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Doc Lightning
Doc Lightning

HOP Mad Doctor
Location: San Francisco, CA, USA
Member Since: 28th May 2001
Total posts: 13920
Posted:So tonight a 54 year old gentleman was brought to the ER by EMS after he started vomiting large amounts of blood at home and then passed out. He has a history of alcoholic liver cirrhosis and hepatocellular carcinoma (liver cancer). When that happens, the blood flow into the liver can become backed up through the veins in the esophagus causing those veins to expand and then rupture. The blood loss can be astounding.

We gave him 10 units of blood, but he developed clotting issues from all the transfusions. There was blood coming out of every orifice. He went into cardiac arrest and after 10 minutes of CPR, we all agreed it was time to stop. And so...he died. Right there. With my hands on his chest. And his wife and three teenage kids in the waiting room.

That's the first time that I've ever actually seen a patient (or anyone) die.

I have seen Death and I have looked him in the eyes. He was not there for me tonight, but his look told it all: "Someday, I will come for you, too."


-Mike )'(
Certified Mad Doctor and HoP High Priest of Nutella

"A buckuht 'n a hooze!" -Valura

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gita
gita

.:*distracted by shiny things*:.
Location: brizvegas
Member Since: 13th Oct 2003
Total posts: 3776
Posted:wow lightning...that must have been a strange experience for you! hug

i've never personally seen anyone/thing die...but i sense it sometimes. i walked past a bus stop today that was blocked off with dodgy yellow wood barricades...i noticed a little section of police tape & had this feeling that someone had been killed there. found out later that that's exactly what happened - a day or two ago!

also - both of my grandmothers died this year - when my mum's mum died i knew. i knew she was sick (stroke & broken leg from the fall), and i had been to see her a week before. she died at about 10.30...a couple of hours later, about midday i just suddenly thought 'she's gone'. mum rang me about 8 that night to tell me...odd...

i guess it's something u will have to deal with as a doctor...i know it can't be easy so heres a few hugs to make it better!! hug hug hug hug hug hug hug hug

and maybe one of these too... beerchug

peace weavesmiley


do not meddle in the affairs of dragons, for you are crunchy and good to eat!

if at first you do succeed, try not to look too astonished!

smile! grin it confuses people!

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gita
gita

.:*distracted by shiny things*:.
Location: brizvegas
Member Since: 13th Oct 2003
Total posts: 3776
Posted:also - what does your signature mean?? the bit that was on a patient's chart????

weavesmiley


do not meddle in the affairs of dragons, for you are crunchy and good to eat!

if at first you do succeed, try not to look too astonished!

smile! grin it confuses people!

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woodnymph
woodnymph

member
Location: london,uk
Member Since: 14th Sep 2003
Total posts: 313
Posted:Mike,that is exactly how my friend died......he died minutes after we got him into the ambulance.I had similiar thoughts to you about death and the image still haunts me.
Now at least i understand what went on inside him ,and that there was nothing else we could have done....


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Doc Lightning
Doc Lightning

HOP Mad Doctor
Location: San Francisco, CA, USA
Member Since: 28th May 2001
Total posts: 13920
Posted:I'm so sorry, woodnymph. frown hug

How old was he?


-Mike )'(
Certified Mad Doctor and HoP High Priest of Nutella

"A buckuht 'n a hooze!" -Valura

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Astar
member
Location: Nova Scotia, Canada.
Member Since: 8th Nov 2002
Total posts: 1591
Posted:The closet I ever came to something like this is when my cat had maimed a squiral, It had ripped one of it's lungs open (it was hanging out deflated) and tore it's legs up. But it was still alive and squirming around, I put it on the block where we split fire wood and chopped it with an axe, I missed and hit it right bellow the heart, I could see it's heart beating still as it franticly looked around and slowly opened and closed it's mouth. I was horrified that I tried to give it a quick death and failed and caused more pain, The second swing finished it off frown

It seems stupid but that seriously disturbed me for a couple of days.


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Doc Lightning
Doc Lightning

HOP Mad Doctor
Location: San Francisco, CA, USA
Member Since: 28th May 2001
Total posts: 13920
Posted:
Quote:
also - what does your signature mean?? the bit that was on a patient's chart????



17yo M c/ hx SBO
17-year-old male with a history of small bowel obstruction

s/p LOA c/ appx
status post lysis of adhesions with appendectomy

POD # 3
post-operative day number 3.


-Mike )'(
Certified Mad Doctor and HoP High Priest of Nutella

"A buckuht 'n a hooze!" -Valura

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gita
gita

.:*distracted by shiny things*:.
Location: brizvegas
Member Since: 13th Oct 2003
Total posts: 3776
Posted:uhuh... ubbloco

i understood some of that?! biggrin thanx for the definitions!!

weavesmiley


do not meddle in the affairs of dragons, for you are crunchy and good to eat!

if at first you do succeed, try not to look too astonished!

smile! grin it confuses people!

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The_Pirate_Dyke_Boy
The_Pirate_Dyke_Boy

HOP Lord of the Pirate Admiralty
Location: Canterbury, UK
Member Since: 5th Nov 2002
Total posts: 1079
Posted:hug

all i can say is you are welcome to as many hugs as you can take, and it happens, especially in ur line of work.

dont worry tho, ur not up for execution any time soon.
hug hug hug hug hug hug hug hug hug hug hug


D.B.
X x X x X

Ship off the starboard! sound general quarters! noise and light discipline! man the cannons! GET ME THE RUM!

Master of the Free Hug Program

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Valura
Valura

Mumma Hen
Location: Brisbane, Australia
Member Since: 25th Apr 2002
Total posts: 6391
Posted:I watched death circle a man I was reading for one day. I knew that there would be death soon, but I also knew it wasnt the man himself... I told him to be aware of a loss that would be around him soon and that healing would be needed... three days later his brother died from a drug overdose... very sad. Death has a palpable feel.. when death is around, you know... I watched death stand near me one time when I was very very very sick... I knew there was more here to do. So I chose not to go... sometimes people have a choice in such matters.. Dr Mike you are very respected in my eyes hug

TAJ "boat mummy." VALURA "yes sweetie you went on a boat, was daddy there with you?" TAJ "no, but monkey on boat" VALURA "well then sweetie, Daddy WAS there with you"

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vanize
vanize

Carpal \'Tunnel
Location: Austin, Texas
Member Since: 21st Aug 2001
Total posts: 3899
Posted:I've seen a few people die from a distance, and I've had to deal with a couple corpses, but never anything up close and personal like that. I've had to put a few animals down, and when I was 25 I gave my dog, who had been my best friend since I was 5, an overdose of sedatives to put him out of his misery and he died in my arms, which is still one of the most upsetting things I have ever done.



But I've never had to watch a person die up close and personal. I would guess that it is even more upsetting when you are resposible for trying to keep him from dying. hug



I'm afraid there is no avoiding the fact that you are going to see it again Mike. I hope it doesn't desensitize you, as you are a wonderful guy. beerchug


-v-

Wiederstand ist Zwecklos!

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woodnymph
woodnymph

member
Location: london,uk
Member Since: 14th Sep 2003
Total posts: 313
Posted:same age almost,55,his funeral was on his birthday. ubbangel

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Narr
Narr

(*) (*) .. for the gnor ;)
Location: sitting on the step
Member Since: 15th Apr 2003
Total posts: 2568
Posted:lightning hug hug hug

i've never seen anyone die but like margita i have felt it .. when my grandma died this summer i had felt strange the whole day, not ill just odd and not right, anyway that night i was tidying my room and all of a sudden my body heated up and i felt like i was on fire and felt the enormous wave of nausea come over me, it all happened within a minute, then i had the wonderful sence of calm..5 mins later the hospital called to say my grandma had passed away.


she who sees from up high smiles

Patrick badger king: *they better hope there's never a jihad on stupidity*

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Kelly
member
Location: London UK
Member Since: 4th Dec 2003
Total posts: 43
Posted:Hey Mike

I can fully sympathise with you on this and understand what you are talking about. I am studying to me a student midwife and sadly have seen both maternal, infant and fetal deaths infront of my eyes. And indeed been active in the care given to those people.
It has always amazed me how quickly dying actually happens in an acute situation and it is that which I find so hard to deal with. One minute the lady/baby is there talking to me and then 10minutes later - gone. Where does all the soul go? I dont know. But if you ever need a chat about this joyous subject then drop me a pm.

Hugs and Bubbles

Kelly


Willing to be taught....learn quick and man I am good with a whip!

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Pink...?
Pink...?

Mistress of Pink...Multicoloured
Location: Over There
Member Since: 6th Apr 2002
Total posts: 6140
Posted:hug

I've only seen someone die once, and at the time i didn't know he was dieing - all i know is he collapsed and people were giving him CPR.

hug hug


Never pick up a duck in a dungeon...

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GottaLoveIt
GottaLoveIt

Sponge
Location: Stevenage
Member Since: 21st Sep 2003
Total posts: 883
Posted:hug hug hug hug hug

You do a great job, Thank you!!!! hug



Monkeys monkeys and bananas

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Rouge Dragon
Rouge Dragon

Insert Champagne Here
Location: without class distinction
Member Since: 21st Jul 2003
Total posts: 13215
Posted:woah. thats terrible. i really dont know what to say. i never want to see someone die. ive come close but never actually seen it. this year i was with my grandfather the morning before he died. we were called into the hospital to see him when they knew he was going to die so we could be with him at the end, but dad had his mobile turned off so we missed the call. im kinda glad i wasnt there tho cos he was rather happy (well, as happy as a cancer patient in palative care can be) when we saw him in the morning.

and i was the one who found my 2 guinea pigs when they died...and i saw my dog as good as dead (under anaesthetic there was no point in waking him from cos the operation would have only had a 10-20% chance of sucess and even then it would have been painful for him)......how do vets (i saw vets cos i remeber the vet nurses watching me cry and not being able to do anything about it) and doctors do it? when the families are outside bawling their eyes out - how do they cope? id completely crumble!

hug hug hug as many hugs as you want buddy! hug hug hug


i would have changed ***** to phallus, and claire to petey Petey

Rougie: but that's what I'm doing here
Arnwyn: what letting me adjust myself in your room?..don't you dare quote that on HoP...

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Mand
Mand

Keeper of the Spitfire
Location: Calgary Canada
Member Since: 24th Oct 2003
Total posts: 2317
Posted:Mike,
I do know how you feel, and for that i'm sending you lots of these-
hug hug hug hug hug hug hug hug hug hug

Unfortunately I've been in a similar place with death twice. Once with me when i had a mountain bike accident, and once outside a pub i used to work in.
There was a guy who'd been drinking at my bar all night. Outside of our pub he was stabbed in the neck in a student attack.
Myself and a doorman tried to help him whilst waiting for an ambulance. Sitting there with my hands over this knife wound, i looked into this guys eyes. I could tell he knew he was going to die. The paramedics said we'd kept him alive, but he then died when he was moved into the ambulance.

On the roadside after my accident, (lying in so much blood i shouldn't still be here) i drifted in and out of conciousness, and really didn't know much of what was going on. Yet i have a strong memory of 'something else being there'. I'm not talking a dude with a sythe, but its the first time in my life i properly prayed to god, and it was that he wouldnt let me die. I wasnt ready.
When i got better the doctors told me i had been very lucky- they nearly lost me.

Mike, i am endebted to people like you who spend their lives making people better. Sometimes people aren't meant to get better though, and this is where you will experience things like this. Just remember what a fantastic job you do.
Oh yeah, and have a few more of these!-
hug hug hug hug hug hug hug hug hug hug


Lets steal a spaceship and head for the sun, and shoot the stars with a lemonade ray gun.

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vanize
vanize

Carpal \'Tunnel
Location: Austin, Texas
Member Since: 21st Aug 2001
Total posts: 3899
Posted:Ah well, if we are going to talk about almost dying ourselves, then I can say I've been just about there 3 times. twice with drowning and once with blood loss from a severe laceration I got while surfing. All three times I saw the white light at the end of the tunnel. BTW, that is the last of your conciousness - your last remaining bit of vision being proccessed by your brain as it shuts down. Do go towards the light - fight for it with all your mental strength if you still need to do something to save yourself.

I can't decide if I am meant to die in the water (since i keep coming close to doing so) or not meant to (if I look at it from the viewpoint of perhaps I have a gaurdian water spirit making sure I don't despite how much trouble I get myself into).


-v-

Wiederstand ist Zwecklos!

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Pele
Pele

the henna lady
Location: WNY, USA
Member Since: 15th Dec 2000
Total posts: 6193
Posted:Mand,
The "outside the pub" story hits close to home. Mine was an old guy on my way home from where I worked at a bar. It is something I have never forgotten, and never will I am sure.

Close to death...I know I was but I don't remember it. No white light or anything, though that could also have been due in part to the sedation drugs. I don't know.

Both make me grateful for the life I have...every moment of it, good or bad.
And that man, in a round about way, was lucky. He had people who cared enough to try to save him. There are people who are not so fortunate. And since it sounds like he was suffering, at least that is over.....typical sounding statement I know, but to think of the pain that that man must have had going through what he was...would life have really been better for him had he lived, after 74 years worth of damage was built up?
No one on earth deserves that.


Pele
Higher, higher burning fire...making music like a choir
"Oooh look! A pub!" -exclaimed after recovering from a stupid fall
"And for the decadence of art, nothing beats a roaring fire." -TMK

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Dentrassi
Dentrassi

ZORT!
Location: Brisbane
Member Since: 9th Apr 2003
Total posts: 3044
Posted:hug hug hug hug hug hug hug hug

"Here kitty kitty...." - Schroedinger.

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Doc Lightning
Doc Lightning

HOP Mad Doctor
Location: San Francisco, CA, USA
Member Since: 28th May 2001
Total posts: 13920
Posted:Well, we have a drunk in the ER now. He's not dying. He's in for drunkenness.

And I don't care. I can't. I can't care because I can't help him. He's got Hepatitis C. He's homeless. He's an alcoholic. He's not going to stop drinking. Per earlier ER notes, he knows he's killing himself. He's been given the opportunity to go to rehab for free. He hasn't.

So all I can do is give him a warm place to stay for the night and send him out in the morning. Poor guy.

But what if he suddenly saw the light and went to rehab and sobered up? Then what? Jobless, HepC positive, homeless... is sobriety going to really help him? It's clear that alcohol got him where he is. But now, I think it's helping him more than it's hurting him.


-Mike )'(
Certified Mad Doctor and HoP High Priest of Nutella

"A buckuht 'n a hooze!" -Valura

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Carpal \'Tunnel
Location: Austin, Texas
Member Since: 21st Aug 2001
Total posts: 3899
Posted:you could give him a copy of "Final Exit"...

seriously though, if he sobers up, then he doesn't have to be homeless and jobless. He won't get rid of the HepC, but quality of life can improve.

But that is his choice. I don't feel much sympathy for people who put themselves into such positions. I respect their lifestyle choice, but I won't support it. I'm sure he begs, and there are many studies that I have seen (both in the States and in South Africa) that indicate that a panhandler's earning potential is significantly more than people working minimum wage jobs (though most are quite skilled at pissing it all away on nothing). Combined with the fact that I personally know a couple of mentally handicapped people who succesfully hold long term jobs (mainly because they are determined to do so in order to prove a point to the world, which I fully respect and honor) and the fact that so many programs are available to help people get their acts together, I can only conclude that living that way is a choice.

People are free to make their own choices, and I'm free to not subsidize the ones I don't agree with any more than I already do with my taxes.

All I am saying is that he could improve his life if he wanted to. He doesn't want to, and that is his ultimately his choice, even if his decision making is clouded by perpetual drunkeness. No need to feel too sorry for him as long as you still treat him like a fellow human, which you obviously are.


-v-

Wiederstand ist Zwecklos!

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woodnymph
woodnymph

member
Location: london,uk
Member Since: 14th Sep 2003
Total posts: 313
Posted:!He's a human being,no less one for his(in your eyes Vanize),unworthy choices.Maybe life has just thrown too much crap for him to handle without the help of alcohol,maybe not......I'm not saying try to save him,and Mike,i think you are doing an amazing job!

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Doc Lightning
Doc Lightning

HOP Mad Doctor
Location: San Francisco, CA, USA
Member Since: 28th May 2001
Total posts: 13920
Posted:I was talking with the social worker and we were saying that for him, it's as if alcohol is palliative care. His liver is palpable 7 centimeters below his ribcage. It's lumpy. He has cirrhosis. He needs a transplant. He has hepatitis C. His blood glucose was 210. He's diabetic.

He's not a candidate for a liver transplant. He's too sick. He'll be dead within a year or two, tops.


-Mike )'(
Certified Mad Doctor and HoP High Priest of Nutella

"A buckuht 'n a hooze!" -Valura

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Carpal \'Tunnel
Location: Austin, Texas
Member Since: 21st Aug 2001
Total posts: 3899
Posted:then give him the book...

-v-

Wiederstand ist Zwecklos!

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Doc Lightning
Doc Lightning

HOP Mad Doctor
Location: San Francisco, CA, USA
Member Since: 28th May 2001
Total posts: 13920
Posted:I dunno. When I look at him, I start to wonder how he got that way.

Look, he was born. He grew up. SOMEONE raised him. Did he go to high school? Did he go to college? Did he have a loving home? How old was he when he started drinking? How did he wind up in the mess he's in? When did he get there?

What's his story?


-Mike )'(
Certified Mad Doctor and HoP High Priest of Nutella

"A buckuht 'n a hooze!" -Valura

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Carpal \'Tunnel
Location: Austin, Texas
Member Since: 21st Aug 2001
Total posts: 3899
Posted:didn't say he wasn't human. infact I rather said that as long as you still treat him as a fellow human, then you needn't feel too burdened with pity. In fact, I feel that pity is dehumanizing.

I do have a rather harsh outlook on some things though, I will give you that Woodnymph. I make no appologies for it, and will only say that life is harsh, especially to those that make unwise choices.

But don't take me for being negative on life. I'm not. I think it is amazingly beautiful, and therefore worth making the right choices for. What saddens me about the person in question is that almost certainly there is no beauty left in his life. I rather be dead than feel that way.


-v-

Wiederstand ist Zwecklos!

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Lurch
Lurch

old hand
Location: Oregon
Member Since: 1st Nov 2003
Total posts: 929
Posted:frown I've had more than my fair share of dealing with death. My grandma was one of 18 children, so my family is rather large. Since about 3rd grade I can't remember a year thats gone by where I haven't gone to a funeral, usually 3 or 4..

I've never had a truely critical patient from my expriences with Search and Rescue, we've had some bad ones though with spinal fractures, broken femurs, broken pelvis etc, but never lost someone while they were in our hands that I know of. Thank God.. I've been on my share of body recoveries as well, suicides, accidents, murders.. There is always something different, there is always that 'feel' when you are in a place like that, sometimes its hard to disassociate yourself and not think of it as a person, even though thats what has to be done to get the job done..

I'm just curious, why weren't you shocking him? Our training has pretty much told us that chances of actually bringing someone back with CPR are nill, its really a way to delay until you can get an AED on scene


#homeofpoi -- irc.newnet.net Come talk to us we're bored frown

Warning: Please Do Not Jump On The Seals

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DeepSoulSheep
DeepSoulSheep

Carpal \'Tunnel
Location: Berlin
Member Since: 25th Sep 2002
Total posts: 2617
Posted:I'd like to share a nice death story.

Each of my Granda's died of cancer. The first one was a few years ago and he was in his fifty's too and he died of liver / pancreatic cancer or something similar to your guy Mike. It was very upsetting because it was the first time somone closer to me had died and I was very close to him.

My second grandfather died of lung / liver cancer about 3 weeks ago. He knew he was going to die. He decided that he didn't want to be in the hospital anymore. He always thought dignity was very important and he wanted to be at home with his family.

He wanted to be made as comfortable as possible with any 'fancy treatments'. He went from being up and about to being confined to his bed very suddenly. Almost immediately, he stopped eating. He was made comfortable with morphine (he'd been on pain killers for a long time).

The first 2 days he was in bed and would still recognise people, but would sleep most of the time. He wasn't able for conversation anymore but there was recognition there. He made an effort every time someone made their first visit but he was less responsive to us who where there with him all the time.

Friends and family visted him on his death bed. All our family travelled back from the UK and America. A day is such a long time in these circumstances. Withing 2 days he went to the 'next level' some sort of jaundice or something. It felt like he had waited for everyone to get home and to have said goodbye.

I left him on sunday night (having work on monday) after spending the whole weekend with him and my family. I knew I wouldn't see him again when I left on sunday night. I had a moment alone and said my goodbyes.

I woke up on monday morning at 5:30 having had a vivid dream involving me and my little sister. I won't go into the whole thing but I woke up when I was shot by these criminals trying to protect her. I got out of bed...went to the bathroom...got a glass of water and it occured to my my grandad might be dead. 5 minutes later my dad rang me and told me he had passed on a few minutes ago......I could feel his presence in my room and told him I loved him. ubblove

He had passed away with his wife of 50 years and all his children around him. He was happy to go and it was a relief to him. He had his faith and he knew where he was going. Even though my faith isn't solid yet, I take comfort in his. He was the only person who wan't upset the whole way throught it. smile

After the experience I feel so much better for it. I feel I understand life a little better. We live, we die, that's what's meant to happen. A day is a lot, and he had many of them, I'm glad as he was that he had a good 78 years.

I'm not afraid of death. I just hope I get to experience as much as possible before he comes for me. I try and appreciate what I have ever day just in case though... ubbangel


I live in a world of infinite possibilities.

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Carpal \'Tunnel
Location: Austin, Texas
Member Since: 21st Aug 2001
Total posts: 3899
Posted:props to you grandpa Jafar. You gotta respect someone who meets death on their own terms.

-v-

Wiederstand ist Zwecklos!

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