Guess who had a Vasovagal syncope yesterday after assisting in the insertion of a nasogastric tube and had to be admitted to the ER due to severely low blood pressure (60/40 mmHg), tunnel vision, and severe diaphoresis?
!!!Ding Ding Ding!!!
Answer is: ME.
Let me explain…
My patient is very ill. He’s in severe liver failure and his INR is very high so he bleeds very easily. Both my supervising intern and the head nurse had a hard time inserting the tube and tried each nostril several times which resulted in heavy nasal bleeding. I’m 100% sure that it was not the bleeding that set me off. I’ve been in a number of surgical theaters and watched many bloody surgeries. I don’t mind blood.
I think what really set me off was a combination of very little breakfast, dehydration, and my patient’s distress. So I blame empathy. My patient was just in so much pain and I felt helpless. He was also very vocal and moaning and repeatedly saying “I just want this to be over”, “I don’t want to do this”, “just let me go…”. To say he’s lethargic is an understatement. I made it through the NGT insertion, even cleaned up the blood. It was after, when I was washing my hands that the tunnel vision, feeling of suffocation, and nausea began. I left the room and went to sit down. As soon as I sat, I was out!! But only momentarily. But when I came too, I was drenched in sweat, very weak, confused the nurses force fed me cookies and orange juice, they were fanning me, and then took my blood pressure. It was actually because of my low blood pressure that they wheeled me down to the emergency room. I was fed again in the ER, rehydrated, and my EKG and blood sugar were checked for completeness.
So, not bad for my third day of rotations… Lol.
As both my mum and attending said, “you were the first one down, but you won’t be the last”.