According to a widespread belief — and we didn’t come up with this in the ER — a drunk is a parasite, who generally only benefits the distillery, if even that.
What to do with a chronic alcoholic — now that is a difficult question.
For family members, they are, to put it mildly, a headache. For the healthcare system and taxpayers, a huge expense. For the medical staff, a nuisance.
For an employer, they’re of no use. For society as a whole… it’s a tragedy in every sense. They vomit all over us — both literally and figuratively.
Some might argue that alcohol consumption is beneficial to the state due to excise taxes. But the costs far outweigh the benefits and are borne by individuals, families, and taxpayers.
Every drunk eventually crawls into your wallet. That’s what we call solidarity-based health insurance. Alcohol poisoning or delirium treatment falls under emergency medical care.
There’s hardly anything more heartbreaking than when a child calls an ambulance because “mom is sick again.” Meaning: she’s on another bender. Yes, to someone, the drunk is a father or a mother, a son or a daughter. This kind of pain and shame cannot be soothed with paracetamol.
In our ER at East Tallinn Central Hospital, we have quite a few regulars. Loyal customers.
Some show up several times a day!
They are found lying somewhere, hypothermic. Thought to be dead, but when lifted up — they’re breathing. The stench is suffocating. They’re brought to the ER, we patch them up, drip them sober, and send them on their way after several hours. But soon enough, they’re back in the ER, limp as boiled spaghetti. As if they had downed another 4–5 promilles around the corner by the hospital.
Just another day in the ER.
In one bed: a young man, completely wasted, tied to the bed by arms and legs, screaming like a beast. Demanding to be released immediately — to kill himself.
In the next bed: another young man, in delirium, shaking uncontrollably. Recently finished a drinking spree, now haunted by visions of vegetables and spiders, wearing diapers.
Both in utter helplessness, tormented by the booze demon, who punishes the harshest when you dare to stop drinking.
A drunk knows what they want. They can be very demanding insured patients.
Give me water. I want a smoke. Davai, a tranquilizer. Let me pee…
Dear Lord, what kind of hospital is this, where you don’t get food, the doctor is never around (actually just was), and you can’t get a clean-sheet bed…
Usually, the average drinker has drunk away both legs and brain. We call that alcoholic polyneuropathy and encephalopathy. Often, they’ve also lost all their loved ones. We call that a social problem.
But some are crafty. What to do if it’s cold and the homeless shelter won’t let you in?
Call the ambulance in the evening and say you’ve got chest pain. Nobody gambles with the heart — they’ll bring you in, check you out, let you sleep at least until the first morning bus.
In the ER, a drunk is well taken care of.
You can’t just tell them at the door: “Go sleep it off!” If you send them home and things go wrong, they could end up dead within hours. Turns out: they had fallen, head bleeding. Brain swelling. Fatal outcome. A doctor can’t live in peace with that.
So nearly every drunk gets a head CT in the ER. Listed at around 100 euros in the Health Insurance Fund price list. But in the ER, the drunk also gets plenty of IV fluids, vitamins, tranquilizers if needed. That’s how taxpayers’ hundreds and thousands and millions quietly trickle away.
Suturing a soft head wound is easy — if there’s a wound, the patient doesn’t really care whether you stitch with anesthesia or not. Once I stitched up a drunk’s head and recommended paracetamol or ibuprofen for pain. The patient politely thanked me and said the only anesthetic he uses is pure whiskey.
Nobody sobers up with a snap of the fingers, so the average drunk occupies an ER observation bed for several hours — in the worst case, for more than half a day!
Sometimes, a drunk brings their “pets” with them.
They find a man somewhere in a gutter, forgotten by the world. Not even that old, maybe about 40! Can’t stand, crawling with bugs. Actually fascinating — you don’t see such specimens every day. Bedbugs require caution — they jump. But scabies and lice — worth a look and a marvel.
Anyway, our well-experienced care workers gear up in hazmat suits and take the client to a pressure shower. Once they’ve had their spa, the doctor can have a chat.
We run our tests and analyses. Let’s say everything looks generally fine.
Still, no one from home usually wants to come pick them up — even if they have a home. And family. No one wants to deal with them outside the hospital. The police also keep their distance because, as uniformed officers have said themselves, they don’t offer taxi services to drunks.
Though lately they’ve been more willing to help “move” the drunk from ER to a detox center.
In truth, a drunk is a human being like all of us. God’s creation. With their own battles, their own dreams. No one has fallen in love with the bottle just — how to say — randomly, through genetics or force majeure… The drunk doesn’t speak about it, but usually, they’ve carried a burden too heavy.
No one is born a drunk.
“Drunk” isn’t even an insult. It’s not a word meant to offend. It’s a neutral noun. A cold fact. Like you say to a squirrel: “You are a squirrel!” A squirrel is a squirrel — no offense taken.
In fact, if you think about it, drunks are often deeply loved. Without irony!
Because think about it: you could sit on a park bench — in sadness, with your sorrow — no one comes to comfort you, no one cares. But a drunk lying there with their sorrow — seemingly dead, in vomit, in a pool of urine, maybe even blood — sooner or later someone empathetic will call an ambulance. Some flashing vehicle will definitely come.
Generally, ambulance crews like bringing patients to the ER. Even when there’s no real reason. Even if the only reason is that the relatives demand it. They stomp their feet (yes, that gets people hospitalized!).
Sometimes it seems like the more patients the crew brings to the hospital, the more bonus they get.
But with drunks, it’s a whole different story: they must be brought in because drunks are deceptive. Their blood alcohol level can mask anything.
One example:
A mother calls an ambulance early morning. Her son is confused, can’t understand anything. Medical history includes alcohol-induced liver disease, toxic encephalopathy, ascites, etc.
When the ambulance arrives, the patient is on the floor, semi-seated. Mumbling. Legs limp. Glasgow coma score: 8. Intoxication or a stroke — who knows.
Even when a withered vagrant has cracked his head, we still call the on-call neurosurgeon to ask if surgical treatment is indicated. Because we are guided by humanity and the Hippocratic oath.
It doesn’t matter that the brain (and the life attached to it) we are trying to save doesn’t mean much to the person anymore.
When you’re totally crushed by life, you eventually start asking: “What’s this life even worth?”
If you ask a drunk — one who’s somewhat lucid — how much they drink, they usually reply: “Not much. Only on birthdays.”
Then it turns out they have a lot of friends, and so it’s practically someone’s birthday every day.
Some say they’ve quit drinking — two days ago.
“You must have an iron constitution,” I compliment a patient who says they’ve drunk half a liter of whiskey daily for ten years.
Alcoholics have highly trained stomachs. At five promille, most of us would be long dead. Yet here he is, semi-sitting in a hospital bed, talking and gesturing with his hands.
In general: you wouldn’t believe how many Estonians really drink. Like animals.
Life somewhere in Lasnamäe or Maardu (and many patients from those areas end up under my care at East Tallinn Central Hospital) runs to a completely different “beat” than what we’re used to in our well-groomed circles of friends.
I love being a doctor. I get to help people. I gain experience. Every shift teaches me something, sharpens my skills.
Even drunks are actually very nice — sometimes we have long conversations. A drunk’s life story is often incredibly intriguing.
But I see absolutely no sustainability in Estonian healthcare.
There is pitch-black darkness at the end of the tunnel.
Hospitals are already filled to the brim with chronic patients.
Every shift starts with the same line: there are no beds, here or there.
The ER doctor is like a lone abandoned soldier on the battlefield — because the internist doesn’t want the drunk, the psychiatric clinic neither; the police show little interest, and the family’s door is closed — meanwhile, the observation room is full of drunks and the ambulance is waiting with the next ones at the door.
We are aging as a society at a staggering pace, wallowing in comfort, and we neither protect nor value our health — this trend is only intensifying.
But on top of that, we have convulsing and delirious drunks, who on some nights take over the ERs and even crowd internal medicine wards.
We are slowly drowning in alcohol.
Then we have service disruptions, and the Health Board slaps the hospital with a fine.
Then, a patient with a life-threatening arrhythmia or acute abdominal pain is left waiting for hours outside the ER door.
Then, Õhtuleht runs a screaming headline on the front page: someone dear was left without emergency care.
Then a sharp-eyed Postimees reader passes the hospital on Ravi 18, sees ambulances lined up outside the door, snaps a flash photo, and sends it off to the click-machine.
And ER doctors keep burning. Mentally.
You just get exhausted when, during a night shift, you end up caring for ten delirious drunks — each wanting to climb the wall at 4 a.m., metaphorically speaking.
You can’t even say to a drunk: “Don’t drink anymore.”
It’s pointless to write in the discharge summary, even in all caps: “ABSOLUTE ALCOHOL PROHIBITION!!”
They drink because they simply can’t do otherwise.
And while we do have rehab, there is no truly effective medication for alcoholism — not without strong motivation.
So really, there’s no need to colonize Mars.
Let’s solve a far more pressing question instead:
What to do with the drunk?
Or the junkie — exactly the same story.
-Toivo Tänavsuu, Facebook
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