20-something male, c/c of LOC. Found the patient sitting in a chair, very obviously drunk. Another bullshit barracks call.

When I asked him what happened, the response wasn't right. "We are he found in on and floor and hit and we are." Nobody is this drunk at 1800 on a Monday. I decided to go through some neuro questions.

"Can you tell me your name?" "We are I and am good to go and this man (pointing at my driver) am putting the medicine on (referring to the BP cuff)"

"Can you tell me where we are?" "We are yes California and Escondido I am (we are in Japan)"

"Who is the president?" "He is am the Hispanic type of hernandez."

Suddenly I'm a lot more interested. He has a sense of grammar and normal speech patterns and seems to understand himself, but it's complete word salad. GCS 13 with a 2 deficit in verbal.

Physical exam revealed swelling to his right temple. Eyes were fine, motor function was consistent with intoxication, nothing else remarkable.

His roommate had found him passed out for an unknown length of time on the floor, presumably falling and hitting his head. He confirmed as much but had no memory of the events after.

I called it in as possible TBI. En route he'd go from GCS 13 to 15 and during the lucid periods I was able to gather two separate falls and head strikes that day, a week of dehydration and heavy cardio in a tropical climate, five units of alcohol consumed that night. He started getting combative and demanding that I open the window for him to piss on the road or let him go on the floor. This was not happening. He couldn't go in the urinal I provided.

We get to the EMD and the doc on call goes through the same questions. He asks who the two escorts are and the patient says "September and am October". It's noon at night and we are four thousand miles away from where we are.

Head and neck CTs turned out negative. Tox panel only returned alcohol. Somehow he really did just get drunk enough to think the president is Hispanic and his friends are months.