Tuesday, February 16, 2010


‘I need ice, Jan. Please. I’ll bleed out otherwise.’
Jack is sitting hunched over on the sofa, a wicker wastebasket lined with a plastic bag set on the coffee table in front of him, spilling over with bloodied kitchen towel. He has a freezer bag filled with crushed ice draped over the back of his neck. Jan, his girlfriend, the woman whose flat this is, stands by in attendance, smiling apologetically and wiping her hands on a tea towel.
‘Okay, Jack. I’ll see if there’s any left.’
Jack makes a dreadful, dredging kind of retch, and a clot like a plump red jelly flops out of his mouth into the basket.
‘I had an operation on my polyps two weeks ago,’ he gasps. ‘Started bleeding and it wouldn’t stop. Ended up in ITU for a week. They kicked me out a few days ago. I’ve been bleeding on and off like this ever since. Up to A&E twice, had my nose packed out, sent home. I told them – I’m gonna bleed and bleed and bleed, but would they listen? No. No one ever listens. So here we are. Have you got ice on your truck?’
‘We’ve got those chemical ice packs.’
‘They’re no good. I need ice.’
‘Let’s see how you get on with them, Jack.’
Reluctantly he submits to having the old pack taken off and one of our packs put in its place.
‘You should wrap it first,’ he says.
‘No, no. They’re designed for contact with the skin.’
‘It’s not cold enough.’
‘It’ll get cold. Give it time.’
Jan comes in with another freezer bag of ice.
‘Give me that,’ says Jack, blindly swiping the air in her general direction. ‘This thing’s no bloody good at all.’
‘I’ll follow up in the car,’ says Jan, gently putting the bag of ice around his neck with the formality of an alderman hanging a gold chain around the neck of the mayor. ‘To keep our options open.’
‘Someone’s got to do something,’ he says, then gags, and begins hauling a rope of congealed blood from his mouth that goes on for so long it’s like watching a magician haul a line of flags from his sleeve. I want to applaud when it comes to an end, but simply watch quietly as it follows everything else into the basket. ‘When I stand up, watch my trousers,’ says Jack, when he gets his breath back. ‘That’ll be the next thing.’
‘Don’t worry. I’m on your trousers,’ I say, as we manoeuvre the carry chair into position.
‘I won’t need that,’ he says. ‘I have to keep forward. That’s no good.’
He stands up. His trousers are firmly belted, but I give them a tug, just to make sure.
‘Hey! Steady!’ he says.
I hand him a vomit bowl, and he allows Jan to take away the basket.
‘So where’s this sodding ambulance?’ he says. With one hand around the bowl and the other grasping his nose, he shuffles out of the room and down the corridor. But suddenly he stops, and turns his head slightly to the side.
‘And just for your information,’ he rasps, ‘when we get to the hospital, I’m not doing a damned thing until you get me more ice.’


lulu's missives said...

Hi Spence,
When I saw the title 'iceman', I thought that this post might be about you and the frozen tundras of the north, didn't expect it to be about icepacks.
Funny how we know 'everything' once we've been through it a few times.

Rach said...

How awful Spence I hope he got it sorted out eventually..xx

Spence Kennedy said...

Hi Jo
I've no idea why he was so insistent on an icepack on his neck. Never heard of that one before. I did feel sorry for him. It was an unpleasant experience. Not the easiest patient in the world to deal with, but that's the way it often goes.

I quite fancy the frozen tundras of the north. I think I'd be all right up there with a spear and a pack of dogs (or a pack of fags).

Hi Rach
Don't know if they sorted him out, but I sincerely hope they did. I think that's what counts as a 'failed discharge'. :/


Shade said...

I'm not usually squeamish about anything I've treated as a first aider, and can usually handle more blood than most of my friends doing it can, but the one patient that's managed to make my stomach a bit jittery was one like yours, nosebleed with a long string of congealed blood that just kept coming and coming! Eww!

Hope your casualty got sorted out ok at hospital.

Eileen said...

I have heard it recommended to put something cold on the back of the neck for a nosebleed - never stopped to think about whether it's as appocryphal as the idea of a spoon down the back of the neck! Might be something to make the sufferer lean forwards - you know how everybody seems to want to tip their head back when they have a nosebleed? Never did understand why anyone would want to swallow blood like that.

Spence Kennedy said...

Hi Explorer
Noses can be so bloody! And the noises that go with them can be pretty expressive, too.

Our man Jack was pretty 'phlegmatic' about the whole thing. Focused on his ice, more than anything!

Hey Eileen
I looked up on Wiki this business of the cold pack on the neck (and Wiki as you know is never, ever wrong). They say that although it's quite common practice, there's no evidence to show that it makes any difference at all.

Maybe it does encourage them to lean forwards, though! So many people do tend to tip their head back, even though that sends the blood down into their stomach and makes them sick. Eech! :/

Thanks v much for the comments.

uphilldowndale said...

My poor old mum has been there so many times. Her nose has been packed, cauterised and packed again. We have had to call upon you guys more than once. We could write a book, but it would be very repetitive :(

Spence Kennedy said...

Poor thing! And if she's got high blood pressure or/and takes blood thinners, it'll only make the whole thing even worse. What a nuisance (the nose, not the mum). I hope she's okay, and not adding any more chapters to that book. :/

samrad said...

I had a nasty nosebleed a while back and believe me, you don't want to tip the head back. even with my head tilted forward and ice it just wouldn't stop and ended up going back into my stomach. We went to A&E and my half-full bucket of blood was looked at by just about everyone on duty, but the bleed stopped for me after about 2 hours and didn't come back.

Spence Kennedy said...

Sounds nasty, SR.

That piece of bad advice ('tip the head back when you have a nose bleed') is part of a whole bunch of health care fallacies that have been hanging around for years. Like 'put butter on a burn' or 'force something between the lips of someone having a fit' or 'don't let someone who's banged their head go to sleep / have pain relief'. There are loads more!

Hope your nose is okay these days.

Mort's Mom said...

Hi Spence,
I was brought up in a pub with a mother who followed a long family tradition of "Pain? Pull yourself together and get on with it". Her stock remedy for everything was a cheese and onion sandwich.Bad cold? Cheese and onion sandwich. Feeling sick? Cheese and onion sandwich. Nose bleed? Cheese and onion sandwich. Sprained ankle? Strap it up then have a cheese and onion sandwich. If you were in severe extremis you would be allowed an Aspro.If that didn't work it was brandy and hot water.
This attitude has been so drummed into me that following my breast cancer diagnosis last June, my first thought was for a cheese and onion sandwich! Indeed this basic of the family medicine chest has seen me through chemotherapy when nausea and the foul taste of everything made it one of my basic food groups!
I am not advocating you turn the back of your ambulance into a sandwich bar, but a small sliced white, a Spanish onion and a slab of cheddar could easily fit into your toolkit.
Think of it as an alternative therapy. Just a suggestion!

Spence Kennedy said...

Hi Mort's Mum
Your mum sounds great. And she's right - you can't beat the healing powers of a good sandwich (and raw onion). I'm going to try it on the very next patient. And if they don't want it, I'll have it.

Actually - even better than a Spanish onion - a pickled onion. The nuclear option.

Hope you're okay xx

Unknown said...

No no, red onion is the way to go :)

I had a teacher in primary school who insisted on 'head back', even though as a 10 year old I knew better. I pointed out that it was forward not back, and he said "it's back, otherwise blood gets on the carpet!". Deary me.

Spence Kennedy said...

Red onion? What do you do with it? Stuff it up your nose?

Okay then. If you're sure. I'll put a string of 'em in my bag.

BTW - saw an episode of Friends last night. Rachel got a nosebleed. So what did she do? Tip her head right back on the sofa! Bah!

Unknown said...

Hi Spence, loved the bit where you were going to applaud him..... my son had nose bleeds from the young age of 16 months, (grown out of it now) but I used to hang him over the bathroom sink to drip in, he learnt to write his name like that to kill the boredom. Things we do for kids.

Spence Kennedy said...

Did he learn to write his name in the blood? (or is that my morbid imagination again?) Glad he grew out of it. Must be such a pain.

Cheers for the comment, Carla. Really appreciated. :)