"Never trust anything that bleeds for 7 days and doesn't die." -- a lonely misogynist.

The only girl prettier than my Amy. Or so Amy says.

(Ooseung)

BLEEDERS

It’s a bit disconcerting when you put a white tissue up to your face, blow your nose, and it comes back sopping wet and deep red.

The first thing I was thinking was do not get any blood on your clothes. It doesn’t help to establish doctor-patient rapport when your doctor’s tie and coat is stained in blood. “There was an accident at the blood bank” just wouldn’t cut it.

Yet, I still had to pause in awe as I saw perfect little pearls the color of dark roses spatter on the tiled floor with all the weight of true life. I marveled at the intense richness of their redness. Like fierce love.

I thrust my head back and plugged my nose. Being an internist, I thought of an informal list of differential diagnoses for my new onset epistaxis (epistaxis means nosebleed for some reason).

Hypertension? I’ve been so stressed out this past month and sleep deprived that I’ve felt like my head was going to explode daily. (Note to self: Don’t ever try the four weeks without a day off thing again.)

Brain tumor. That would suck. But think of the drama.

Anime effect. Did my peripheral vision subconsciously see a boomingly hot babe walk by, causing my nose to bleed like in those manga comics? Or maybe I just smelled her. That makes more sense. No, it doesn’t.

Cocaine abuse. Well, this doesn’t apply to me of course, but if I keep working like this, I’m sure I could easily afford the habit. Actually I have been drinking those Red Bull and Monster drinks lately. (Note: The active ingredient in these energy drinks is not the “taurine” or “ginseng” or other bullshit that their marketing wants you to fall for. It’s caffeine and lots of it.)

Trauma. Or in this case, nose picking. I’m guilty daily but I don’t think it’s a problem and I’m not going to quit anyhow.

(Pectoral bruises courtesy of Brazilian Jiu-Jitsu.)

Infection/rhinitis. Yeah, this is probably it. I’ve been sick for the past week with a runny nose and flu/cold-like symptoms. One becomes a little immuno-suppressed with stress and sleep deprivation. Or maybe it’s a …

NEW Hemorrhagic virus. Seems like half of my patient list are bleeders of some sort:

40-year guy whose blood cells decided to explode (“hemolyze”) the night after I admitted him. His hemoglobin went from 11 (close to normal) to 3 (chop off an arm and let it spurt until the floor is too slippery to walk on) in one night. Two questions: 1) Why him? and 2) Why me? He’s actually doing better now. Diagnosis: Acute Idiopathic Hemolytic Anemia (Idiopathic means “we have no fucking clue why.”)

Then I had a “reformed” alcoholic cirrhotic (scarred liver) who was on Coumadin (i.e. “rat poison”, has to be monitored monthly or else) and was taking it like candy for the past six months. He finally came into the ER when he was just too tired to take anymore and his stools looked black (from blood). His hemoglobin was 3 as well.

When my partner called me with another bleeder crapping blood out of as his ass with a hemoglobin of nearly 7 (a seriously low number), I told her, “That’s double what my other bleeders came in on. Tell him to come back when he’s REALLY bleeding.” I was kidding of course.

Anyways, I got home and started to tell Amy my nosebleed story and diagnostic possibilities, when she said the same happened to her that day and her solution,

"We need a humidifier. This house gets really dry with the heat on now."

(Sun Su)

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RENAL NEVADA

I had a patient recently who passed about a dozen kidney stones and let me take pictures of them.
These little suckers can be pretty painful as they scrape their way down the ureters.

Drink more water.

Golden shower complete with nuggets.