Dr. Clara Hom was a junior clinical faculty
member who shared a 2-bedroom apartment with her older brother, in a suburb just outside
of Denver, Colorado. During the day, Dr. Hom worked in the cardiology unit, but some evenings
she would do night shifts in the Intensive Care Unit. She really hated moonlighting,
but took on the extra shifts to help pay off her 220,000 dollars in student loans. “Another
Saturday, another shift. Two more of these and then I can have a full weekend off – a
golden weekend.” Dr. Hom thought aloud as she was leaving her home. An hour later, Dr. Hom arrived at the Intensive
Care Unit. The woman who did the day shift was eager to head out and whipped through
the sign out. She said, “On the right side, beds 1-4 we’re just monitoring for postoperative
complications, 5 and 6 are patients with cardiac problems. On the left side, we have two patients,
22-years old Sarah Arroyo, and 26-year old Isaac Berg.” Arroyo has been having recurrent
bleeding post-tonsillectomy, and Berg has ARDS from who knows what, and is now he’s
on mechanical ventilation – the plan is to keep him steady on his settings overnight.”
And like that, the sign-out was completed and Dr. Hom was left alone to settle in for
the night. The night slipped by quietly, no big issues.
Dr. Hom felt relieved – she liked the money, but being in the ICU scared her and the feeling
had never really gone away over the years. It was about 6:02am Dr. Hom was called by
Sarah Arroyo’s nurse because she had been spitting up some blood. Dr. Hom checked her
tonsil beds, and she saw bright red streaks running down the back of Sarah’s throat.
She tried to remain composed, but her stomach began to turn. “Nurse, bring me a kidney
dish.” Dr. Hom advised Sarah to spit the blood out
in the kidney dish, rather than swallowing it. Sarah nodded and looked calm, it was her
third time experiencing bleeding, and she knew the drill. Dr. Hom’s mind was racing.
It was 6:07am, and she had 53 minutes left in his shift. She gave herself a quick pep
talk “You’ve got this, you just have to keep everything steady for 53 minutes, and
then the daytime team will be here, and everything will be alright.” Dr. Hom went to the bedside
and noticed that the bleeding was becoming more brisk – 46 minutes left to go. “Nurse,
bring me 2 cold saline bottles!” She was hoping to cause local vasoconstriction by
applying the cold saline to Sarah’s neck. Unfortunately, it didn’t seem to help and
soon Sarah has filled up a third kidney dish with blood and was barely able to stay alert
– 35 minutes left to go. Dr. Hom had ordered blood products to be given, but Sarah’s
IV had infiltrated and the nursing team was having a hard time placing a new one. Dr.
Hom tried to apply silver nitrate to Sarah’s tonsils to help stop the bleeding, but it
was impossible to see what she was doing and the bleeding only seemed to worsen. 18 minutes
left to go. At that point, Sarah began vomiting dark blood, which Dr. Hom initially thought
was blood that she had swallowed, but soon the vomiting worsened and Sarah was unconscious.
Dr. Hom called for a code blue at 6:55am. Within minutes, they placed an IV and start
to give fluids, but Sarah had lost too much blood already. Sarah went into hypovolemic
shock and died. A few weeks later, Dr. Hom received a letter
stating that the hospital was being sued and that she was being named specifically because
she was responsible for managing Sarah Arroyo. Now – to rewind this back – let’s imagine
that Dr. Hom had called the emergency assistance when she was unable to control the bleeding
with 35 minutes left to go in her shift. Perhaps they could have avoided a code blue altogether,
and Sarah’s life may have been saved. The moral: In an emergency, get help quickly.