The following was transcribed from a voice recording on the personal cell phone of Dr. Shea Sullivan. It was found in the aftermath of the incident that occurred at the clinic of Keylight Surgical Associates on 36th and Wesson. It has been posted in its entirety. Reader discretion is advised.

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There’s a saying amongst us surgeons that I’ve always loved: “all bleeding stops eventually”. The sentiment conveyed by this saying has always struck me, its multiple meanings and interpretations.

First, there are the positive connotations behind the saying: you throw a stitch and tie off an artery, pack the seeping wound, or cauterize a vessel and the bleeding stops.

Then there are the negative implications, the inevitable: the patient becomes volume depleted, exsanguinates, and the bleeding eventually stops.

It’s a stoic viewpoint that allows you to take a deep breath when the blood keeps coming and time is running out. Whatever happens, you must remember: “all bleeding stops eventually”.

I was removing a lipoma (otherwise known as a fatty tumor) from the posterior scalp of a young gentleman in his early 30’s by the name of Patrick. It was the last patient of the day.

“You can scram. I’ll take it from here,” I told my nurse Sheila. I could sense her antsy agitation. Her kid had a school concert this evening that she had to get home and get ready for. We were already running way behind and she had already set up my sterile field.

“You sure, doc?”

“Yeah, yeah. If I get too messy, you can clean it up in the morning.” I winked at her.

“Thanks a bunch,” she said and darted out the door.

“Make a mess?” the patient asked with fear in his voice.

“The scalp tends to bleed a lot. You won’t feel a thing,” I replied.

I was standing at the head of the bed with the patient in the lateral decubitus position, that is, he was lying on his side. While I injected lidocaine with a small needle into the patient’s scalp, I could hear him wincing and breathing through his teeth with each little poke and infusion.

It was always an interesting juxtaposition once the local anaesthesia was obtained. You got to witness someone go from bitching and moaning over a simple needlestick and the burn of the lidocaine to completely oblivious to the scalpel slicing through their flesh.

After dissecting the tumor from the surrounding tissues, I stuck in my thumb and pulled out the plum-sized fatty tumor. It was a beauty. Globules of orangeish fat with blood vessels criss-crossing the surface glistened under the lamp. I placed the gleaming gem of fat on the mayo stand and returned to the patient.

“All done,” I said as I applied pressure to his bleeding scalp. “Do you wanna see it?”

“I’m good, doc. I wouldn’t wanna pass out on you.”

“Fair enough.”

The gauze I held to his head had already been soaked completely through and blood was running down the back of his head and onto the exam table. I tossed the square onto the mayo stand and grabbed a handful more.

“What is that? Is that blood?” he asked, his eyes wide.

“Yeah. Sorry,” I said, wiping at the mess on his neck and around his shoulders. “Got a little on your shirt there. It’ll come out with some cold water and peroxide. Like I said, these things can bleed a lot.”

He didn’t respond, only took a deep and calming breath.

I pushed with enough pressure for the bleeding to abate. It offered a momentary glimpse of a gaping incision devoid of blood before the gash slowly filled again. Well, not too slowly. I had half expected to see a pumper—a patient had once painted the walls in here with his arterial spray—but there was only a steady seepage that easily soaked through the gauze.

I repeated the process again and again. Apply pressure, check for bleeding, apply pressure, check again. I concluded that the bleeding was not coming from the margins of the incision, but rather somewhere else. I lifted up the edge of his cut scalp with a pair of forceps and peered underneath, as if I was peeking underneath a rug for a misplaced earring. There was only wet darkness within.

“Doing ok Patrick?” I asked.

“Um...yeah.”

“I’ve just got a bleeder in here somewhere that I need to stop. These things happen sometimes. No need to worry.”

I wondered if Patrick was going over the informed consent he had signed, especially the portion that warned of the “extremely rare and unusual risk of serious injury or death”. Most patient’s skimmed over the forms as these were largely a formality for the simple kind of procedures we did in the outpatient clinic setting.

Squares of used gauze began to pile up on the mayo stand, damp and red. I had had enough. I continued to hold pressure on the scalp, adding more gauze whenever the current gauze got soaked. Soon, he had six inches of dressing jutting from his head, me applying pressure. I tossed this aside and threw some figure eight ties down with suture, blindly attempting to tie off the bleeding vessel.

I stood back to examine my work. For a second, the bleeding had slowed.

“Almost done,” I said in a reassuring manner.

A trickle of blood began. The patient’s matted and crusty hair.

I felt my heart rate quicken and a thought floated across my mind.

What if I can’t get it to stop bleeding?

This thought only appeared for the briefest instant and I was able to keep my steely resolve, to focus on the task at hand, mostly thanks to my years of experience, but also in part due to that old mantra.

All bleeding stops eventually.

If a wound could mock, it would be this one. Like a child dribbling out a mouthful of water, a surge of blood oozed out of the wound. It flooded down the back of Patrick’s head and neck. I figured the shirt might be a loss at this point.

“Gah!” Patrick gasped.

I grabbed a handful of gauze and held it to the wound.

“Hold this,” I said urgently. “Push hard.”

He kept his neck stiff and held the gauze to his head with shaky fingers.

It was time to quit fucking around.

I wheeled the Bovie cart over to the table, lifted up Patrick’s shirt and slapped the electrode pad to his skin.

“Just gonna use a little cautery,” I said.

Blood sizzled and popped and the smell of burnt hair filled the room. Thin wisps of smoke snaked upwards like ghostly fingers reaching for the light.

“Breathe deep for me. Nothing we can’t handle.”

But the blood still came.

Even when I packed the wound with Gelfoam, a hemostatic product, the blood still came.

At what point would I have to check my pride at the door and call someone?

I myself had been the recipient of such calls. Family doctors had called me in a panic, getting in too deep with their own procedures, and I had nonchalantly arrived to solve their problems.

Yet I was the only surgeon in a small town. There was no one to call. I would have to call an ambulance for transport to a bigger facility.

The back of his shirt had been completely drenched and his hips rested in a puddle, his blue jeans turning dark. My own clothes were stained and red speckled my forearms, my face, my glasses. A little rivulet of blood dripped off of the table and onto the floor.

Patrick’s skin felt clammy and cool. Was my own pride worth so much that I wouldn’t call for help until he had lost a pulse?

No, it was time.

“Patrick? Patrick?”

“Yeah,” he said weakly.

“Just checking. I tell ya, this beats all I’ve ever seen. I’m gonna have to call someone, get you transported to the hospital, ok?”

“Sure.”

“Now I’m going to need you to hold this gauze once again while I step out of the room. Got it?”

“Got it.” His voice sounded like it was coming from the bottom of a well.

Wads of used and bloody gauze littered the mayo stand, had fallen on the floor and I was down to just a small stack of unused dressing.

No matter what I’ve encountered in my medical career, I have never run. This is largely unnecessary and only contributes to panic and anxious thinking. However, I have been known to walk very quickly from time to time.

And that’s what I did when I started out of the room and that’s what I can attribute to my carelessness as I stepped in a slick puddle of Patrick’s blood that had somehow pooled up underneath the exam table. My feet went airborne and the overhead fluorescent lights filled my field of view as I became parallel to the ground. The loud thunk of my skull hitting the floor was the last thing I heard.

#

Imagine a suboptimal hot tub temperature. The kind of temperature where you get in and it’s just warm enough to be mildly infuriating. Nothing cold enough for you to call the manager over. Maybe just hot enough to let the grandkids play in without worry or discomfort. You soak for a while and it doesn’t feel right because it’s roughly the same temperature as your own body. The water neither lifts nor lowers your natural warmth.

Stick your finger in your mouth. That’s how warm this bathtub is.

If you took the average body temperatures of the folks that end up in this hot tub, you’d get a reference point of about 98.6 degrees Fahrenheit (37 degrees Celsius). Give or take.

Can you picture yourself sitting in this lukewarm bath? The feel of the liquid on your skin? Now picture the water is accompanied by a metallic smell, hints of copper. Picture water the color of rose petals. Picture how it doesn’t quite have the same texture of water. It’s stickier somehow.

I came to, bleary and disoriented. I was lying supine in a warm liquid as I stared at ceiling tiles. The liquid sloshed in and out of my ears as I moved my head. Soon, other sounds entered my awareness. The sound of a waterfall, an indoor fountain at the mall, currents of water trickling and splashing into another body of water.

Relaxing.

To my right, a crimson curtain cascaded down, splashing and deteriorating into the pool that I found myself lying in. In a dreamlike daze, I held my fingers up to the warm and dripping liquid, let it run down my hand and forearm. How the light glinted off of the blood.

The blood.

The patient.

I instantly sat up, got my bearings, and rose to my feet. I had the patient to attend to. Everything was an impossibility that I just couldn’t figure out. The sheer amount of blood in the room and the fact that its volume comprised gallons upon gallons and that it was still coming.

This couldn’t be real. At any point I would wake up from the most realistic nightmare I’d ever had, spend the waking hour with relief that the horrors I had witnessed were nonexistent in waking life.

But no such moment ever came and the scene continued to play out before me.

Patrick still lay on the exam table, his eyes rolled back under half-closed lids. The bent fingers of his hands were relaxed against his head in a weak pantomime of holding pressure. The wound poured and gushed from his head with all the force of a busted water main, like a fire hydrant that has been intentionally opened up for kids to splash around in.

I started over towards Patrick’s head. I had to stop the bleeding. As I sloshed and splashed through the flooded room, my head went light and my legs rubbery. I could feel myself buckling and going down again. I leaned over the table and onto his damp body, the room spinning, hung on for dear life and consciousness.

#

Still the blood came.

Beyond any reason or natural law, the blood still came.

Despite sewing the wound shut multiple times only for sutures to buckle and tear under the insane amount of pressure, the blood still came.

Despite removing my shirt and using it as a large pressure dressing, the blood still came.

It came from his nose and eyes and ears. I could plug one area momentarily only for the liquid to find some other path of least resistance.

I abandoned any pretense of saving the patient. He was clearly still alive if not conscious. What else but his beating heart would be causing the blood to continue to pump? I only wanted to leave and call in reinforcements, maybe an exorcist or shaman.

Yet, I couldn’t exit the room. The blood was now up to my knees and the liquid applied pressure to the door preventing me from opening it. At least that’s what I suspected; physics had never been my strong point. There was a high probability of other forces at work against me for the door could not be removed from its hinges either, even with the assistance of a scalpel handle.

I dropped into a defeated despair, sat on a chair at the corner of the room and watched Patrick continue to bleed, his limp body on the table forming an ornamental sanguine fountain.

“Sorry, buddy,” I said to him, the blood coming up to the seat, the chair shifting in buoyancy.

I put my head in my hands. The mantra came back.

All bleeding stops eventually.

I found a brief solace in the stoic saying, but cynicism returned. Whoever had written that saying had never been in a situation like this, a patient bleeding an infinite supply of blood.

All bleeding stops eventually, unless it doesn’t.

A lifetime ago in school, in residency, we were hammered home the principles of the ABCs when it came to an emergency situation. You had to make sure the airway was clear. That was A.

B was breathing.

C was circulation, the pumping of the heart. You had to take care of those things in that sequence to stabilize the patient. Establish an airway and respirations, then take care of the compressions.

An ER doctor I followed around on my emergency medicine rotation would walk past the room of a screaming child or patient and often remark, “Welp, A and B are working.”

As for Patrick, A and B were working. I could see the shallow rise and fall of his chest.

C was definitely working.

#

The lights have begun to flicker. The depth of the flood has reached past my waist and I wade through the gory deluge. I have scoured my cabinets for fresh #10 blades, battery-powered electrocauteries, the cast saw I have used on occasion to remove casts from healed fractures. I am going to explore. I am going to find out where the circulation is coming from. I don’t know what I’ll find. Whatever happens there is only one thing that I know for certain, one constant truth that I have to put my faith in.

All bleeding stops eventually

~~~[ll]