Drinking at the poker table is fine, just get a driver

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Lately, I’ve been working a lot of my ER shifts at a busy major trauma center. Trauma care actually demands a different mind-set than standard ER medical problems, such as strokes or belly pain. It’s scripted and mechanical. There’s a protocol for trauma, almost like a mantra: First check “A” then “B” then “C” etc. If you identify too closely with the smashed body in front of you it interferes with the critical task of finding important broken body parts and fixing them fast. It’s demanding and stressful.

Thank goodness my favorite poker room is on my way home. I know if I head straight home after a rough evening shift my whole household, including the dog, will be asleep and yet my mind will still be operating in high gear. Instead, a few hours of cards are just what I need to unwind and settle my psyche for sleep. It was during one of these evening sessions that I ran into “The Kid.”

He was brash, loud and hyper-aggressive. With an ugly pierced left eyebrow and a Florida Gators cap twisted a few degrees off-center, he seemed to be raising every pot and collecting chips as fast as he was swigging beer after beer. I knew if I waited for the right time I could double through him.

Eventually, I flopped top set and succeeded in getting it all-in against him. But two cards later, the Kid’s backdoor draw got there and I pushed him all of my chips. The cardroom was just about to close so I headed for the exit. The Kid, stumbling a little and talking loudly on his cell phone, followed me into the elevator and down to the parking lot. He looked up briefly and acknowledged me. “Sorry ’bout that hand, Dude.” I nodded and replied “No worry, Kid. It happens.”

In the parking lot, I watched him get into a red sports car and drive off. No seat belt, clearly loaded, still on the phone. Some day, I thought, he’ll end up a grim statistic.
The National Transportation and Safety Board released some interesting stats. Highway deaths are way down, 9 percent less than last year and at its best in 55 years. Why is that? Here are a few reasons:

The recession has people driving less but that’s only a small part of it. Public awareness campaigns clearly are a big factor. Tell people enough times about the importance of seat belts or the dangers of driving and drinking or driving and texting and some people will change their behavior. Safer cars are another reason for the drop. Newer cars have more airbags than cup holders and those antilock breaks keep skids from turning into rollovers.

My advice to my poker brethren is straightforward and simple: Buckle up; pull over to make a call or send a text; and above all, if you like to have a few beers while you play, plan in advance for someone else to drive you home. Remember, even if someone smashes into you, the law presumes the fault lies with the guy who’s been drinking. If there’s an injury or death, you get to wear an orange jumpsuit for a very long time.

Routinely in the ER, I ask drivers who smell of alcohol if they think they’re legally drunk. Routinely they say no and routinely they’re wrong. The legal threshold is lower than you think. And for those who use narcotic painkillers, tranquilizers, over-the-counter cough medicine, Soma, Benadryl or even pot, understand that there are plenty of medical studies demonstrating that these drugs impair reaction time and driving skills. A few safety precautions could mean many more years at the poker table.

What about the Kid? Did I ever run into him again? Did I ever regret failing to warn him about the dangers of his behaviors? Read on.

A few weeks later, I was cranking out patients when a “trauma code” radio call came through. “MVA, 22-year-old, no seat belt, shattered windshield, massive head and facial trauma, 3-minute ETA.” My team suited up (gowns, gloves, goggles, masks).

He arrived stinking of beer and trussed up like a turkey, strapped to a long-board. As the muscular paramedics hoisted him onto our stretcher, a flash of orange and blue caught my eye. Tucked underneath one of the straps was a crushed, bloody Gators cap.

I caught my breath. “Do I know this guy? Is it the Kid?”

I suddenly felt deep remorse, a sad sinking feeling that I might have some connection to this “trauma code.” He might be someone I actually knew. We had a relationship. We had grappled like gladiators on the green felt of the poker arena and he had temporarily come out on top. I understood how he played. I knew this guy. I should’ve said something that night.

Now he lay in front of me broken and gurgling, unable to breathe through the vomit and blood. I searched his smashed face for familiar features but there was too much blood, too much swelling and distortion to tell for sure. Then I saw it.

His left eyebrow, one of the few square inches of his face not smeared with blood, was clean, no piercing, no scar. It wasn’t him. I suddenly could breathe again.

Now it was my job to try to save his life. As I reached for suction and an endotracheal tube, my mantra kicked in: “A” is for airway.

— An avid poker player, Frank Toscano, M.D. is a board-certified emergency physician with more than 28 years of front-line experience. He’s medical
director for Red Bamboo Medi Spa in Clearwater, Fla. Email your poker-health
questions to ftoscano@redbamboomedispa.com