Thursday, August 25, 2011

Bleeding Stories

I had a 58 year old patient one night who came in because he couldn’t stop bleeding.

The first sight I had of him was when I glanced into the room where the nurse was checking him in. I wasn’t planning on talking to him, but he was sitting on the gurney with his feet towards me, and a bloody washcloth between his feet. My eye zoomed straight in to a definite blood splatter right across his crotch! Now, here’s the thing about blood. It doesn’t go up, usually. It goes down. Unless, of course, it is squirting out of something, like say, an open artery. Veins don’t squirt, only arteries do. But even if it was an arterial bleed, how would it squirt upwards from his ankle to his crotch? It took me a few minutes to get the story straight, but eventually it came out that he had been lying on his back with his leg up in the air when the bleeding started. He had been taking off his socks to go to bed and he had felt something rough underneath the sock. He scratched it and it came off and started bleeding, and he couldn’t get it to stop, so he went and stood in the bath tub and called his daughter. She came to see and she couldn’t get it to stop either, so she covered it with a wash cloth, took off her belt, wrapped it three times around his ankle, and buckled it. Then she drove him into the ER where I saw him. It’s somewhat ironic that my intervention was to teach a man in his fifties how to stop a bleeding cut with direct pressure and to scold him for picking at his scabs. Seriously though, the number of people who don’t know how to do something as simple as stop bleeding is astonishing. Even civilian EMS personnel are generally useless at stopping bleeding.

This incident led the nurse to share a story from when she was working in a trauma center in a major city (I won’t say which city, but it was in the New York, San Francisco, Houston level of majorness) and an upper class looking lady came running in at three in the morning with blood all over her face. “Look,” she said, “I don’t want you to tell anyone I’m here, and I don’t want anyone to know what happened.”

“Okay,” said the nurse. “Why is that?”

“Do you know who I am,” the lady asked.

“No,” the nurse said, “I’m a travel nurse, I’m not from around here. Who are you?”

“I’m the mayor.”

“You have a nose bleed. What’s so terrible about that?”

“I was picking my nose. People cannot know about this!”

I don’t know whether or not that ever got out, but apparently the mayor, before she left for the hospital had called her son when she couldn’t get the bleeding to stop. Then she had decided she didn’t want him to know what happened, hung up and left for the ER herself. He was worried, so he came over and knocked on her door, and getting no response, peered in through the windows. And of course, all he saw was an empty house with blood all over the floor. So he called his buddies and they kicked down the door and raided his mom’s house while she was at the ER. I wonder how she explained that one when she came home to a house surrounded by lights and sirens.

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