Tuesday, July 22, 2008

On Pathology

Students in the department today. This usually means it's very quiet, but not today. Chief among the citizens who walked right out of a textbook was a fella who had been rather too friendly with the booze; years of one too many had rotted his liver, shrivelling it and firming it up, making it almost impassible for its rich blood supply. So now blood finds another way round, and one of those ways is through large dilated veins at the base of his oesophagus.

When these varices leak, they do so like a hose. He's been through this once before, but been lost to follow up. So he sat before us, shivering, an odd lemon yellow tint to his gaunt skin. Even as we called the Magicians and the endoscopist, telling them that he was stable, we knew it would turn out to be a lie.

But he didn't look too bad.

'Fooled you'

Innocently mumbling something about feeling a bit rough, he sat up and disgorged a river of claret. Bowl after bowl he filled, till his pressure dropped low enough that he couldn't hold his head up no more.

And still it came.

Then we moved in a blur. Organised flail - central lines, arterial lines, blood, platelets, the works. Curiously, he was most worried about having to have a catheter, and fretted about the speck of vomitus that streaked his chest, daubing him like some sort of Biblical door-frame. Odd, what seems important when one's life is literally draining away.

As all this raged, a young fella stabbed to the chest occupied my colleague on nights, and as I left, I saw the Sister of the Night pass him a CodeBlue sheet. I didn't catch the full story, but distinctly heard the words septic and unwell.

When it rains, it rains...

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