Life-Giving Blood

It was Saturday around noon, and I was busy seeing patients in my AM clinic and juggling some issues from the ER. I received word from the family medicine resident that a patient had arrived who was suffering from an apparent intestinal bleed, with the source likely being in the stomach or the duodenum (the first part of the intestines after the stomach). We started him on some medicine in his IV for a suspected bleeding ulcer and admitted him to a hospital bed. The next step was to perform an upper endoscopy procedure to try to diagnose the cause and severity of the bleeding. However, before doing so, the patient would have to be hemodynamically stable. That’s a fancy way of saying that he would have to have a relatively normal blood pressure and pulse, and that he would appear to have a decent blood supply to all of his vital organs. Unfortunately our patient did not meet these criteria. His pulse was high, his blood pressure was low, and he appeared very sleepy (which was a result of not getting sufficient blood flow to his brain).

How do you “stabilize” a patient who has lost copious amounts of blood? By giving him loads of blood and IV fluid, of course! We began this process. After getting the equivalent of two 2-liter bottles of IV fluid pumped in, he had not stabilized. Simultaneously, he was receiving red blood cells as fast as we could give them (not fast—when they come from the lab they are packed into a very compressed state, and they run into the patient’s veins over a span of about 3 hours). After receiving the only three units of packed red cells that we had in our hospital, plus two units of fresh plasma, he STILL had not stabilized, and his symptoms told us that his intestines were still actively bleeding. There is a Red Cross in the next town over, but our lab informed me that there was no way to contact them during the night. Could we transfer the patient to another province? The patient elected to stay in our hospital, even though two important facts had become clear:
1) We had run out of blood
2) Our patient was bleeding to death.

Now it’s time to crunch the data a bit. These numbers are estimates, but they will give us some ideas of this patient’s condition. A human male about the size of my patient typically has approximately 5 liters of blood volume. We measure red blood cells, the part that carries the oxygen, by “the hemoglobin”.  A unit of whole blood contains about 450 milliliters of volume, and is expected to raise the hemoglobin by about 1.5 grams/deciliter. Our patient, before he started bleeding, probably had a hemoglobin value of around 14, which is normal. When he arrived at our hospital, his hemoglobin was 11. The next morning, after receiving the above-mentioned transfusions, his hemoglobin was 4. It was clear that our patient had essentially bled out his entire blood volume, and was now just hanging on for dear life with the little bit of blood that he had received from our lab upon his admission. At that point he looked worse than ever. He was as white as a ghost and barely responsive, and we still had no blood to offer him.

Now it was Sunday morning, and we began to ask everyone, “What can we do!!??” Our lab technician mentioned that if there were people present who wanted to give blood to our patient, the necessary tests could be performed to make that happen. Of course the donor would need to have blood type either O+ or O-, since our patient had O+ blood. The first person to step up and donate was one of our surgeons, Dr. Mattias Egberth. He was followed closely by one of our medical students, David Garcia. At about that time, approximately 20 of the patient’s relatives arrived to visit and to wish him well. They began to ask, “Can we donate as well?” Within just a few hours, we had rounded up SIX units of whole blood, which the patient gladly received. Now he was waking up, and for the first time since his admission, he was hemodynamically stable. We performed the endoscopy procedure and found a large ulcer in his duodenum. It was no longer bleeding! Thank you, God!

In all, we calculated that our patient had lost his entire blood supply and then some. By day number three, essentially none of his circulating blood was his own. He had received three units of packed red cells, six units of whole blood, and five units of fresh plasma, all because of donations by fourteen different people who were willing to give their own blood. The patient and his family were extremely grateful and humbled to know that he was alive through the sacrifice of fourteen other people, many of whom did not even know him.

Blood is an amazing creation of God, and it has long symbolized “sacrifice.” In Moses’ time, the blood of an animal was poured out on an altar in a petition for the forgiveness of sins. This was only a temporary, imperfect solution for man’s sin problem. But God made a perfect way, the only way, to salvation through the sacrificial blood of His perfect Son, Jesus Christ. “He personally carried our sins in his body on the cross so that we can be dead to sin and live for what is right. By his wounds you are healed.” (1 Peter 2:24, New Living Translation) We are alive today, and we can live in Heaven forever, because of the blood of Another, because of the blood of Jesus Christ.  And the power of Jesus’ blood does not stop when we pray to accept Him as our Rescuer. Instead, our sinful nature dies, and His perfect, righteous nature goes on living. In the same way that my patient received a completely new supply of circulating blood, we are continually filled with Christ’s perfection.

The patient gladly gave permission to share his picture and story on our blog.

Keep the Door Shut

Ever since we arrived home from our trip to the states we’ve had a little problem: jungle critters. I’ve always prided myself that our house was pretty cockroach free, but they’ve made a comeback. However, they are the least of our worries. Several nights ago Dan and I were sitting on the couch and in walks a tarantula, even with the screen door closed. He wasn’t too big but several nights later his larger cousin came to join him right in the middle of our marriage class.

An even bigger problem has been Mr. Rat. I’d never had an encounter with one until a few weeks ago. Dan was on call at the hospital and I kept hearing rustling in the laundry room. I called Dan to come home to find the culprit and after investigating he said he couldn’t find anything. As he was walking out of the laundry room he kicked the washer and out ran an enormous rat (well at least I thought it was enormous). I’m usually a pretty calm person when it comes to creepy-crawlies, but I went running for my life . Over the next week and a half the rat became Dan’s biggest nemesis as he tried multiple ways to get rid of it. The first night the rat ate all the poison we left out for him and we thought our troubles were over. However we knew he was back the next night when he go into some “sacred” cereal we’d bought in the states. Now we knew our rat had a strong stomach. Next Dan tried a homemade bucket trap in hopes of drowning the rat, but our visitor was pretty smart and only would eat the food at the front of the plank leading up to the water. After that Dan moved to a spring trap. Dan set it up several nights in a row so sensitive that it took him quite a while to get it to set without snapping back on Dan. Somehow our rat was able to get the food every time without setting it on himself. Now we knew our rat wasn’t just smart, but a genius. After several more days I was preparing lunch and looked over and there sat Mr. Rat in the laundry room right in the middle of the day. Now he’d gotten way too arrogant. I climbed on the counter and told Dan to get over there. Dan grabbed a broom and used his baseball skills to stun him. As Dan brushed him outside to finish him off he kept making these sad little squeaks and we almost felt sorry for him. Maybe he’d visited us so many nights we felt partial to our unwanted pest.
Last night was the scariest of all. As we were sitting in the living room I looked into the kitchen and there was a snake slithering around. His coloring was black, red, and yellow, and both Dan and I thought coral snake. He was a little guy, but our adrenaline was running as Dan brushed him out of the house and killed him with the broom handle. Thankfully we didn’t have Anna on her floor mat. We investigated on the computer and are hopeful his markings tell us it’s a harmless black ground snake, which mimic the coloring of a poisonous coral snake…we sure hope so.
Though it rains almost every day here, it is the rainy season and maybe our unwanted guests are trying to escape the rain. Almost all the critters have come at night when we’ve had the screen doors closed but the main doors open. Hopefully by keeping the doors closed we can keep them away; at least that’s what I keep telling myself.
AUGH…as I write this Jael is yelling that there’s a frog in the house!

Our snake after Dan got through finishing him off.