Now I have seen it all (not for the faint of heart)

After taking a break to go to the outpatient Infectious Disease Institute Clinic, I returned to the inpatient cancer ward yesterday.  There was a 17 year old patient there who was being seen by the medical student.  I asked the medical student if he needed any assistance and he hesitated.  The patient promptly began to vomit bright red clot-filled blood into a bucket.  Now, I will fully admit that I can be squeamish but I was able to remain calm despite the fact that in all my years of training and practice I have NEVER seen this before.  I went through the assessment with him and told him what needed to be done and asked him to get everything started.  She stopped vomitting and layed back down. 

The oncology attending arrives and asks how far we have gotten on rounds.  As if on cue, the patient vomitted another round of bright red blood with gigantic chunks of clot which unfortunately landed on the floor.  "Ahhhhh, that is not nice", the attending replied and he commenced rounding.  Despite my previous experiences, I still had some expectation that the sight of bloody vomit would incite some panic or rapid and decisive action.  As we went through the chart, it was discovered that she had not gotten the medications that were recommended the day before when she first started vomitting blood.  Her personal attendant was no where to be found and the attending physician reminded me that when there is no attendant, the patient's care is compromised because there is no one to obtain and administer the medications that are prescribed. 

I asked how to get a GI consult.  Unfortunately, it seemed that of the two endoscopes available, neither one has the fully ability to band, sclerose, or biopsy.  We were, again, in Old Mulago.  Any scoping would need to be done in New Mulago which is about 1/4-1/3 of a mile away.  The GI attending would need to come up the hill to do the consult first and then decide what to do from there. There would be a delay in even getting the consult because we did not have our cell phones available to call.

I was amazed by the team's ability to continue rounds despite the 17 year old who had again vomitted blood for a 3rd time.  I was completely distracted but felt helpless. 

This morning, I am preparing to go back to the ward with the hope that she received at least some of the things that she needed and that she is still alive.