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.