Friday, April 21, 2006


Sometimes you hear somebody resort to the old cliche "you can't tell a book by its cover," which in these faith-based anti-liberal hate-filled days of Republican screed is so not true... consider the epic tomes of Michael (fake name Savage) Wiener and Ann (Adam's Apple) Coulter, for example, whose titles alone eloquently save you the bother of actually reading the contents inside.

The Young One Who Pays No Heed to Parental Authority has lately ironically discovered, thanks to me, the songs of the Beatles. So the "White Album" has been in the CD player and as you know the cover of that doesn't tell you anything at all except the name of The Beatles when that was who they were.

Plain white wrapper, music of glorious beauty and variety inside. Who'd 'a thunk it?

He had been bleeding from the moment he returned from the operating room. The doctors had surgically incised a few cysts from each armpit. I didn't see any external sutures. Looked like they slit each open, espressed whatever ooze was in these, (there were a few) and then sent him back to us.

He wasn't my patient, but the looks on the faces of the nurses involved told me to take a stroll down that way. My little team was under control, which I rarely have the pleasure of saying. I'm a magnet for the most unpleasant things usually. Feces, degrading cardiac rhythms, sagging blood pressures. That's my ilk.

The patient's nurse, a nearby nurse, and the admission/discharge/transfer nurse were all taking turns holding pressure on the guy's armpit, but it was still oozing a steady trickle of blood. I brought a few boxes of 4X4 gauze. Then I took a turn myself, holding pressure with a wad of gauze while his nurse injected morphine.

He was talking on the phone while holding his left arm straight out above shoulder level to his side, so we could try to soak up the blood trickling from his armpit. Blood was on the sheet under his arm.

"Careful, he's HIV," said his nurse to me. She looked like she was about to cry, but it wasn't an emotional thing. She was fronting down a case of double pink-eye. I was properly gloved.

Once every few minutes I'd peek under the gauze to note the trickle. The A/D/T nurse spelled me, but I came back later to hold pressure again and see how things were going.

The surgeon who excised the cysts was off, so he told the nurse to try the on-call trauma surgeon, and he just said that he was 45 minutes out and to "hold pressure." The nurse explained that we had been doing that for like over an hour but he had no more to add.

The medical doctors she tried to call deferred it to surgery, but eventually a medical resident showed up and wrote orders for blood pressure meds (170/105 last, 205/110 before going to the OR.) He also ordered some STAT labs so we could check the anticoags and hemoglobin.

A little blood goes a long way. I was holding pressure again when the ADT nurse spelled me and I took a look at the blood.

It looked like blood.

Sure, it was HIV positive and Sam knows I wouldn't want to take that home with me. But it looked like plain old blood and nothing else.

After a couple hours of various nurses holding pressure on a one-centimeter-length armpit incision, it finally eased off bleeding. They'd wrapped a wad of gauze with kling to hold it over the wounds, and no blood was visible. He had his arm down.

I wondered. The next time I have a patient with uncontrollable bleeding from the armpit, I will have him hold his arm down. I do not know why; it's an instinct thing. I mentioned it to the guy's nurse, but it didn't really seem important. It's probably nothing.

"At night all cats are gray."

To which I might add: "At night all black Labrador Retrievers are... gray?!"


Eli Blake said...

A week ago, my wife had surgery at St. Joseph's. Do you know anybody who works there?

The first day was rough, but the staff there was very professional.

Don't know about how the bill will turn out though, not looking forward to it at all.

The Platypus said...

"Careful, he's HIV,..." Yeh, we always tell each other, usually with finger pointing to that line in the chart, maybe accompanied by a certain kind of expression, or with a code word like "T-cell issues", even though we won't, or shouldn't, do anything differently with the patient than we would with anybody else.