A 29 year old with a recent cholecystecomy, history of alcohol abuse etc, cirhosis, etc, comes in because he...surprise, surprise...ran out of oxycodone.

Because of the liver disease, he was careful to tell me, he couldn't take acetaminophen.  But because of the pain and no oxy's since yesterday he had had a few beers in spite of the fact that his discharge instructions clearly said "STOP DRINKING".

I couldn't help it.  I blurted, "You're a dumbass"

He looked guilty. "Well, but I didn't think just a couple of beers would really make that much difference"

I felt bad for him.  I felt bad that I called him a dumbass.

I told Mac what I had done.  He cocked his head to one side, considering for a moment.  "Well", said Mac, "he IS a dumbass".

As I was discharging him I tried to get into his head a little.  I apologized for calling him a dumbass.

"Oh, I am a dumbass, my wife says it to me too.  I know it.  I realize that even one beer is too many"

Me: "I don't say this to everyone.  But I'm an old woman with kids older than you are, and I am seriously concerned about you.  You're too young for this.  Do you have kids?"

"Yeah, two, and one on the way.  The oldest one is 6"

Me: "Those babies need their daddy.  I hope you can get the help you need to be there for them"

The saddest thing is that I don't think he will be around long.  It's sad.  He seemed like a nice kid who just went off the rails.