Finding Hemo

I’m not squeamish, but if you are, you might want to consider waiting for my next post.

I never had a nosebleed before — or, rather, I never had a nosebleed of any consequence (I don’t have high blood pressure or any of the usual contributing ailments), but in the wake of my conjunctivitis, a throat infection and a few environmental extremes (all of which seem to have conspired as driving factors), I had a pretty serious one last Sunday.

Benignly enough, it started as a little red drop at my feet while putting the kids to bed.

Fifteen minutes later, there were considerably alarming little fountains gushing out of both nostrils and splashing down my throat — not a good sign, as it made it significantly harder to manage and pretty much nullified the usual trick of applying pressure and ice.

To make a long (and suitably bloody and dramatic) story short, we ended up calling for an ambulance to take me to the nearest public emergency room with an E.N.T., which was supposedly at St. Joseph’s. An hour or so after the entire rigmarole began, we arrived there with the bleeding somewhat under control, only to find out that their E.N.T. was only on duty until 20:00.

Bloody civil servants. As if I needed another reason to despise local health policies.

So onwards to St. Mary’s (Lisbon’s largest public hospital), where after a timely resurgence of said bleeding during triage and a labyrinthine trek through the building on a rickety wheelchair we eventually arrived at the sole open emergency E.N.T. service south of Coimbra (as we were gleefully told by the doctors there, as if, you know, it was actually something to be proud of as a nation).

This is where the squeamish who made it this far might want to think again and skip the rest of the post, since things are about to get positively medieval.

There are (or so I’m told) two primary ways to deal with epistaxis (i.e., nasal bleeding):

  • Cauterization of the burst capillaries, a quick way to deal with frontal epistaxis (where you can actually see the source of the bleeding)
  • Tamponading of the nasal cavity using a variety of materials, which is pretty much the catch-all technique

Since I had posterior epistaxis and there was absolutely no way to determine the origin of the bleeding (which was too profuse), I got the catch-all technique: a pair of compressed foam polymer tampons shoved down my nostrils.

Fortunately, those first tampons weren’t too painful (or hard). But they didn’t apply enough pressure (took them around an hour for me to feel the bleeding return), and so, twelve hours later and after a number of recurrences of posterior bleeding, a third doctor (this time in a private hospital) was shoving the sixth and seventh tampons (now approximately 12cm long and sadistically bereft of gel coating) both at once in a by now somewhat desperate attempt to stop the bleeding.

As you may have gathered by now, that day established a new, lower mark on my already sub-optimal appreciation of Mondays.

After all, it isn’t every day that you have half a dozen medieval contraptions shoved into a particularly sensitive portion of your anatomy in an attempt to stop you from bleeding (and, in fact, historical records show that in medieval times, such insertions were usually done to achieve precisely the opposite).

And in case you’re curious (which you most surely are not by now), the overall sensation of having one of those things tapped down your nose is roughly tantamount to having an oversized popsicle stick shoved in — without the popsicle, of course, and roughened round the edges to boot.

After that sixth attempt and my understandable lack of interest in sitting around bleeding, we moved on to a balloon catheter, which looks like so:

Looks rather soft and bouncy, right?

Well, let me attempt to describe what happens when one of these is applied — even though you’ll initially feel like a contestant in the Viking’s ancient human bagpipe contests (in which they tried to turn their opponents into musical instruments by dint of vivisection and liberal application of horns to unsuitable orifices), these are actually inflated with saline solution, so the initial impression is of moderate coolness and relief.

However, there is quite a lot more room to fill inside your nasal cavity than you’d otherwise expect — and once that’s achieved, you’ll notice it immediately, for your palate is pushed down and your eye socket sort of creaks outward, making you aware of two rather fascinating consequences: first off, one of the main nerve bundles inside your upper jaw is suddenly compressed to the point where you are visited by the grandmother of all tooth aches (who apparently carries around a fair amount of heavy and painful luggage), and once the posterior section is filled, the gag reflex kicks in — as if the entire cast of Riverdance was doing a heavy jig down your throat on hobnail boots.

And then you panic, because that’s just the beginning. Your nasal septum is now reversed and your other nostril compressed into uselessness, leaving you feeling like a beached koi who’s got a rock stuck across both gills.

Were I a full-blooded Englishman, at this point I’d probably have been mildly outraged at that doctor instead of mewling and burbling like a beached (and corked) porpoise.

I did get my own back, though, for when he said he felt lousy doing that to me and asked me how I was feeling I clearly managed to enunciate the words “I deliede dat do de a rhedoridal quesdion, no?”, subtly punctuated with bloody spittle.

The rest of the week was comparatively mild, in the sense that the painkillers worked well enough for me to nod off every hour or so until the little mad chimpanzees playing percussion on my teeth with steel nails returned from their leisure periods of trying to unhinge my jaw with toothpicks or squirting blood clots through my tear ducts, and the throbbing sensation inside my skull slowly dialed itself down from a full-blown rendition of Eiffel 65’s I’m Blue by the Percussion Section of the Chinese Army’s Heavy Artillery Division to One-Armed Phil Collins Beating A Dead Ox over the course of a few days.

Sleeping was a delicate (and utterly unsuccessful) balancing act that mostly consisted of setting my head in a position where the protrusions wouldn’t be confused with the indoor piping that festooned the nearby radiator, closing my eyes and gambling on the fact that the IV wouldn’t fill my bladder to capacity prior to 3AM, in which case I’d then attempt to navigate the required course with all the grace and majesty of the Titanic with an iceberg stuck into its skull while leaning onto a trolley with what I can only classify as a schizophrenically biased attitude against straight lines.

But all was not lost — I had a brief chance of enjoying the full splendor of minimalist hospital cuisine — cold grain soup followed by jell-o, cold carrot soup followed by ice cream, cold tomato soup followed by cold roasted apple, cold porridge, colder porridge (a subtle play on the overall wateriness and blandness of the thing especially crafted for the true gourmet) and the piéce de resistance, cold crème brulée au Diazepam (my favorite, since it made the chimps — and a fair amount of linear time — go quiet for a bit).

Fortunately things appear to have worked out well enough for me to have the thing deflated last Friday and kicked out to return home (with a strange sensation of roominess and heretofore unexplored natural caverns inside my nostrils) and I will now proceed to methodically tease out the remaining blood clots from my sinus cavities and sleep as much as humanly possible until Monday, by which time I’ll have a follow-up consultation with the E.N.T.

Somehow, I half expect to return from there with a graduation note bearing the seal of the Spanish Inquisition.