I held tight to the IV that I had worked so hard to get into the vein. The patient continued to heave while I secured the IV. I looked up at the nurse and she apologized with a smile as I looked at my once freshly pressed white coat now stained with blood. I handed the IV port to the nurse so she could begin siphoning off the blood that was needed for all the lab tests we were about to order. I took my stained lab coat off and threw it in the biohazard bin. This coat was too far gone with 40 - 50% 3rd degree stains there was no saving this coat. I washed my hands and arms in the exam room sink while the nurse continued to get the blood samples.
The patient slumped back on the exam table and moaned interrupted occasionally by surging dry heaves. I asked the husband several questions about his wife and her condition. He explained how they had been enjoying a nice evening when his wife became violently ill. He seemed oblivious to the fact that his wife looked as though she had been covered in yellow highlighter which told me that she had been yellow for a while and the onset was insidious. I asked about her drinking and he boldly denied that there was an issue with alcohol. "we only drink socially" he said. I quietly thought to myself, they must be pretty social people because her condition screams 30 years of being extremely social.
I returned to the moaning patient to examine her and continue my quest for clues. The dry heaving had subsided and I needed to get a nasogastric tube in her nose and to her stomach so that I could determine if she was actively bleeding. Many alcoholics will have a gastric bleed that can be life threatening if it is not stopped. I put on new gloves and grabbed the tube. I knew this was going to be a wrestling match to get the tube placed. The nurse helped secure the patient as I prepared the tube and numbed the patient's nose and throat with some lidocaine gel. I inserted the tube in the patient's nose and she bucked and kicked. I asked here to swallow and told her it would all be over soon if she cooperated. To everyone's surprise she swallowed without any issue and I was able to pass the tube all the way into her stomach.
I hooked the other end of the tube up to the suction and flipped the switch. I watched as a blackish red fluid began to flow from the patient's stomach up her esophagus and out through her nose. This fluid started to fill up the bucket that was attached to the tube. I had several spare buckets ready to go. I continued to push saline into her belly at the same time. This process requires that you continue to fill the patient's belly with saline and then suction the stomach until all you see is clear fluid coming from the stomach. If you do not get clear fluid and it remains red then you know you are dealing with an active bleed. Alcoholics bleed.
I leaned against the wall and watched as the fluid continued to come out. I hoped that the color would begin to fade from black red to clear. I looked at her nervous husband and could tell he loved this women and I wondered what their life had been like. How many kids did they have? What kind of work did he do? What kind of work did she do? Did they have any grand kids? How did they meet?
My thoughts were interrupted when I noticed that the patient's hand began to flap. It was like she was trying to clap with one hand. I had seen this before and knew what it was, this was asterixis.......
To be continued.... (It won't take a month this time)
