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Doc Lightning
GOLD Member since May 2001

HOP Mad Doctor
Location: San Francisco, CA, USA

Total posts: 13920

Posted:7th Dec 2003So 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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pounce
SILVER Member since Jan 2003

pounce

All the neurotic makings of America's lesser known sweetheart
Location: body in Las Vegas, heart all a...

Total posts: 9831

Posted:9th Dec 2003i have to agree with both of you (vanize and lightning). i get people coming into my office every day with terrible pasts. and i see how they made the choice to be where they are, but sometimes the choices available to them weren't exactly all that great. i respect a person's choice to be where they are. and i've been in that place where i just wanted to save everyone, to help everyone, to fix everyone. and after countless headaches, frustrations, and days where i went home and cried, i realized you can't change anyone who doesn't want to be changed. and it's frustrating and it sucks, but it's the truth. there has to be some sort of little spark in them that says "i don't like my life the way it is and i'm willing to work to change it." i've worked in both voluntary and involuntary programs, and it's the same situation in both. i used to think it wasn't, but it's true. even in involuntary programs, the clients still have that choice. many of them will say what you want to hear so they can get out of the program and go back to the way they were. that's why we have such a high recidivism rate in drug/alcohol/domestic violence/sex offender programs. does that mean we shouldn't still try? no. but for your own mental health, you have to realize that you can't save them all. what frustrates me the most though, is the people who come in saying they want help, but they won't do a damn thing to try. and as hard it has been for me to learn and do it, i've realized that sometimes it's appropriate to "fire" my clients. when i've got someone coming in saying that they want help, but won't work with me at all, and i know i've exhausted every resource i have, i'll confront it, ask them what they really want and why they aren't trying. it sucks. but it's human nature.

just my three cents

I was always scared with my mother's obsession with the good scissors. It made me wonder if there were evil scissors lurking in the house somewhere.

Do not meddle in the affairs of dragons for you are crunchy and good with ketchup.

**giggles**

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Doc Lightning
GOLD Member since May 2001

HOP Mad Doctor
Location: San Francisco, CA, USA

Total posts: 13920

Posted:9th Dec 2003Quote:
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

The problem was physiology. He wasn't going into cardiac arrest from atrial fibrillation or from myocardial infarction. He was in arrest from hypoperfusion, or low blood pressure. We had already dumped 10 units of blood into him, blood bank was screaming at us that there were other patients who needed blood, too, and he wouldn't stop bleeding no matter what we did.

His rhythm wasn't shockable and so at that point, CPR was simply a way of keeping his heart going while we could figure out what to do next to get his heart started again. But we realized there was nothing we could do because we couldn't stabilize his blood pressure, bleeding, or volume.

His clotting system was so messed up that he actually did continue to bleed for quite a while after he died just because his blood wasn't clotting. They say it was an hour before they could finally allow the family to view the body.

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

"A buckuht 'n a hooze!" -Valura

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Doc Lightning
GOLD Member since May 2001

HOP Mad Doctor
Location: San Francisco, CA, USA

Total posts: 13920

Posted:9th Dec 2003Quote:
.I could feel his presence in my room and told him I loved him.

My dad visited me exactly in the same way the afternoon that he died.

There he was, in his early 20's, wearing his Navy uniform, and grinning at me. He was proud...and grateful that I'd let him go.

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

"A buckuht 'n a hooze!" -Valura

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Icarus
GOLD Member since Sep 2003

member
Location: , Australia

Total posts: 165

Posted:9th Dec 2003It takes someone who is extremely caring to work in the area that you do, and I have a huge amount of respect for anyone who tries to make peoples lives, even towards the end, more comfortable. If you persist with this job Mike, you will see death more and more. I am guessing you will learn to harden yourself to it. However it will (and should) always effect you. I appologise if this sounds condesending but i do believe that death makes life more special. The human mind is an amazing thing and dispite being able to logically explain death and even exept that it will accur around you, it will not stop your heart from tearing everytime you see it. You should know that the man's family appreciate you. I am guessing that will always be one of the hardest parts of your job, but relitives appreciate you helping him, and that he was not alone, more then they will ever say. And you also need to keep telling yourself that you will save more lives then you will see pass. You will see death again, but you will also see life come back when it was going to be lost. And that will be because of you. All of this you would have told yourself already, but i just wanted you to know that my hat goes off to you, you are doing an amazing job.
Thankyou.
hug

... simplify ...

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Rouge Dragon
BRONZE Member since Jul 2003

Insert Champagne Here
Location: without class distinction, Aus...

Total posts: 13215

Posted:9th Dec 2003be compassionate to families. i remember being really angry with my aunt cos she worked in a hosspital or something and had removed herself from death, therefore when her own father was dying just said "i see cancer patients die every day". i decided i wouldnt want her to nurse me if i was seriously sick.

but on the other hand my friends mum nursed my cousin in intensive care and she told me compassionately about how all the nurses were sad when he died because they worked so hard to help him. she'd see death all the time but she wasnt callous about it at all.

you guys are amazing. hats off to you all. i know i couldnt do it

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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arsn

How do you change this thing???
Location: Behind the couch...

Total posts: 1903

Posted:9th Dec 2003Quote:
Originally posted by Rouge Dragon
therefore when her own father was dying just said "i see cancer patients die every day".

Rouge, first off, I don't wish to return bad memories.

What your aunt may have been doing is the only thing she knew how to do. Being a nurse she may have seen death take others so many times, that it would effect her to the point of she just couldn't show it... If everytime a patient died she would break down and cry, it would make anybody else who saw her feel as if their chances were dropping aswell. She needed to be strong, she needed to appear strong, she needed to feel strong, because that's all she's known.

I can't hear you... I have a banana in my ear.

"You mean I'll have to use my brain?... but I use staff!!!" ~ ben-ja-men

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Rouge Dragon
BRONZE Member since Jul 2003

Insert Champagne Here
Location: without class distinction, Aus...

Total posts: 13215

Posted:9th Dec 2003i realised that. it was just that the rest of us found it hard watching her display little outward compassion for her own father. but thiking about it now she did have my 2 little cousins who prolly didnt understand what was going on so she would have needed to be strong for them, whereas i completely understood what was going on (well, minus the medico talk!) so noone needed to put up a brave face for me!

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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