All Bleeding Stops Eventually: A Lenny Moss Mystery

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I do not have the luxury of saying in response to mass shootings “well there shouldn’t be shootings” or “we should ban guns” or any such macro-level political ‘solutions.’ I am tasked with doing something productive for the population I serve in the face of this risk. Calls for mental health funding, red flag laws, media reform, or various flavors of gun control are all well and good but are part of a separate discussion. Those long-term systemic policy discussions are not going to help the victim of a shooting who’s bleeding out on the ground while the police are searching for the shooter. But bystander or self-intervention to stop the bleeding could.

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. 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.” Florence Nightingale was an activist, a social reformer, a statistician, and a bold nurse who defied stifling British conventions to change history. An indisputable pioneer, Nightingale died in 1910 aged of 90, leaving behind an inspirational legacy that benefits everyone’s medical care today. Which leads me to another of my favorite old medical phrases: Tincture of Time. A tincture, for those of you who are not pharmacists in the 1910’s, is a concentrated liquid herbal extract, made from soaking plants with assumed medical properties in alcohol. So, Tincture of Time is the “medicine” of just waiting for a patient to heal themselves. Sometimes, that’s the best thing to do. Or the only thing to do. If you’ve already tried all the actual medicines.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. 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. Rhythm is key. Use as many sounds and cadences as possible. Think of dialogue as a form of percussive music. You can vary the speed of the language, the number of beats per line, volume, density. You can use silences, fragments, elongated sentences, interruptions, overlapping conversation, physical activity, monologues, nonsense, non-sequiturs, foreign languages. In a Newsnight special marking the NHS’s 75th anniversary, Kirsty Wark asks the big questions about the future of UK healthcare. Broadcasting live from Addenbrookes Hospital in Cambridge, Kirsty will be joined by TV doctor Xand van Tullekan and people working at the heart of the health service, to ask is the NHS on life support or fit for the future? BBC One

Think of information in a play like an IV drip -- dispense just enough to keep the body alive, but not too much too soon. 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”. 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.

CBBC

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

Rossaint R, Bouillon B, Cerny V, Coats TJ, Duranteau J, Fernández-Mondéjar E, Stahel PF, Hunt BJ, Komadina R, Nardi G, Neugebauer E, Ozier Y, Riddez L, Schultz A, Vincent JL, Spahn DR, Task Force for Advanced Bleeding Care in Trauma: Management of bleeding following major trauma: an updated European guideline. Crit Care 2010, 14: R52. 10.1186/cc8943 A play must be organized. This is another word for structure. You organize a meal, your closet, your time -- why not your play? Spahn DR, Cerny V, Coats TJ, Duranteau J, Fernández-Mondéjar E, Gordini G, Stahel PF, Hunt BJ, Komadina R, Neugebauer E, Ozier Y, Riddez L, Schultz A, Vincent JL, Rossaint R, Task Force for Advanced Bleeding Care in Trauma: Management of bleeding following major trauma: a European guideline. Crit Care 2007, 11: R17. 10.1186/cc5686

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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. 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. Comedian and broadcaster Dr Phil Hammond's How I Ruined Medicine draws on his own experiences to ask if his investigations into medical malpractice have done more harm than good for healthcare overall.