Bleeding peptic ulcers occasionally cross the path of general surgeons. Usually they stop bleeding with conservative treatment. But sometimes they don’t. Then you need to whip out the trusty knife. Even then usually the operation is little more than routine. This case, however was exceptional.
He was white as a sheet. He had been bleeding for three days but only decided to come to the hospital when he started falling over. It seemed he could at least recognise falling over as not normal. The initial gastroscopy showed a penetrating duodenal ulcer with no active bleeding. the body had managed to curtail the bleeding, partially because of vasoconstriction, but mainly due to a low blood pressure which in itself was due to loss of blood.
I got drips going and ordered the necessary blood. Unfortunately as the resus progressed his blood pressure normalised and the tenuous clot in the bleeding vessel could no longer hold back the inevitable. It quickly became apparent that we were not winning and soon we were in theater.
Not too long after the ulcer was nicely exposed and I looked upon something squirting blood with much too much enthusiasm for my liking. A strong thick stream of blood was propelled out at great speed. The artery was also tucked up under the edge of the ulcer in a position that was pretty difficult to access. I put my finger on it and took a moment.
During my moment I had a few thoughts. The first was pretty much that the patient was going to die in the next few minutes right there in theater under my hands with my finger still probably on the point of bleeding. This thought seemed to emanate from two glands just above my kidneys. It was not a productive attitude to have and wasn’t going to help me to get control of the bleeding, so I put it out of my mind. The patient dying was not an option I was willing to give in to.
The next thought was related to the adrenaline that was coursing through my veins. I automatically thought of people who go out and intentionally take part in activities for the expressed purpose of pushing their adrenaline levels up. Don’t get me wrong, I have nothing against that. It’s just that after an adrenaline-inducing operation, the last thing I want to do is go out and get some more. Adrenaline-inducing operations are surprisingly common in my particular line.
Maybe I’m getting a bit older. When I was still training I was much more keen on getting the high stress cases. These days I’m quite happy to miss them. Usually, however, they do not miss me. They seem to hunt me down. So generally I just want to go home and collapse in a heap on the floor, often in the corner after a day’s work. There I tend to lick my wounds or eat worms, depending pretty much on the availability of worms at that time of year.
P.S. I got control and the patient did well.
*This blog post was originally published at other things amanzi*