Geriatrics and Pediatrics
My mother is in Wayne General (now St. Joseph's) after throwing up what looks exactly like coffee grounds. The whole story:
Thursday night she had a seizure. She had a grand mal seizure, which is uglier than the little ones that are still disturbing to other people. Ray said that the post-dictal phase was too long and so he called 9-1-1 (this took years of training to get him to react the right way to emergencies, so no criticising!). They did a CAT scan of the brain (of which I don't know what was seen, having been on call for our own patients), then sent her home.
She vomited at 0800 and as much as I don't recall the conversation, I do remember him trying to describe the vomitus and asking if it looked like coffee grounds He immediately said yes, and I said hang up now and call the doctor. Tell him it looks like coffee grounds. He'll know what it means.
I know what it means. It means internal bleeding.
Internal bleeding can be ulcers or a major GI bleed or a whole host of things. But my mother has no history of ulcerations or GI issues (other than late-in-life self diagnosing herself with IBS, which really means nothing). She is taking Coumadin, a blood thinner that is like aspirin on crack. It's one of the worst drugs on the market. We hate it - this is the kind of drug that kills people in the field. It's not good if we can't stop the blood flow.
Well, I don;t know where the blood in her system is coming from specifically, but there is a tube down one nostril into her stomach. Her veins are all for shit, so they had to tap her in the top left part of her chest. (I missed that by moments, unfortunately. We don't see that in the field often), and she's not a compliant patient. She is the patient that rips IVs out of her hand or arm. I suppose we are fortunate that the right side of her is non-functional so it makes it much harder to rip tubes.
She did not seen to see us or really know where she was - although it is an argument that the fear in her eyes made me think that she knows this is serious. It is tough to know what she is thinking or feeling but I know fear. The look is unmistakable. I said the reassuring words but really, there is nothing good to say about internal bleeding and where this will go.
Welcome to aging parents.
The pediatrics side was simpler. One of our patients on Father's Day was 8 days old. Eight days old. This human life was so tiny, her head fit in my hand... my tiny hand. It was amazing. I still have no desire to be parent; but what an experience.
The balance of life. Old and young, they're all in diapers.