Stories to make a grown man cry. Not for the faint of heart

Miscellaneous and Personal Stuff I Must Share
1

So, your SDMB medical professionals are starting a thread to swap stories that are messy, depressing or just plain criminal

enter at your own risk

So I’ll start with something moderate
Back when I was working PICU, and had only been a nurse for about a year, I had a kid with a progressive connective tissue break down disease which eventually killed him. He had an NG tube that was clamped and which I took only a quick look at on my first assessment. On my second I checked it more closely and found that he had begun to bleed. Now if you’ve ever heard the term “coffee ground emesis” it’s not a joke, partially digested blood looks just like used coffee grounds, sure don’t smell like it though. So about half way through the process of sucking 400-500 ml out of this kids’ stomach, I ducked out pound some of my tepid coffee before it became completely undrinkable. My nurse manager happened to be there and mentioned the similarity of the fluids and I realized that I’d arrived as an RN

2

Ok, I’ll go back in time as well. This is also about a GI bleed, little more graphic, however.
My first job was at a university hospital (so long ago it didn’t have an ICU)
For extra money, I would occasionally be a healthy volunteer for drug studies. Sometimes it required me to spend a night in the hospital. The research unit was next door to my unit, so, I’d go to over to chat.
It was about 9:30 PM, I thought I’d go over and see who I could pester on my unit. As I walked down the hall in my jammies, I saw a man in one of the rooms sitting on the side of the bed looking a little green and scared. I stuck my head in and asked if he was ok. He looked over at me, then down at the trash can he’d pulled in front of him. Without answering, he vomited a rush of bright red blood. It just kept coming. I yelled for help, then, went in to see what I could do.
In the end, not much. By the time I got across the room, he was unconscious, I kept him from falling off the bed, but by then he was dead. I started CPR, but the resident stopped me when he saw the trash can.
The trash can, maybe a three gallon size, was nearly full. He had emptied his entire blood volume into it.
He was a dialysis patient, who had been admitted that morning for “weak and dizzy all over.” On post, they found that Aspergillus had erroded through his inominant artery and his esophogus.

I had to throw those jammies away.

3

I was in blood bank one night when I got a frantic call from one of two surgeons in the OR working on a fem-pop bypass. The patient had an occult abdominal aneurysm that blew, and now he was bleeding out. The surgeon wanted O neg RBC units RIGHT NOW, but the patient had Duffy A antibodies. This required a full crossmatch of Fya antigen negative blood that we would have had to identify by typing. We finally got this through to the second surgeon that it would be at least 20 minutes before we could have units ready for transfusion. My super and I frantically pulled segments off of every red cell unit the patient could have received (type O and A at least), and started antigen typing and crossmatching. About ten minutes later, the second surgeon called back and said that the family decided against heroic measures. We were stunned, and sat there staring at the incubating tubes for a couple of minutes without saying anything. I could almost feel that patient’s soul rise from the hospital as we cleaned up and put everything away.

The medical director of that same lab was in the morgue one night, working on a stillborn infant (possibly due to Budd-Chiari Syndrome). He called up to the lab and asked that someone bring some tissue cassettes down for biopsies he was preparing. It was a slow night, so I volunteered. I watched him work for a few minutes, and then went back up to my bench. When I got home, I saw my 9 month old son in his crib, and I broke down. Months later, I asked to observe an autopsy on an adult that was much easier to deal with.

Vlad/Igor, MT(ASCP)

4

If this thread really rolls, I’ll tell you about watching an organ harvest on a 3 year old

5

I have a bunch, but I’ll just tell you a recent one. This goes in the “depressing” category. I think the worst stories are all pediatrics stories (which is why I’m not doing pediatrics), but this is about as bad as it gets for adult medicine.

I saw a 47 year old woman in the emergency center (EC, our hospital director is particular about it not being called an ER) on Wednesday. She looked 70. It was my last day of clinical responsibilities on the psychiatry rotation and medical school in general. I saw her at 3:30 PM, meaning this was the last patient I would ever see as a medical student.

In October, she had been admitted with hypotension, metabolic acidosis, and shock to the MICU. Over the next few weeks, she developed ARDS and pulled through. After, her platelets started dropping, she was diagnosed with TTP. Plasmapheresis could only be started after she threw thrombi into all 4 extremities. Over the next few days, she necrosed all 4 extremities, and had to have them all amputated.

Her primary reasons for admission had nothing to do with this, though. She had chronic, severe, ear pain, for which she had taken a handful of aspirin as that was the only pain killer she could afford. She denied any previous suicidal ideation. During her 3 month hospital stay, they found out what was causing the ear pain – poorly differentiated squamous cell carcinoma of the tongue and throat. On discharge in January, she was given the earliest date possible for starting outpatient chemo (this is a county hospital) – March. She couldn’t make it due to feeling too weak, so she was bumped back to April.

Wednesday, she showed up for pre-chemo blood work. She was horribly, miserably depressed, crying uncontrollably, thinking of suicide. She had missed her dialysis on Wednesday due to chronic pain (oh yeah, she’s in end stage renal disease as well). So they couldn’t start her chemo on Thursday. We had to decide what to do. Well, limitation of medical resources means that for psychiatric hospitalization, she would have to wait around 4 days for a bed, and camp out in the EC until then. She also couldn’t have chemo on a psych floor. And truly, she was a low suicide risk as she was dependent completely on her common law husband for everything.

Medicine was also filled, and she had nothing emergently wrong with her. Renal wouldn’t dialyze her because although her potassium was high, she had no EKG changes and was not emergent. Oncology was called to see her, but there are lots of reservations about managing a person’s pain in the EC (drug seeking is a huuuge problem) and if she missed her chemo appointment the next day, it would probably take a month to reschedule her.

Basically, our hands were tied. I left before her situation resolved completely, but I imagine the best solution, given her circumstance and our very limited resources, would be to discharge her with a few weeks of vicodin and instructions to go to dialysis and reschedule her chemo. Pretty much, do nothing.

6

[hijack]

Wow. I think this could be a really interesting thread. But could you guys and gals do us all a big favor and remember that most of us are lay persons and unable to read through stuff like this:

(That’s as far as I got in that post 'till my brain just flat gave up … )

Thanks.

Lucy

[/hijack]

7

TTP – thrombotic thrombocytopenic purpura, a disease where autoantibodies form against platelets, causing the platelets to clump up inside the blood vessels, form clots, which mobilize and block arteries. You treat this by exchanging the plasma portion of the blood – filtering it out and replacing it with someone else’s. This is called plasmapheresis. Our lady had made clots and killed both arms and both legs (and her kidneys) before treatment became effective. This meant that she was in kidney failure and had to have all of her extremities cut off.

poorly differentiated squamous cell carcinoma – bad cancer of the tongue, usually associated with smoking

The rest of my story deals with where to put her in the hospital. The answer, as it looked when I was leaving, was “nowhere.” Internal medicine, oncology, renal, or psychiatry couldn’t admit her for various reasons and limitations of resources. So we sent her home.

8

Congrat’s on finishing med school! Nice feeling, no? But whoa, that means you may never learn more about TTP. So, are you certain that it’s got to do with “autoantibodies”? :slight_smile: Here, take a peek. :wink:

9

Is it my turn to be “messy”? Maybe I could tell you about the guy who jumped in front of a subway train and was brought to our E.R. Someone observed, “hey, he’s missing his leg”. “No he’s not”, came a reply. “It’s in the green garbage bag under the stretcher”.

Or, how about one about another ‘jumper’, but this time from the ninth floor to the sidewalk. His balls had shot through his scrotum. Ouch :eek:

I’m here all week.

10

KarlGauss, I have trouble believing that your jumper who’d done the gravity-assist double orchidectomy would actually require ER services…

And for how long did he require them?

11

Awwwww crap. :o I’ve been off Medicine too long – I’ll get the tar beat into me and then beat out of me and then given back to me as an IV push starting in 2 months. I got it confused with ITP. At least I got the treatment right (no steroids or splenectomy at least).

12

I am not a doctor or nurse, but I have heard some stories that will make your hair curl.

I used to work at MRDD as a temp, and I was stationed in the head office. I was present when a nurse came in crying. She said a boy with severe developmental problems (he was practically catatonic) had soiled his diaper. She began to remove his clothes and found that he was covered in roaches.

She said that the notion that this poor boy was covered in bugs and couldn’t communicate that fact chilled her to the bone. I have to agree. The boy was only minimally responsive, so I’m hoping he didn’t know, or couldn’t feel them. I can’t imagine anything worse than if he could.

13

Weeeeeeeeellllllllllllllllll…I think I’ll go read the cute baby thread now…

14

I’d have trouble too. The subway guy was DOA and the high jumper was taken straight to Pathology (where I was at the time).

15

I have to say the most depressing medical report I’ve ever read was one where the patient, a 1-year-old, was in perfect health.

The clinical data part of the X-ray (the part where they say why the patient came to the hospital in the first place) read “found on dead mother.”

16

Ok, you guys are too depressing. Here’s one that gave me the will to go on.
I worked in the PICU, where all the heart surgeries came post op. We heard there was a 900 gram premie in the NICU with Hypo-plastic Left Heart syndrome. This is a fatal error, without intervention, once the fetal circulation closes.
They had him on meds to keep the PDA (Patent Ductus Arteriosis, part of the fore-mentioned fetal circ), open.

I hate taking care of premies. They feel funny and they try to die when you give them a bath.

The day before he was scheduled for the first phase of a Norwood procedure, I told my charge nurse, in no uncertain terms, not to give the little rat to me.
Of course, the next day I find there’s “No one else as qualified, and you know you love a train wreck…”

I worked 7 pm to 7 am, so when I hadn’t heard anything by 8 pm I called OR. No one answered! That’s a bad sign. It means they have everyone busy.
Finally, at 9:30 they call to say they’re on their way.

They roll through the door, Anasethesia bagging and squeezing a full, adult sized bag of blood. Normally, a little guy gets 10 cc per kg since, he weighed 900 grams, a normal unit was 9 ccs.
Blood was pouring into his chest tube. The surgeon, or God, as he thought of himself, said “Oh good, I’ll be able to go home tonight.” Meaning, I would take care of everything. Ha!
I told him if he moved out of my line of vision I would hunt him down, if it took the rest of my life.
I guess he believed me.

He insisted that the anastomosis was good, and this was just oozing from anticoagulation.
I knew better, and so did he.
So, we thrashed and thrashed. We did open chest CPR twice in the next three hours. After the first time he decided to leave the chest open with sterile clear sticky stuff over it. (like that Glad™ press n seal wrap) We changed it every half hour. I gave the tiny thing 5 times his blood volume over that 4 hours.

At midnight, the surgeon, finally admitted the babe needed to go back to OR.
We packed up in less than 5 minutes (I’d been planning ahead) They were gone 45 minutes. When they got back, the chest was still open, but dry. The BP was stable, heart rate under 200 for the first time.
The surgeon sat back in the chair I’d told him earlier to park himself in. I smiled.
At 4 am, when all had been well for 4 hours, he meekly asked if it was alright if he went home now. Being the kindly person I am, I said yes.

I kept the little guy as a primary patient. He was in the ICU for over a month. He went back to surgery one other time during that stay, but that was just to close his chest.

When he was two years old, he came back for the next phase of his Norwood. As far as I know, he’s still doing well.
His family moved back to Mexico after his final procedure.

17

I too, work in the medical field, though I haven’t yet had the experience as the rest of your nurses and such. <bow in respect>

Anyway, I work as a nurse’s aide in a nursing home, and I have seen some of the nastiest things… We have a guy that came in yesterday that likes to finger paint, eat the paint, then get a hard-on when you clean off the *paint. We have a lot of those.
[SIZE=1]paint=shit

I also have a GI bleed story, this 88 year old woman started puking and just wouldn’t stop. It was all blood, but not the nice red normal looking blood. It was black, like tar. It was clotted and slimy. THe smell was awful, but the worst part was how it just kept coming up. I had only been an aide for like a week and was shocked.

A mildly funny, (if you are kind of sick) story, I was training a girl on my floor when we had a resident pass away. She was freaked out, but I was going to walk her through taking care of the body in preperation to be picked up. I negleted to tell her the towel I rolled up and placed under the lady’s chin-to prevent the grotesque jaw drop head rolling look- needed to be held put. When the girl I was training went to roll the body towards her, the jaw feel open, the head flopped and ahem juice ran from the mouth down the poor girl’s pants. I quickly righted the situation, no real harm had been doon, exept to the new girl. She never has come back…

18

Thanks for sharing that picunurse. And thank god for nurses, generally.

This, however, is one of the funniest things I have read on the boards in ages. You do have a way with words, ma’am. :smiley:

19

Mild in comparison, but growing up, my grandmother owned a nursing home. This was in the late 1950’s early 60’s. Every Saturday, I had to go there for a few hours. I was a little kid, but grandma told me to make the rounds and talk to the patients as nobody ever visited them. Many Saturdays I would show up and ask, “where’s Mrs. Anderson?” only to be told she died on Wednesday.

I learned about death early.

But the saddest was a little lady who had a son with a family that lived about half hour away. He never came to visit, but one year, he called and said he was going to pick her up and take her to his house for Christmas. She spent weeks and handmade gifts for her son, his wife and the kids. She wrapped them beautifully and tied them up with pretty bows. Every week she would show me what she had done. Christmas Day, I went to the nursing home and saw her, dressed in her best, her hair done, and was all excited.

Her son never showed up.

To this day, I will never allow a poinsettia or Easter lily in my house. They were the plants people sent to those patients in the nursing home, instead of visiting them. and they are the saddest memories I have of my childhood.

20

These “medical professionals” threads always make me feel like the relief pitcher in the minor league training camp. We don’t get any interesting stories in the lab. After all these years, my best one is still the time we got sent a testicle to test. Since we do DNA and RNA testing, the first step is to chop the thing up into mush. All the female lab workers fought to get to be the one to do it.

We have some bitter women working in our lab.

But, yeah, that’s nothing compared to everyone else’s.