Nursing can be a very messy
career. It is not unusual to leave after a twelve hour shift, with
mystery stains on your scrubs or shoes. Or to see things come from
patients that you have never seen before. It is also likely you may see a
scene that you feel should be included in a horror movie just because it would
put some of the bloody scenes from Hollywood to shame.
I was caring for a patient one night
who was complaining of severe abdominal distress. He could not tell me
what exactly was wrong. Just that there was something weird with his
stomach. I asked him if he was nauseous or if it was more pain, but he
said he couldn’t tell. He said it just felt really funny and he knew
something wasn’t right. I gave him some Zofran to help settle his
stomach. Upon assessment I noticed that the stomach did look and feel
quite distended. Now this patient was a liver patient and abdominal
distention is common with this type of patient, however something just didn’t
feel right about the whole situation. So I did the only thing I knew to
do. I called the doctor and asked him to come see the patient. Of
course, the doctor told me he was stuck in the ER admitting patients but he
would be up there as soon as he could. (In other words I just got nicely
brushed off and he didn’t think it was any concern). The next thing I
knew the patient was vomiting. I was dreading going in the room, because
vomit and I do not mix very well. I am a sympathetic vomiter and I did
not see this ending well for either one of us.
However, I sucked it up and went in
to care for my patient. As I entered the room, I noticed his vomit did
not look right (yes, only nurses and doctors would say something like that and
actually pay attention to that). It was really dark and looked like
coffee grounds. This is a sign of a GI bleed, so I was worried and called
the doctor back. He was still not very concerned at this time and told me
to just monitor the patient. This was fine until the patient just kept
getting worse and worse. I finally called the doctor back and told him
that he really needed to come see the patient because it was just getting
worse. I finally got the doctor to agree, only to have him show up on the
floor and stand in the hallway and talk on the phone for the next 45 minutes
while I was trying to figure out what he wanted to do about the patient.
By this time his abdomen had doubled in size and he was still vomiting what
appeared to be blood.
Finally the doctor got off the phone
and ordered his labs to be drawn to check his blood cell count. After a
minute of thinking about it, he then also ordered a Nasogastric tube to be
placed and turned to suction to remove some of the blood from the abdominal
cavity.
As I was preparing to place the
tube, my fellow co-worker came to assist. We finished preparing and began
to place the tube, but discovered we were going to have more trouble than we
should have. The patient had a deviated septum which means we could only
use one nostril. The first attempt the tube coiled up instead of going
straight down the throat. A second attempt was just as unsuccessful.
Instead of trying and failing a third time, I did the only thing I could think
of…I went and asked another nurse to help.
She also failed the first time, but
her second time was a little bit successful, however as she was finishing, the
patient began to cough and gag. Of course as he coughed and gagged, he
began to spit up large blood clots, and large amounts of blood. His
coughing was so forceful, blood ended up on the wall across from his bed.
There was blood everywhere. Seriously, it looked like a scene that should
belong in Exorcist or some other movie. It was a mess and where he was
coughing so much the tube would not advance. We had to pull it out.
Thankfully Rapid response was able to get the tube placed and suction was set
up. Although the patient felt horrible for the next few days he was much
better within a few days.
