All Bleeding Stops . . . Eventually

Ruby Vee, BSN

Years ago when I worked in the MICU of a midwestern university teaching hospital, I took care of a patient named dan. Dan's original problem is lost in the recesses of my memory. I honestly don't remember why he came to the hospital in the first place. He was a farmer; he may have had some sort of farming accident that got later led to an infection. For whatever reason, he'd been in the MICU for a couple of weeks. He was agitated and combative, always a joy, and he had an arterial line and a central line. Conversing with dan was always an unpleasant experience. He was an angry young man, upset about being in the hospital, about being in the ICU, about not getting enough drugs to "make it fun" and about life in general.

Even his mother and his girlfriend seemed anxious to get out of his presence and were un[phased by the restrictive visiting hours we used to have in the ICU. They seemed to visit more out of a sense of duty than from any genuine desire to be in his presence, and his girlfriend's visits seemed to taper off as his "incarceration" progressed. Then one night dan announced that he was going home.

Like good little nurses, my friend karen and I (one of us was in charge and one of us was taking care of dan that night, but for the life of me I can't remember who did what) explained to him why he needed to be in the hospital, why he needed to be in the ICU and the consequences of leaving. He didn't care. He wanted to go home. As he became increasingly adamant about going home, he became increasingly agitated and then combative. About the time he picked up the knife off his dinner tray and threatened to "cut off your tits", we called the "code grey" for security and restrained him. Restraints accompanied by a hefty dose of "the fun drugs" seemed to calm dan down considerably, and he drifted off to sleep. Satisfied that we had things under control, karen and I both breathed a heavy sigh of relief. It was late in the shift, neither of us had eaten. So we got out our lunches (this was a night shift and over a quarter century ago, so things were slightly different then) and sat down at the charting table next to the monitors to eat.

Things were quiet, even in dan's room. He had a nice, steady ecg and art line waveforms, not a lot of artifact and from what we could see through the window into his room, he looked comfortable. We were all the way to the dessert course (fresh fruit) when dan's monitor started to alarm. I looked up to see an enormous amount of artifact on his monitor, and when we looked into his room we didn't see Dan.

I met him in the doorway to his room. The central line was on the floor and there was blood oozing fairly briskly from the hole in his neck. But the interesting thing was his art line. He'd somehow disconnected it . . . Un-oh. He'd chewed the tubing apart and when he let go of it, blood spurted out the ragged end of the pressure tubing.

This was in the early 1980s -- right about the time HIV and AIDS were coming to the forefront and everyone was worried about them. Including dan, it seems.

"Stay back," he ordered, "or I'll spray you." to emphasize his point, he allowed the blood to spurt in our direction. No amount of reasoning seemed to reach him. And the blood continued to leak from his art line at an alarming rate. We called his doctor, who complained that he didn't know what we wanted him to do, and couldn't we just take care of it ourselves? "we are taking care of it ourselves, but the hospital requires a doctor's signature on our plan," Karen told him sweetly. "Right now the verbal orders says "do you know what time it is? This better be good! Why are you bothering me with this nonsense? Just take care of it yourselves." he rousted himself and was at the scene in very short order.

Having recently read "house of god," I was familiar with "all bleeding stops eventually," and when Karen proposed calling security to rush him and tie him down, I wasn't enthusiastic about getting sprayed with possibly aids infected blood. Neither were the three security guards milling around our unit trying to remain inconspicuous. "let's just wait," the md said finally. "He'll stop bleeding sooner or later." so while Dan stood in his doorway yelling and threatening, we waited. When he started to get a little pale and shaky, we had already called the blood bank to make sure they had a current sample and to order several units of blood. And when dan passed out, we were ready!

He woke up, once again restrained to the bed. We'd put in a new art line and central line and were transfusing blood. Strangely, his desire to leave the hospital had evaporated -- at least until he was fully transfused again and the md allowed us to start to taper "the fun drugs".

All Bleeding Stops . . . Eventually

About Ruby Vee, BSN

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