WhiteCoat

You Never Know What’s Coming Next

I smiled a little bit when the nurse handed me the next patient’s chart.
An 18 year old had come in at 2 AM complaining of blood in his stool. Other docs may have yelled at him for waiting until 2AM to be seen in the ED for this “problem.” I just figured he’d need a little reassurance about some hemorrhoids or an explanation on how to manage a fissure. No big deal. A quick in and out.
I walked in and he was sitting on the bed smiling.
“How’s it goin’, doc?”
“Good, so tell me about the blood in your stool.”
“Well, the past few times that I went, there was blood there.”
“Do you mean stool with blood in it or do you mean that you’re passing blood instead of stool?”
“There’s a lot of blood there. I went in the toilet and left it there so you could look at it.”

That’s one of those things that is sometimes helpful but that down deep very few doctors want to hear. Right up there with “I brought my stool in a baggie for you to look at,” “the poopy diaper is sitting on the counter over there” and the one woman who was attempting to disimpact herself who held up her finger and said “its about that color” – referring to the stool still stuck underneath her fingernail.

“OK, I’ll check it after I get done looking at you.”

The tech was just finishing up her vital signs (which were all normal) and I asked her to get orthostatic blood pressures while she still had the blood pressure cuff in place.

Then a funny thing happened.

As the patient stood up, he started wobbling a bit. I thought he was kidding at first. Then he started to fall forward towards the tech. I reached over the bed, grabbed his shirt, and pulled him back onto the bed. He was out cold. His face was white and his lips were pale – never a good sign. His pulse shot up to 150 and his blood pressure dropped to 70 systolic. I ran over to the toilet and it was filled with blood. Definitely not a hemorrhoid. Got two IVs in and called for blood. We tipped the head of the bed back and soon he was back in the land of the conscious again.

“Did I just pass out?”
“Yes … yes you did.”

Got him a commode in the room and he ended up having a couple more bloody bowel movements. His hemoglobin was 9, which was low, but it was probably a lot lower than that after losing all the extra blood. Called in the cavalry who admitted him to the ICU. Ended up having an AV malformation.

The next time I went to the bathroom, I passed something a little strange looking, also. It looked like this (credit):

istockphoto_7862250-brickGotta love the ED. Even when you think you’ve got a handle on things, you never know what’s coming through the door.

13 Responses to “You Never Know What’s Coming Next”

  1. exi says:

    The brick was definitely the best part.

  2. SeaSpray says:

    Interesting story. Given the age and his perkiness (can a guy be perky?)it would seem that maybe it was something minor.

    But the lady with poo under her fingernail? That gives EVEN MORE meaning to Trench Doc’s “Germaphobe” post I put up says this “occasional” germaphobe. ;) Just think of ALL the things she touched! I mean come on! She obviously wasn’t playing with a full deck…was she? if that ever happened to me with me…I still couldn’t get to the sink fast enough to scrub thoroughly enough! Please don’t associate me with a poo nail but a glitter nail is just fine. ;)

    Love the brick! :)

    P.S. I am one of those patients that unless significant pain or vomiting is involved…will always be perky and smiling back at you and that I probably present as feeling better than I do or not being as concerned as I am.

  3. Nurse K says:

    When 18 year olds come in with “diarrhea”, I go through my littany of ?s and every single one says they have bright red blood in their stool when I ask, or at least most of them. Yawn. Exaggerators.

  4. SeaSpray says:

    O.k….I’m sorry this off track but I remember an ED doc discussing the fact that women with long finger nails can’t possibly get it totally clean under there with a quick hand wash, etc.

    Right after that, I went to a deli that I had liked but had never paid attention to just how long the owner’s fingernails were. LONG! I ordered cold cuts. She didn’t (never did)use gloves. With each slice of meat/cheese I kept staring at her fingernails,(enter with Hitchcock music now) recalling what the doc said, imagined what could be under there and with everything in me wanted to tell her the importance of wearing gloves…I r-e-a-l-l-y, r-e-a-l-l-y wanted to tell her…but I stayed quiet.

    And what started the conversation in the ED was that they were then saying that nurses could not have long fingernails even though they were gloved. And so he was saying that the nurses who know how to scrub etc., wouldn’t get it totally sanitary and so I was thinking how much less a lay person would think to “scrub” before preparing foods.

    BTW…ever look at some restrooms where you know and are trusting that the employee washed thoroughly and didn’t touch knobs etc? Or see private deli people handle money, rub their pockets or hair(with gloves on)and then touch your sandwich? I’m just sayin.. :) I’m taking Mom shopping now and yes…i am ordering from the deli. :)

  5. SeaSpray says:

    Sorry…last one…I never did go back to the deli that was owned by the lady with the long fingernails (just couldn’t) but we did eat the cold cuts and obviously survived.

    OK, my grandmother used to say “You have to eat a pound of dirt before you die.” But I don’t think that kind of “dirt” was supposed to be included.

  6. cowgalutah says:

    yikes…that one hits a little close to home for me this week. Aunty was dx with cirrhosis of the liver…she had just went in to the Dr’s office with a bit of blood (ya) in her stool. Found out she has all sorts of problems…sorry enough about this, it’s your blog after all!

  7. ERnursey says:

    The ER, full of experiences to humble us.

  8. SeaSpray says:

    No…probably not WhiteCoat. :)

    Did you not see the size of the brick I passed??

  9. Dr. Val says:

    Whoah. Great case. LOVED the visual aid. :)

  10. SeaSpray says:

    LOL! OK maybe you ate a pound or two. ;)

  11. Kelly says:

    Still laughing. The brick…what a great way to get the message across.

  12. mar says:

    Keep trying to pass more bricks, wont be long till you have a little house by the beach,you’ll only need a bit of land!

    Love the story, same happened with my other half,didn’t end up in icu, did a job on him in xray with a few plugs. These Irish docs just something else.

  13. Nowheet Owl says:

    scary… describing it just not enough, eh? have to bring it in a baggie. dang. i have more respect for doctors now. :D

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