(I originally posted this in May of 2006. The back story to this back story is as follows: There is a type of competition in lindy hop called “Jack and Jill“, which focuses on the abilities of dancers to dance well together in a social context—that is, their talents to adopt to and improvise with each other. This is in contrast to the performance of a choreographed routine. The clinical material is a toxic amalgamation of patients we have all seen in the emergency room.)

Jack and Jill went up the hill to fetch a pail of water. Jack fell down and broke his crown and Jill came tumbling after.

Jack had consumed about a fifth of gin about an hour prior to this incident. Due to this inebriation, he was unable to ambulate safely and subsequently could not coordinate his motor activity. It is unclear if he lost consciousness when his head hit the ground (he was yelling obscenities at the ambulance service and continued to scream expletives upon arrival at the emergency room; he was not directable and was ultimately placed in four point restraints due to his attempts to assault staff). However, he was moving all of his extremities and he clearly had a GCS of 15 at presentation. His blood alcohol level was near 400.

Jack was obviously unable to provide any pertinent history as to why he and Jill went up the hill to fetch a pail of water. Witnesses at the scene stated that Jack actually pulled Jill down the hill and that she actually did not go “tumbling after” him. Police records indicated that Jill had called 911 at least four times in the past year due to concerns that Jack was going to kill her; she stated that Jack “flew into rages” when he was intoxicated with alcohol or methamphetamine, another substance he frequently used. Jack was incarcerated for about nine months last year due to domestic violence charges; it is unclear at this time if these were solely directed against Jill.

As a result of the fall, Jill sustained several contusions and abrasions, mostly on her left arm and left leg. Radiographs revealed a comminuted fracture of her left humerus. She reported that she clearly recalled all the events surrounding this incident, but the physicians ordered a head CT scan due to fears of litigation in the event that she did sustain a head injury.

Jack’s urine toxicology screen was positive only for marijuana. Jill’’s urine toxicology screen revealed marijuana and opiates. Her past records indicated potential misuse of prescription narcotics; she was hospitalized about three years prior after sustaining a fall from a fourth-floor balcony. The history surrounding that incident was also unclear; there was some suspicion that Jack had pushed her off of the balcony into Quite Contrary Mary’s garden. Both Jack and Jill denied any foul play; she stated that like Humpty Dumpty, she was sitting on the edge of the balcony and simply had a great fall.

Jack’s physical exam and radiographs did not reveal any acute pathology, but due to his alcohol intoxication and assaultive behavior, he was admitted to the neurology service with an admission diagnosis of “alcohol intoxication”. The neurology service consulted the psychiatry service for assistance with his withdrawal symptoms. Jack later also began to articulate desires to kill Jill’s mother due to her constant intrusions into the relationship Jack had with her daughter. He also mentioned his intentions to kill the witnesses who reported that he pulled Jill down the hill. “They’re lying, all of them!” he yelled. “She tumbled after me! That gold-digging whore—once my crown broke, she wanted nothing more to do with me! Money, that’s all that skank wants!”

Although Jill sustained relatively little injury, she was ultimately admitted to the hospital to the general surgery service. While in the emergency room, she developed abdominal pain. A CT scan of her abdomen revealed some vague stranding around her pancreas and spleen; her physical exam, however, did not reveal any significant tenderness, rebound, or guarding. The surgeons elected to watch her overnight and perform serial exams and labs on her in the event that her pancreas or spleen were indeed injured.

(My apologies to Mother Goose.)