Tuesday, February 22, 2005


All bleeding stops eventually.

As I was leaving the hospital for the evening, I got called into a patient's room emergently because he suddenly started bleeding from his neck. I run into the room to find a gaggle of nurses running around in a frenzy and a mountain of gauze on the patient. The best initial treatment for any type of bleeding is direct pressure on the site of bleeding. This is true whether you cut yourself in the kitchen or get shot with a bullet in a war zone. A mountain of gauze helps hide the bleeding, but doesn't actually do anything to stop the bleeding.

So I remove the mountain of gauze to find that this man is bleeding from the site where a previous hemodialysis catheter was removed. Obviously, the blood clot that initially made the wound hemostatic had been dislodged and the best way to restore hemostasis was to hold pressure on his neck until the blood had a chance to form a clot again. Which I did.

Of course, as soon as the bleeding stops, all the nurses leave the room, and I'm stuck holding pressure in this man's neck.

"Aaaagh. What are you doing?"

I looked down at the patient, who was scowling at me. "I'm sorry, I know this is painful, but I need to hold down on your neck for about 10 minutes to stop your bleeding."

"Aaaaagh. That hurts! I want you to stop!"

I informed him that if I let go, he'll resume bleeding, and most likely bleed to death. But all he could concentrate on was the pressure in his neck and wanted me to leave him alone. After a bit of groaning and carrying on, he started to bargain with me.

"I'll tell you what. Lighten up on my neck a bit. Please."

"No," I replied.

"I'll give you some money. Please. My neck!"

I just rolled my eyes and concentrated on getting this man's neck to stop bleeding.

"You're hurtin' me! Do you even know what you're doing! You're hurtin' me!"

A nurse pokes her head in at this point, "Is everything OK?"

I look at her, but I'm not quite sure how to respond. Before I can think of something witty, she retracts her head and disappears. All of a sudden I'm brought back to the moment by a jab in my ribs.

"How you like that? See, I can hurt you too!" Jab! Jab! Jab!

I've got both my hands on this guy's neck trying to keep him from bleeding to death and this 75 year old guy is reaching up and poking me in my side with this bony finger. I couldn't defend myself. No nurse was available to restrain the patient. So I suffered through the next 5 minutes, holding pressure on a patient's neck, getting poked in the ribs while listening to him whail about how I'm trying to kill him, and laughing because I couldn't think of a more bizarre way to end the day.