Bleeding noses, Cocaine… All in a day’s work.

My Early Internal Rotation is coming to an end fast and despite torturous ward rounds, I must concur with John Abernathy when he says,

“The hospital is the only proper College in which to rear a true disciple of Aesculapius.”

Funny things happen on our calls – such as the 70-year-old granny who presented with signs of ventricular failure and seemed lucid as anything while telling me that she is as fit as a horse and has never experienced any health problems whatsoever. Until her (thick) file arrived and it appeared that she was quite well-known to our hospital. She then proceeded to tell me that it was certainly not her file; despite the coinciding personal details.

She was a darling.

A young man with Aplastic Anaemia presented with massive epistaxis. His nose had actually been packed by a regional hospital two days before and it had still not subsided. We called in the ENT and he told us we could watch if we donned the appropriate protective gear – the first time I had to cover myself for the patient’s protection and not my own (these patients can be extremely susceptible to any kind of antigen).

One of the first things the ENT said to the patient was that he brought some cocaine to stop the bleeding. You should have seen the size of his eyes! His mother looked a bit suspicious too.

The bleed turned out to come from Little’s Area, which is a highly vascular area of the nose that is quite easy to cauterise. It was chemically cauterised so the teenager didn’t get his (presumably first) run-in with Snow White. I couldn’t tell if he was disappointed or relieved; but he stabilised rapidly thereafter. I had never before seen someone needing transfusions due to a nosebleed.

Probably one of my rarest and most striking patients came in with severe polymyositis – basically an autoimmune disease against your own striated muscles. He started exhibiting symptoms 18 months ago and it could not be controlled by steroids. Currently he has some use of his toes and his hands only – the mnemonic goes “hairs, chairs and stairs”; illustrating how the proximal muscles are affected first.

The most striking thing was his mother and her entire support-network. Despite the fact that they clearly suffer, her strength and love for her son was evident.

Yesterday morning he unfortunately went into respiratory arrest and had to be intubated. The problem is that once these patients are intubated, it is extremely difficult to get their diaphragm to restart the work of respiration. Imagine being able to feel everything and experience everything, but not being able to move… and now not being able to talk as you have a tube down your throat.

From http://www.uvahealth.com

His mother was devastated. When you see someone you love like that, it seems they are on the brink on death. We explained to her that this is not the case. I guess it is open to personal opinion whether that is better or worse.

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3 thoughts on “Bleeding noses, Cocaine… All in a day’s work.”

    1. It certainly can; which is why it is so important for doctors not to revolve their entire lives around their jobs. Coping mechanisms are also very important – I’m still working on that bit. Thanks for stopping by!

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