Medical Mondays: Think Outside The Species

Today's post is a walk down memory lane. One of my teaching attendings told me this story a long time ago in med school. I'm sure I'm about to mess up some of the details of this story, but anyway, here goes.

In the 1980's, a young man in this twenties came into the ER on an almost weekly basis. He would show up in the waiting room, vomit a quart of red blood all over the floor, and get ushered into an ER slot immediately.

He complained of excruciating stomach pain and terrible dizzness. After getting IV's placed and labs drawn, the ER staff would find him dangerously anemic. He'd get blood tranfusions immediately, perhaps 2 or 3 PRBCs (packed red blood cells, or concentrated red cells).

As soon as he was stable, they'd offer him an emergent endoscopy (a camera down his mouth into his stomach under light anesthesia) to find the source of the bleeding.

He always refused. He'd tear out his IVs, and leave AMA (against medical advice).

To the frustration of the GI, Medicine, and ER staff, he kept coming to the ER.

He kept getting vomiting blood.

He kept getting transfused.

He kept refusing the life-saving diagnostic test that might save his life.

Finally, one day after another ER visit, a curious medical student asked if he could look at the vomited blood under the microscope.

This is what he saw:


See, the blood the guy vomited all had nuclei in the red cells. Human red blood cells lose their nucleus during the maturation process. They look like little red bags with nothing in them.

What was wrong with this guy? And why did his blood look like that?

Well, the smart medical student also looked at the patient's real blood (a sample taken from his vein) under a microscope too. And it looked normal, like the blood on the left side of the picture.

Turns out, this guy was donating blood for money. Afterwards, he'd go to a local slaughterhouse, buy a few pints of chicken's blood (avian blood always has nuclei in the red blood cells). Then he'd go to the ER, drink the lot right outside the door, walk in and make some noise about his stomach hurting, then hurl chicken blood all over the place.

Let me tell you, there's nothing like a man vomiting a ton of red blood to make the ER staff jump up and take notice.

As always, his lab test would show he was anemic (because he'd just donated); the ER would stabilize him by transfusing blood; and he'd disappear before the endoscopy.

Then, his veins plump with new, transfused blood, he'd head for another Red Cross center and sell off the pints of blood he'd just received.

Is that crazy and brilliant and awful, or what?

Lesson learned. When thinking of a weird medical situation for your story, also consider thinking outside the species.

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Also, don't forget to check out Laura Diamond's Mental Health Mondays and Sarah Fine's The Strangest Situation.