I find myself often confused. There’s so much to know in this world that I am at a loss for words when I recognize the concepts, ideas and facts I have yet to grasp. I understand that God created me with a very specific purpose. Yet my frustration mounts around this time every year when we approach the in-service examination, and it is painfully obvious how much I still have yet to learn. And even worse, just how much I have forgotten. It keeps me humble. My study book has more colored ink and coffee stain then actual printed ink, often making it difficult to find a clean spot to make my notes. I’ve officially decided on retiring the book after this year’s test. New book, new edition, new clean pages!!
I just got completely off topic. I was talking about being confused. Human behavior often confuses me as well. There was a point when I had entertained Psychiatry as a potential field. Human behavior can be predicted and explained, it follows a text book pattern. It’s really quite fascinating to study, and hence why I had entertained the idea. But then, take a read at my last post... I no longer think that would be fun.
I was confused by a page I received the other day. It didn’t help that the medicine doctor on the other end of the line couldn’t exactly tell me why he had paged. But he told me about his patient. She had undergone a bone marrow biopsy two days prior, and had been bleeding from the needle puncture site since then. Bleed enough that she was about to receive her fourth transfusion. Easy enough story, but why call surgery? We have knifes, if we cut what’s already bleeding, it will only cause it to bleed more. The medicine doctor wondered if we had any tricks to stop the bleeding. To which I responded, hold pressure. And, he laughed. Must have thought I had said a good joke or something. I reiterated the need to hold pressure expressing my 100% sincerity. He evaded the topic by saying they had put a pressure dressing. ....fast forwarding the rest of the exchange, I do end up seeing this lady. Taking down what was supposed to be a “pressure dressing”, I find the culprit, a tiny needle hole over her hip bone with a continual red leak escaping from underneath. I wad up a piece of cellulose polymer and with my finger push it hard against the insulting hemorrhage. And then I don’t move. Four minutes into holding pressure, I asked the patient if anyone had done that for her? “Done what?” She responded. “This!” I exclaimed, “Hold this pressure!” No, she said. No one had held pressure.
I am confused. The lady’s blood was diseased. It’s why it did not want to clot. But instead of treating the disease, or even treating the patient. Nothing had been done for two days. She had been allowed to bleed for two days, with nothing more than a haphazard dressing. The nurse told me that at one point, they had found the patient laying in a 2 inch pool of her blood. I’m confused, why nothing was done for two days. I’m confused, why they would transfuse blood, but not platelets (which is what she actually really needed). I’m confused, why they thought a small dressing on a hip could suffice as a pressure dressing, and I’m confused why the idea of holding pressure was so funny to whom I initially spoke to on the phone.
I’ve used the situation as a teaching opportunity for the med students. Emphasizing the importance of holding pressure, and not being afraid to touch your patient.
One of our Vascular Surgeon’s at Westchester has his list of P’s for bleeding.
Pressure, Prolene, Packing, Protamine, Platelets, Patience and Prayer
If I could take liberties with Dr. Mateo’s list, I would make it as follows... Pressure, Prolene, Pressure, Packing, Pressure, Protamine, Pressure, Platelets, Pressure, Patience, Pressure, and Prayer.
Much Love.
