One breathing treatment and trip to the ER later I didn’t feel much different. As we exited the vehicle into the cold night air a fresh wave of nausea came over me and I started to shiver again. This time without numbness or tingling. We entered into the ER and I quickly had a small host of new friends mobbing me. The medic changed the stretcher into a chair. I was about to exit when a sudden wave of nausea took me over the edge and I began to violently get sick. One nurse took my bag and offered me a new one with a suspicious look in her eye. A moment later she announced: “Well, this is crystal clear guiac positive.” Guiac positive is a bedside test that confirms the presence of blood in fluids.
I slowly hobbled over to the ER cart (think army cot makes a poor attempt at a lazy boy arm chair) and got in. Lots of nurses were asking questions from different directions. One asked me for my name and date of birth just as another nurse had stuck a thermometer in my mouth. I immediately thought of how when I am one of the nurses mobbing new patients I ask them their name and date of birth while someone is taking their temperature and then explain that I am training to be a dentist, one of my ice breakers.
A respiratory therapist came in and promptly scolded me for breathing too fast and hard. She quickly relieved us of her presence at which point my night slowly started to improve. Nurses now set themselves to establishing IV access to get labs and give fluids. Typically people can get IVs into me in half of a second but this particular night took 2 nurses and 4 attempts. They all apologized for not being able to get a line into me sooner to which I replied that being poked wasn’t a ranking concern to me. At some point during all of this the ER doctor came in to interview me himself. I was having another gasping episode and trying to answer everyone’s questions so he made a quick exit and I never saw him again. I was able to let him and the nurses know that in addition to my usual party trick of not being able to breathe well I had recently started allergy shots and show him a photo of the screening results so he could decide if he needed to be concerned about it at all.
About an hour and a liter of IV fluids later I started to feel like a human being again. Given the concern for me and active bleeding the staff had told me they were tentatively planning on sending me from their stand alone ER to the larger mothership hospital for a GI consult and for fluids. My blood counts were all coming back abnormally high (red blood cells 6.18 with a normal range of 4.5-5.9 and hemoglobin of 18.1 that would normally be 13.5-17.5). More notably my lactic acid level (aka lactate) was elevated from a normal range of 0.6-2.0 to 3.3.
This revelation coupled with a new low grade fever got me another liter of IV fluids as well as a continuous IV fluid infusion. The bedside nurse was really driving the process; she made certain that the doctor knew that my lactate was up. She also made sure that I had IV fluids going. Many times the ER doctors will hold a patient for IV hydration but then wait for the receiving units to start the said hydration. My nurse wasn’t certain how long I would be with them but she didn’t make sure that I wouldn’t have to wait for treatments to start.
Other results started to come in my first cat scan didn’t show any bleeding anywhere but didn’t get the clarity that they had hoped for to rule out pulmonary clots so I was awarded a second cat scan that later cleared me of that particular concern. I had been texting back and forth with someone during the night and noted that I would be shocked if it were to be a clot as that my risk factors tend to be so low that they would be negative numbers.
The transport medics arrived and in a strange twist of fate the lead medic was an individual whom I had sent numerous patients from my previous hospital job to their respective rehabs. We bantered on a little bit as we made our 3am journey to the mothership.
The rest of the morning was relatively uneventful. I slept very little, as is common in the hospital. Morning labs had shown a 4 point drop in my hemoglobin but it was felt that was due to me being so dehydrated. The GI doctor came in and stated that he felt I did not have true GI bleed and that we could avoid sending an scopes throughout my innards. Apparently wretching can cause small amounts of bleeding that can trigger positive guiac results. There had been intermittent concerns about bleeding due to my taking large dosages of ibuprofen for my foot but he felt this wasn’t a concern. I was fine with this notion. The primary physician team offered me the option of staying another night but I felt that given I could now keep fluids down I was fine with going home. The hospital was probably better served by having someone who needed to be there in that bed and I no longer needed it.
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One of my ER nurses made a comment upon reading my records and seeing that I work in critical care:
” You having to ask someone to call the squad and help you must have been hard.”
It’s so nice when you feel like someone gets you. I really do have better ideas of how to spend the evening that don’t involve a sudden ambulance ride to the ER in front of my family and neighbors (and later being billed for it.) I later found out that as I was walking with the medics into the back of the squad one of the neighborhood girls my son likes to play with became distraught over it. It seems she had been staring nose to glass out the window and upon seeing me became panicked and bolted out the front door blurting “It’s Paul! It’s Paul!” This was quickly countered by her parents: “If he’s walking then he’s ok! Get back inside; you don’t have a jacket on!” I think something that we in medicine forget is that most of our patients asking for help don’t want to be there. This is made more difficult by frequent flyers who DO want to be in the ER but feeling like you are being lumped into their category is extremely frustrating. I didn’t feel like I had that much of a vibe off of my providers this time but it has felt that way in the past.
I don’t particularly like the idea that simply going up 2 flights of stairs when I feel sick might be a cause if this type of reaction. It would seem out if the realm of possibilities except for the fact that this evening happened.
Burn pits, Sand and IEDs 