Thursday, June 4, 2009

Torn From The Inside



A 58 yo male came to the ER accompanied by a scantily clad female in high heels. He was complaining of excruciating lower back pain that began suddenly in his hotel room. The married business man (very honest guy btw) was in town for a conference and was apparently lonely. He said he picked up a prostitute, and she was on top of him during sex when "his lower back when out." He stated the pain was ripping and causing his right lower leg to feel cold and numb.

When I evaluated him, he was diaphoretic (sweating) and unable to move is right leg. His right leg was cold without distal pulses. We immediately suspected that the prostitute ripped him from the inside causing a ruptured abdominal artery. However, the CT scan illustrated a Type A aortic dissection that ripped from the chest all the way down to the common illiacs (the aortic seperates into two vessels at the bottom of your stomach). This is a deadly thing to have. Though he was still communicating, the blood supply to his spinal canal, one kidney, and heart were being compromised.

When I told him the bad news and that he would need life saving surgery, he called his wife at home to tell her that "his big vessel in his chest and belly were tearing. " Of course, he left off the major story of how it happened! The patient was admitted to the ICU and was scheduled for an aortic repair, but died of cardiac failure shortly after admission.

When I was leaving the ER, one of my fellow collegues said "Hey, did you get that lady's number? I hear she can really f**k!? I shook my head in sadness for everyone that day.

-Doc Sensitive

10 comments:

One Nurse said...

OMG!! That is terrible. That poor wife! I bet the prostitute thinks again before having sex like THAT again! That would certainly be a bad day in the life of a doc or a nurse!

Ont-RN said...

He was "scheduled for aortic repair"? Isn't that the kind of thing you run, with butt-cheeks squeezed tightly together, directly to the OR? And dragging along the rapid infuser with about a dozen units of blood pumping into him as fast as you can.

Marco said...

Credit to the prostitute for accompanying him. She could have called 911 and left it at that.

Marco

DreamingTree said...

58 years old?! What a way to die. I hope his wife never learns the details...

Your colleague could really use some sensitivity training.

08armydoc said...

Did anyone (including the patient) tell the wife the instigating factor?

Trust us....we're doctors said...

RE Ont-RN:

The grammar was a little off, but scheduled as in that day. If they are leaking but stable, you have a little time. BUT it takes hours to convince a cardiovascular surgeon to get their ass to the hospital and do the operation. He died fast.

Me said...

I'm without words.

LivingDeadNurse said...

That was a rude comment from your coworker. i think the prostitute shouldn't have gone to the ER with him. Tad bit creepy

ERP said...

Ah yes, men (I assume your colleague was a man) will risk life and limb for a good bit of rodgering.....

Anonymous said...

we had one that was aged 45 die last week