At least swallow one pill
At midnight one night, a patient came into the ER claiming he had overdosed on his wife's Valium because he was depressed. Turns out, at nine the next day he'd be sentenced to prison for aggrevated sexual assault. (He was currently out on bail.) He waved his wife's Valium bottle at me and insisted he needed to be admitted because of his supposed suicide attempt. When I asked how many pills he'd taken, he said, "at least a dozen." "How long ago did you swallow them?" I asked.
He averted his eyes and said, "Oh, at least three hours ago, so it's too late to pump my stomach."
If he had swallowed twelve Valium three hours ago, he should be nearly comatose, not conversing with me.Suspicious his whole "suicide attempt" was a rouse, I counted the pills in the bottle. His wife had filled the script two weeks ago and there were still sixteen pills in the bottle, suggesting he had taken none. When I confronted him with this fact, he shrugged. "She must have skipped some pills."
I didn't believe a word of it. To prove my point, I ordered a blood and urine drug screen. I also insisted on pumping his stomach and using Charcoal slurries just in case I was wrong and he had ODed. (Alright, I admit it. I also did it to punish him for manipulating us.) The ER doctor insisted that because he claimed he'd attempted suicide, we had to admit him and get a psychiatrist to see him in the morning, even though we both knew he was a con artist trying to delay his prison sentence.
Sure enough, the drug screen came back without a trace of Valium in his blood or urine. The idiot should have at least swallowed one pill to make the drug screen positive and to validate his story. The judge was disgusted with his phony suicide attempt and so was I.
Sally Burbank M.D.