Inside

In a small hospital the general word about goings-on spreads quickly, so we had already heard about the guy coming in from the state prison.

The nightshift nurse manager had already gotten some Sotradecol and Buscopan from the pharmacy. They already had the endoscope going in the emergency room and we had a Blakemore tube and suction set up in the ICU.



His labwork was low so they had already crossmatched him for four units of packed cells.

I had no doubt in my mind about what I'd be doing that night.

There were two of us in the ICU and I just had one other patient who was a routine post-endarterectomy with an arterial line. Systolics in the 140's and she was sound asleep.

Before the door to the unit opened we could hear him saying loudly "I'm gonna die!" I looked at Karen, the other nurse; my mentor really, and she shrugged back.

The surgeon was accompanying the patient, blood was already running, and we settled the guy in and Dr. Gellman sunk the Blakemore.

Did I say that there was blood everywhere? The patient was soaked. He'd been coughing. This was not good. Esophageal varices can bleed out very quickly. But after a couple of hours things seemed to be going okay. His blood pressures were always good, he didn't much complain of pain, and the tamponade seemed to be working because the stuff we were suctioning out of his stomache was looking more green than black or red.

He really seemed to appreciate what we were doing for him. He was polite, respectful, but deeply in fear for his life. We talked a little as I cleaned him up. He was in for a long time on drug charges. He'd started selling when he was eight or nine years old.

Along the way he had become a bit of a user himself and damaged his liver. Thus the varices.

He was gone when I came back the next night. He bled out, bradycardia set in, he lost his pressures and died just like he knew he would.

The doctors were pissed off. Dr. Gellman said "it didn't have to happen" and added that if the patient were on the outside maybe a Prilosec prescription and some routine care could have prevented the whole mess.