Playing Lead Guitar
"Oh, I'm the lead guitarist in a Southern rock band," I lied.
"I bet you are," she replied, peering over her reading glasses at my soul.
"If I leave here tomorrow
Would you still remember me?
For I must be travelling on, now,
'cause there's too many places I've got to see."
Esophageal varices are blood filled devils at the base of the esophagus, that arise from the azygos vein, and the superior vena cava. Usually the result of portal hypertension from liver damage, whether caused by alcoholism or hepatitis, they can become the cause of a dramatic blood spewing demise in a matter of minutes.
When the first strains of "Free Bird" begin to sound from my iPod, a metamorphosis takes place with my team. Some suddenly realize they missed their smoke break. Others realize that they are being summoned, and they enter my suite with trepidation in their hearts, but willing.
"But, if I stayed here with you, girl,
Things just couldn't be the same.
'cause I'm as free as a bird now,
And this bird you can not change.
Lord knows, I can't change."
When Big Joe rolled the gurney containing the young black man in, there were already splatters of crimson on his sneakers and blood on his pillow. I went through my recital of preparations with the chirping at the beginning of "Free Bird" filling the air. "Do you drink? Smoke? Illegal drugs?" Negative. "Hepatitis, HIV, AIDS, Tuberculosis, Sickle Cell?" No.
Realizing that Lynyrd Skynyrd may be the last thing this young man wanted to hear, I switched the playlist to Motown.
"You can't hurry love
No, you just have to wait
She said love don't come easy
It's a game of give and take......."
"False teeth, false eyes, hearing aid, hairpiece?" I asked as though reciting a poem long memorized. The young man removed a partial plate with several gold teeth. "Tounge ring or lip ring?" No. I looked over his history, searching for an idiology. He had been banded on five previous occasions. That was not good. Each previous banding had likely resulted in scar tissue right where we needed to work. I got my goggles out of the drawer and tightened the cinch securing them to my head.
The team assembled, consent obtained, we began the sedation. He did not fight much as we entered his esophagus with the gastroscope. For a man of his age, that was not a good sign. The base of his esophagus was a fearsome mass of lavender scar tissue and one violent purple bulging clot. "Bander," I ordered.
A band ligator was being loaded on an alternate scope. It is a device that can deploy seven rubber bands, one at a time. Seven chances, seven little rubber life preservers to stop a varicele bleed. Just yesterday, we had saved a life by working with two scopes, the first applying direct pressure against a hemorrhaging varicele while the equipment was loaded on another. "Hurry."
"Ligator." As the first scope was ripped from the young man's esophagus, a great rush of bubbling blood spewed from his mouth and nostrils. I quickly inserted the Yankauer to the back of his oropharynx to keep us from being sprayed in a volcanic gush of hematemesis. The banding scope went down into the torrent of blood, the monitor screen an unfocused blur of red. My physician was relying on memory, working blind. I continued to manage the flow of frothy crimson as best I could when at last the cup to the bander reached it's mark and sucked the tissue inside.
"Although I might be laughing loud and hearty
Deep inside I'm blue
So take a good look at my face
You'll see my smile looks out of place
If you look closer, it's easy to trace
The tracks of my tears."
Through the ligation cup, we were looking directly into the azygos vein, at it's opposite wall. Pop! The first band was deployed. Suction released. The tide of blood blew the precarious band off the scar tissue, washing it right up and out of the young man's mouth. Quickly the physician reapplied pressure to the area with the gastroscope itself.
"Get me blood!" I ordered.
"They are still type and matching."
"Emergency O positive!" I ordered again as I looked towards the monitors.
"Outside I'm masquerading
Inside my hope is fading"
37/12...... SpO2-0. Damn. "He's not moving air Doc," I called for the crash cart. Big Joe rolled it in. Laryngoscope. ET tube. Bag. No carotid pulse. "Start CPR." Big Joe found his mark and as I bagged, he brought up the pressure with his compressions. "Have we got that blood yet?!!"
"Morrhuate Sodium," Doc ordered. "Epi!" More blood gushed from the young man's mouth and nostrils, dribbling across his dead eyes. "Epi."
Emergency O positive blood was spiked and shoved in. A femoral line was inserted and secured.
"Stop compressions." No pulse. "Resume CPR." I switched positions with Joe and he bagged as I compressed the chest. When the respiratory therapist arrived, she relieved Joe and he left the room. With each compression, more blood was being blown from the patient's mouth. The respiratory therapist cupped her hand over the patient's mouth to keep the cataclysmic flow off of us.
Another unit of blood. Bagging and compressions. Nothing. Finally, CPR was stopped. He was dead. Bled out. My paper scrub cap was stuck to my forehead with sweat and blood. I found Joe crouched outside the door. He had grown up with the young man. They were team mates on their high school football team. Friends. "I'm sorry," I said. Joe just nodded. Dried tears streaked his face.
"Bye, bye, its been a sweet love.
Though this feeling I can't change.
But please don't take it badly,
'Cause Lord knows I'm to blame."