* * Anonymous Doc

Monday, May 10, 2010

Middle of the afternoon yesterday, a nurse pages me. Patient's hematocrit is 5, down from 9-- that's low. "He lost half of his blood since the last test" low. "He has a major internal bleed" low.

I run to his room to see what's going on. He wasn't my patient-- on the weekend, you cover for the people who have the day off, so this was a patient on someone else's list, I'd never seen him before, I'd never examined him, I didn't know his usual condition. I asked the nurse to take a look, the nurse said he looked like he's looked all week. I looked at his chart-- quickly, though-- if there was something acute happening, I didn't have time to read every note and carefully study the chart. He's not a getting-better patient, he has very little brain activity, it's not like we're dealing with someone in a state where he can tell us what's wrong. But still, patient having a massive bleed, you need to figure this out, you need to do something.

Examined the patient, very quickly. One eye not opening right. Left side of his face not completely normal, I didn't think. Issue on one side of the body, massive bleed-- I thought stroke, and thought it was pretty obvious.

Called my resident, my resident said to get him to cat scan, stat. We did another blood draw on the way, just to re-check everything. Scan comes back normal -- no evidence of stroke. Condition hasn't changed, we have no idea what's going on.

Blood comes back. Hematocrit back up to 9.

That's not actually possible-- his hematocrit couldn't have dropped to 5 and then come back up to 9, that didn't happen. I call the lab-- "one of these tests could not have been his blood."

The lab insists they did not make a mistake, and definitely not with this latest one.

But then how to explain the eye muscle weakness?

I couldn't. And I didn't know what to do.

Nursing shift changed. New nurse comes on, happens to pass the patient's room, comes in to check. I ask her-- did he look like this yesterday?


"What do you mean, sure? Look at his eye."

"Uh, he has a glass eye."


"He has a glass eye."

Maybe that should be in the chart! In big letters!

So, okay, he's stable. But if that wasn't his blood that came back with a hematocrit of 5 -- whose was it, and do we have a patient with a massive internal bleed that we haven't identified yet.

We have no idea. I still have no idea. The lab has no idea.

Excuse me while I check to make sure all of my patients have their own lab results and not their neighbor's. Gosh.


  1. http://www.youtube.com/watch?v=l9K4BKkLaCI

    They should probably play this in your hospital.

  2. Maybe the phlebotomist drew the blood above an IV of from a line without the proper waste? You could check the electrolytes on the 5gm sample to check if none weren't tested originally.