Scary

There have been a couple of times I've felt scared in the hospital as a medical student. Some of the times where I anticipated feeling terror were surprisingly un-terrifying. For example, being in the trauma bay when an ambulance comes screaming in with motorcycle crash victims or gunshot wounds is not nearly as scary as I thought it would be. Maybe it's because the environment is one in which the patients are expected to be in critical condition on arrival (we have a trauma center in addition to our ED, so the super critical patients with bloody gorey stuff end up in trauma). Maybe when you expect a patient with body parts falling off and a blood pressure of 70/40, and you get...a patient with body parts falling off and a blood pressure of 70/40, you're par for the course.

One incident that terrified me was recently when I was in the ED evaluating a patient in Bed 4. She was a woman with end-stage liver disease who was yellower than a highlighter thanks to her bilirubin of 45. She was critically ill but able to relate her history. I was busy scribbling notes when I heard a most horrible retching sound from behind the curtain next to us. I tried to ignore it and continue listening to my patient. Noises like coughing, retching, moaning, and screaming are the background noise of a busy ED and nothing to get terribly excited about. The third round of retching sounded especially disgusting. Something about it did not sound like normal vomiting to me. I peeked behind the curtain to see what the hell was going on and saw a frail man in his 60s staring into his lap, which was saturated with what appeared to be pure blood. I saw him retch again and bring up a large volume of bright red blood with huge clots, some the size of golf balls.

In medical school, when you learn about gastrointestinal bleeds, they tell you to always quantify the amount of blood. I always wondered how much "a lot" is. One person's "a lot" could be very different than another person's. My professor told me at the time that when we saw a big upper GI bleed, there would be no question about it. "A lot" is any amount large enough to result in you soiling your drawers when you see it.

The poor man was shaking and absolutely white as the sheets he was sweating through. His nurse ran over right as I was reaching down to elevate the head of his bed (to prevent him from choking on his vomit/blood and aspirating it into his lungs). When she saw him covered in his vomited blood, she hollered for the ED attending, who flew over and started yelling orders to IV fluids and blood products to be hung STAT!

I'm not sure why this incident was so horrifying for me. Maybe because it caught me off guard...I expect the ED to have crazy stuff going on when a patient arrives and is unstable, but not after the patient is settled in and awaiting a bed on the medical floor. It's all about your expectations, I think.