Built Tough

I was consulted by a colleague to see a patient that needed to be admitted to the ICU. As I entered the patient’s room in the Emergency Department, I saw a man lying down on a stretcher, with an oxygen mask over his face, and was obviously laboring to breath. His heart rate was quite rapid and his blood pressure was borderline low. However, even if he was in apparent medical distress, he still looked menacing, so I approached him with caution.

He was a 34-year-old ginormous man.  He was 6 foot 5 inches in length, with his legs protruding way out of the stretcher, and weighed 405 pounds (yes, I confirmed it, as I had to adjust the medication I had to give him). His head was shaven, and he had a mustache and a beard that tells you “don’t mess with me!”. He was tattooed all over his body, from his legs, arms, chest and back, and to the top of his head. He looked like he belongs to wrestle mania ring or MMA cage to me.

After working him up, we determined that he had extensive bilateral blood clots in his lungs (pulmonary embolism), which is a medical emergency and can be life threatening. The clots (thrombus) were formed from his legs and broke off and settled and caused blockage in the arteries of his lungs. It is amazing that a tiny clump of blood clot can bring down even the most hulking and fiercest man.

I was asked by the Emergency Room physician if we need to give our patient thrombolytic (a strong clot-buster medicine), like pouring Drain-O in a clogged sink. I told him that in my opinion, it was not necessary, he just needed to be started on intravenous heparin (blood thinner) immediately, and needed to be observed in the ICU closely.

After talking to him and obtaining his history, my impression of him changed. He was very soft-spoken (or maybe because he’s out of breath), and was very respectful. He was educated and hard-working. In fact he works two jobs. He is an informational technologist (IT) in a large telephone company during the day, and a bouncer at a club at night. I guess, he needs to project the “savage” look for his job as a bouncer.

The next morning, when I rounded on him, he had his 3-year-old daughter cuddled with him in his hospital bed, while his 5-year-old son sits quietly by the side of the bed. I thought to myself that this one tough dude, definitely had a soft spot. I met his wife, who looked apprehensive. My patient claimed that he was feeling better, but he still required a high flow oxygen to keep his oxygen saturation up. I told him and his wife, that I believe he will be fine. In fact, I told him that he was stable enough to be transferred out of the ICU. This news wiped away the look of anxiety from his wife’s face.

The following day, he was sitting in his bed, and told me he feels strong enough to get out of bed. He even asked me if he can take a shower; his wife is already complaining, as he explained with a smile. I was told by the nurse that he moaned about the frequent blood draw (which is necessary for the continuous adjustment of the heparin drip), as he was squeamish with needles. Really?! With all his tattoos, he was afraid of needles?

I explained to him, while an inverted bottle of intravenous heparin hang on a pole and coursing through his vein, that he will be on anticoagulation pills, warfarin (yes, that’s the ingredient in some rat poison!), for at least 6 months if not even longer. This was to prevent blood clot from forming again in his system. I discussed with him, what would be the limitations in his activity, being on a blood thinner. I told him no more new tattoos, and no more “contact” sports, as he would likely bleed to death.

He was saddened as he told me that he had an unfinished tattoo in the back of his head, but was at peace with that. But he was more disheartened to the fact that he would not be able to work as a bouncer anymore. He told me that the club where he works was in a rough part of town, and having “contact” or roughhousing people is almost always a necessity in his job.

As I listened more to him, he told me that he would be alright. At least he still have his daytime job, and at least he is still alive to tell his tale. Besides, he has a young family that depended on him, and he cannot quit on them.

I thought he has a tough exterior. But his resolve is even tougher.