hear, I spoke louder. The emergency department rang with rumbling beds and overhead pages and alarms. Finally, I set a hand on her shoulder and she looked up, leaving a damp make-up impression of her face in the pillow. She was on her side, and a pink bucket lay beneath her.

"I took a bunch of pills," she said. "I'm scared I'm going to die."

I wished I could promise her that she wouldn't die.

"It was caffeine. I drove to the store and bought a bottle and swallowed them all."

She told me she had taken about 50 pills of Nodoz, 200 mg of caffeine each. A quick visit to Wikipedia told me this was equivalent to about 40 Starbucks tall coffees. The patient had taken them because of the voices. I clarified. She overdosed because she couldn't take the voices anymore, not because the voices were commanding her to kill herself. This flight of impulse was followed by some nausea, vomiting, and lightheadedness, prompting the patient's mother to call 911.

In the emergency department, they had done the usual work-up for an ingestion. Poison control did not recommend charcoal and there was no antidote. She was started on fluids, her electrolytes were repleted, and she was being monitored for any unusual heart rhythms. But a laboratory test for muscle breakdown - her creatinine kinase - kept rising, and so the emergency department called the medicine service to admit her to the hospital.