Wednesday, November 9, 2016
Personally Intervening in the Case of Public Intoxication
I am at the Fairmont Copley Plaza Hotel in Boston. I made the trip for the Harvard Neuropsychiatry Course. My wife and I decided to go out and look at some architecture and walked out the side entrance onto Dartmouth Street. There on the sidewalk was a young woman who appeared to be doing a down dog. The only problem is that she did not seem to be able to get out of it. As she pushed herself up, it was apparent she was severely intoxicated. She had drawn a small group of observers, people were staring at her and not doing much of anything. Being strangers in town we decided to keep moving and let the locals handle it and headed down Dartmouth toward Boylston Street. After about 100 yards the young woman got up and started walking down the sidewalk and at times staggering into the street. Vehicles travelling at about 30-40 mph had to stop or take evasive action in order to avoid her. She was not aware of the near misses and kept wandering farther out into traffic. This was unfolding in full view of hundreds of people in Copley Square and three television camera trucks interviewing people about the election results.
At that point, I could not stand by to wait for her to get hit by a car. I was in Philadelphia once back in 1975 on a packed sidewalk. At the red light a guy next to me inexplicably stepped off the curb against the light and was hit by a speeding van. I can still see his body arcing through the air and landing face down on the asphalt about 50 yards away. I don't want to see that again. I walked up to the woman and physically guided her back onto the sidewalk and asked if I could call someone. She was obviously intoxicated and her speech was 80% unintelligible. She was able to tell me that she wanted to get on a subway train to a suburb. There were two subway stations available and a passerby helped us out by telling us where we needed to take her. I helped her across Dartmouth and at that point she became agitated and started to walk out into the street again. I tried to guide her to a seat at a bus stop and she slumped against the edge of the bus shelter and it looked like she was going to fall asleep. At that point, I asked my wife to call 911, because it was obvious that she could not safely travel on her own.
She became agitated and angry. She demanded to know where I was taking her and bolted across the street to the the wrong subway station. We had the 911 operator on the line and when we reported what happened, the operator said: "well she's on the subway - it's out of our hands now" and hung up! We crossed the street and went underground looking for her. I was concerned that she would fall off the subway platform. She had negotiated the turnstiles and it was not obvious how that happened, but there were some embarrassed looks on the faces of the transit personnel.
I watched her get on the train. One precarious short step forward, followed by a long lean backwards. During the lean, all of the exiting passengers halted in their tracks as if they were waiting for her to fall over. After a few seconds - she regained her balance and plummeted past them onto the train. The train pulled out and she was gone....
We helped her as much as we could. Two people assisted us, hundreds did not. We avoided a catastrophe - at least in our immediate vicinity. From the public official we called, that was apparently all that the citizenry of Boston expected. I did not notice until later at night that there were a significant number of people with chronic mental illness around Copley Square. Many of them were incoherent or shouting illogical statements in a loud and vaguely threatening manner. Still - they were not wandering in traffic and appearing to be at high risk for a fatal encounter. It is possible I guess that the threshold for intervention is altered in that context, but the young women in question was neatly dressed and obviously ataxic, dysarthric, and sedated at times. In that case, the many people who saw her decided to do nothing but watch.
I thought I would document this all here with a suggestion. If you see a fellow citizen intoxicated and in danger, I recommend intervening in that situation. I don't think that you want to be second guessing yourself if you elect to do nothing and witness a catastrophic event. This is a clear example about why public intoxication is not a humorous event like it is typically portrayed in the movies. It is also an example of the limits of what can be done. Of course you always have to use your judgment in these situations. You can't put yourself in danger. Private citizens cannot take physical custody of another person. I could only help this person as much as she would allow even though her judgment was clearly impaired.
Acute intoxication can easily be a life threatening experience. The danger can be either the direct result of the intoxicant or the result of inadequate self care. I have seen too many people killed outright or in a trauma or burn unit because of that lack of ability to take care of oneself. Even an unsupervised fall at home can be fatal.
So - do what you can.......
George Dawson, MD, DFAPA
For some reason, I have had the opportunity to intervene in many of these incidents in the past varying from a retiree backpedaling out of a rural convenience store and slamming into me at 7AM in northern Wisconsin - to picking up someone off a hospital floor and getting him to the Emergency Department. My wife was with me for the first incident and she was quite upset thinking that the old guy had a heart attack or a stroke. I told her not to worry - he was drunk even though it was 7 AM and he had driven himself to the store across a busy highway.
Photo at the top is from Wikimedia Commons with the following references from that site: By User:Eos12 (Own work) [Public domain], via Wikimedia Commons https://commons.wikimedia.org/wiki/File%3ACopleySquare.jpg per the listed release into the public domain by the originator.