Just when you think you got everything covered, you don’t!
This should go down as one of the weirdest moments I have had in private practice.
Toward the end of my day at Care Practice I had a patient that needed a simple Intramuscular injection. I gave her the shot and all was well. About a minute later she complained of feeling a little light headed. I had the exam table all set up perfectly and sat her down so she was comfortable and laying down without risk of falling if she were to pass out. Every doctor has had numerous patients experience a brief loss of consciousness related to something we call a vasovagal reaction. Essentially it is a reflex of passing out that many patients experience following an injection or a blood draw. I myself had one when I was ten years old and a nurse, while drawing my blood, mentioned that she had found a juicy vein. For what every reason the word juicy coupled with a needle in my arm made me drop like a rock. These episodes are usually very brief and not a big deal as long as people don’t fall or hurt themselves. It usually lasts a few seconds and they come right back in a cold and clammy sweat and feel better after a few minutes. In this case I thought I had all my bases covered. She was resting with her eyes closed on my exam table and looked fine. Then I realized she had in fact passed out when her arm fell slightly to her side.
Having a patient pass out is often a bit of a calamity as you would expect. Many a doctor has thrown his or her back out trying to keep a patient from hitting the ground during one of these episodes. Most people don’t realize how hard it is to hold up 150 lbs. of dead weight. One of the maneuvers I often have to do is what we call hockey checking. Basically they are going down and you simply can’t just grab a limp person effectively enough to keep them from going down. What I often do is wedge their body between mine and the wall to keep them upright while I then use my hands to get a better grip and maneuver them to a place where I can set them down more gently. We call it hockey checking because it resembles a hockey player pinning an opponent to the boards with their body.
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For a split second or two I felt a false sense of accomplishment like I was glad that I had all the bases covered and got her seated right when she mentioned she felt a little light headed. That short thought was quickly interrupted with the sound of her beginning to retch ever so slightly. Now I have seen several hundred people vasovagal before. Everyone of them gets a little nauseous, but rarely have I seen any of them vomit. Certainly when ever they go down I am very quick to turn them on their side just in case they vomit. In this case the exam table was at a 50 degree angle which provided some safety, but actually made turning her on her side something that wasn’t as easy to do. Of course when she started retching I immediately reached over to her and placed both of my hands on her checks and tilted her head forward to reduce the risk of aspiration. Aspiration is a term we use for inhaling ones own vomit, which can be very dangerous. Right when I did this she projectile vomited straight up all over her and myself. It was like a fountain straight up into the air and all over everything. I continued to lift her head and turn it to the side in one swift motion and she again projectile vomited all over the medical cabinet, my legs, and the floor. This entire episode probably lasted all of 30 seconds, but it felt like five minutes. Shortly thereafter the patients regained consciousness to a grissly sight. I am standing over her holding her head completely covered in vomit as she is as well. Instead of clammy and sweaty she is actually soaking wet with the lunch she had finished just an hour before. Keep in mind she was briefly unconscious and unaware of what had just transpired. It probably looked to her like I had just vomited all over her.
We both had to essentially rinse off our entire clothes and the staff needed to clean the room for more than an hour before we could use it again. It had never occurred to me that there would ever be a need to keep shampoo in the clinic. We both could have used some on this occasion. A few hours later I went home and I was starving after finishing the clinic very late. I quickly prepared a small amount of soup to eat before I was going to jump in the shower. Just when it was brought to a full boil I somehow slipped and accidentally spilled boiling hot soup all over my right hand and and left foot. I am not sure what really happened, but it left me with one of the worst burns I have ever had. I was in so much pain that I had to have ice packs on every moment or it was intolerable. If I even took the ice off for a few moments the pain would double in intensity. If you have ever had a severe burn you know that the last thing you want to get anywhere near is warm or hot water. So that entire evening I sat in severe pain, with rotating ice packs, smelling of vomit, and unable to take a shower.
The lessons I took away from that day were fairly simple. #1 Always shower first before making your soup. #2 A healthy reminder that just when you think you have everything covered you likely don’t.
Dr. Blackledge
