Tragedy in The Toilet

This is written in retrospect.

It was a nice peaceful quiet working Friday. Both my colleagues and I have finished all our outstanding jobs and have clerked in all the patients that arrived at the ward. So, we decided to have our first coffee break for the week. (mind you, it was a busy week). Sat down at the usual coffee shop, and ordered my usual mug of tea with a scone.

15 mins later...

*teeeteeeet *teeteeeet (that's my pager going)

I made a face when it went off because I was lazy to answer it and was kinda surprised to get a page from the ward. I called the ward and was informed about a patient with a low haemoglobin of 6.5. The patient was actually a border in the ward. So I didnt know much about him.

So I quickly gulped down the remaining half mug of tea and rushed up to the ward to review that patient. I first looked into his notes to get some background about the reason for his admission. My effort was futile. There was no new notes written in his casenotes. The only information I managed to gather from the nurses was he was transferred from a different hospital and he is known to have diabetes.

Right. That wasn't very helpful, was it?

Ok. I decided to speak to the patient myself about his current admission. The patient was placed in a sideroom. The door to his room was closed, so I knocked at it first and opened the door. "That's weird," I thought. Patient was not at his bed. I called his name a few times, and actually went into the room to see if he was around. There was still no sight of him.

"Uurrghhh...uurrgghhh"

I turned around I followed the direction of the moan. There I found the patient lying on the floor, with his pants halfway down his legs, and faeces splattered all over him and some on the floor. *fuck

I shook him to see if he was alert. And thank god, he was. I shouted for help and the nurses came to clean him and bring him back to his bed. Remember this man has a haemoglobin of 6.5 and guess what? His faeces were very dark brown-blackish in colour. So there you go. I have found the reason for his problem. He was obviously bleeding from his upper GI tract. He looked very very pale, was tachycardic, tachypnoeic and sats were 88% on air. BP was still ok.

I've managed to get IV access on him in order to get crossmatch 4 units of red cells for transfusion. My colleague helped me to phone the SHO for review and he came almost immediately. I was supposed to take some blood gases from him too, but unfortunately, I failed miserably. The patient was very oedamatous to the extent where I could not really palpate for his radial pulse. There was pitting oedema at his wrist!

Oh well, the SHO managed to get the ABGs, and the patient was resuscitated and they took him for an emergency upper GI endoscopy.

*phew (so much for a quiet and peaceful Friday, eh?)