74yo dad bleeding from stomach in NYC. Do we go to a hospital?

April 13, 2020 3:38 PM

My dad was hit by a truck in October. One of his vertebra was fractured. To manage the pain, he took Advil every day. In early February, he started having trouble with his digestion. Every time he eats something, he has terrible diarrhea, and he wakes up every night with terrible reflux. Today, he tried to pass gas and felt liquid coming out. It was a lot of blood. After a while, he went back to the toilet because his stomach hurt, and more blood came out. What do we do?

He had a doctor’s appointment scheduled for March, but it was canceled because of COVID. He said he would see a doctor in May, once the doctor’s office re-opened, and refused to see a doctor via telemedicine. Now we're in an emergency situation, and it doesn't seem safe for him to go to the hospital since he's in Manhattan and is high risk.

He is now resting and says it doesn’t hurt, but obviously we are very, very concerned. We suspect this has something to do with the Advil, and I wish he'd gone to the doctor in February, but here we are. YANMD, but what would you do?

posted by saltypup to Health & Fitness (34 answers total)

Yes, a lot of blood in the gut is one of the few things on the immediate hospital trip list.
posted by ambrosen at 3:41 PM on April 13, 2020 [56 favorites]

IANAD. This is internal bleeding and it is absolutely an emergency. I would suggest that the risk of catching covid19 at hospital (even for a high risk person, even in NYC) is less severe than the risk of unconsciousness and death from the internal bleeding.
posted by escapepod at 3:43 PM on April 13, 2020 [17 favorites]

Yes, please go.
Or, at the least, is he now willing to communicate with a doctor via telemedicine for a consult?
posted by calgirl at 3:44 PM on April 13, 2020 [1 favorite]

Call the hospital and see what they recommend (they will probably recommend you bring him in). You will not be able to visit him (I assume) so make sure he has phone, chargers, etc. when you bring him. Catching COVID is bad, but this is just as bad, and it’s definitely for sure happening right now. He won’t definitely get COVID if you bring him to the hospital. He’s definitely got internal bleeding right now.
posted by mskyle at 3:46 PM on April 13, 2020 [13 favorites]

This is absolutely a medical emergency that calls for going to the hospital immediately.
posted by obfuscation at 3:48 PM on April 13, 2020 [13 favorites]

Please go!
posted by praemunire at 3:48 PM on April 13, 2020 [5 favorites]

With internal bleeding maybe going to the hospital needs to happen RIGHT NOW, before the resting and before the pain part begins again?

Is this not something where one can call 911 and ask how best to proceed? (I do not know, but that's what I'd be inclined to do in this situation)
posted by xm at 3:50 PM on April 13, 2020 [5 favorites]

Also, I am so sorry you are going through this on top of the pandemic..
posted by xm at 3:52 PM on April 13, 2020 [4 favorites]

There is an iOS app called Maven that offers (usually quite soon) telemedicine appointments with nurse practitioners. I would call them and/or your insurance advice nurse if I could be done with the call in 30 minutes or less. I might also try calling ahead to the ER to see if they have a non-COVID entrance.
posted by hungrytiger at 3:54 PM on April 13, 2020 [1 favorite]

The Mayo Clinic has a guide about rectal bleeding and how quickly you should go to the doctor about it depending on symptoms
posted by hungrytiger at 3:56 PM on April 13, 2020 [4 favorites]

I am a physician. I am not your father's physician. This is a medical emergency. Go to the hospital immediately. Call 911 if you have to. Do NOT try to call telemedicine or anything else that might delay you. Do NOT let him eat or drink anything right now. He may need an emergency upper endoscopy to stop the bleeding.
posted by demons in the base at 4:07 PM on April 13, 2020 [77 favorites]

IAAD. Go to the emergency room.
posted by i_am_a_fiesta at 4:15 PM on April 13, 2020 [22 favorites]

Do you need another doctor (not your dad's doctor) saying this is a medical emergency and to go to the hospital immediately?

Go to the hospital immediately.
posted by basalganglia at 4:15 PM on April 13, 2020 [31 favorites]

Not the right kind of doctor, but I can't think of anything other than inability to breathe that's equivalent to this emergency. This isn't a time for telehealth. Go NOW.
posted by Everydayville at 4:21 PM on April 13, 2020 [10 favorites]

Please update this later; I hope he's okay.
posted by theora55 at 5:03 PM on April 13, 2020 [36 favorites]

Go. My father took daily Advil, suddenly developed a bleeding ulcer and by the time they got it dealt with in middle-of-the-night emergency surgery, they’d put nine units of blood back into him—a complete oil change as it were. If your dad’s trying to talk you out of this, ignore him and 911 his ass to the hospital.
posted by mumkin at 6:33 PM on April 13, 2020 [5 favorites]

Go. Go now. Put your mask on and his and go.

Wishing both of you the best luck.
posted by ananci at 6:40 PM on April 13, 2020 [1 favorite]

Stop reading and go.
posted by bile and syntax at 7:28 PM on April 13, 2020

Emergency room. Now.
posted by SLC Mom at 7:59 PM on April 13, 2020

I had a bleeding ulcer once, also probably due to Advil. My ulcer was initially misdiagnosed as something else by a walk-in clinic, but after a week, I was sufficiently weak that I decided to go to the hospital. I still ended up needing a transfusion of 2 pints of blood, even though I was not, as your father is, bleeding enough to be passing liquid blood. If your dad hasn’t already gone to the hospital, he needs to.
posted by hhc5 at 8:17 PM on April 13, 2020 [4 favorites]

Please do update. I am white knuckling it for you. I hope you are at the ER and able to be together.
posted by sweltering at 1:08 AM on April 14, 2020

Response by poster: Thanks to everyone who contributed above. My dad has been admitted to the hospital and put on IV. I’m not able to be with him as I’m stuck in another city, but my brother was able to take him (though he left because they asked). Hasn’t gotten a blood transfusion yet and is still bleeding a bit, but treatment and testing will hopefully come soon. The doctors seem busy—my dad’s wondering if he’s been forgotten—but I think they’re just pulled into more urgent cases, and my dad is in good spirits.

Thanks again to all. We can use your good vibes right now.
posted by saltypup at 7:44 AM on April 14, 2020 [45 favorites]

WebMD offers this (The site sucks but the advice is spot on)

https://www.webmd.com/ arthritis/features/ making-decision-on-nsaids
posted by JJ86 at 7:58 AM on April 14, 2020

Thanks for the update. Sending healing light. This must be so stressful, but you've done the right thing for him, and he's likely to recover well now that he's getting treatment.
posted by theora55 at 8:37 AM on April 14, 2020

You did the right thing - yes, for others, this is a sign you need to go to the ER immediately.
posted by Miko at 11:10 AM on April 14, 2020

Response by poster: Another update: My dad actually never got admitted and was in the ER the whole time (b/c they didn't have enough beds/staff). He was released. As he walked over to my brother (10-20ft), he had a syncope episode (basically passed out) and is now back in the ER. He continues to bleed. There are tons of COVID patients in the ER. A friend who's an NYC ER doc said he would send him home b/c hospitals can't do much for syncope and he'll get COVID if he stays in the ER--but this was before I learned that he's bleeding again. For those still following, any idea if sending him back to the ER was the right move (or should we take him out)?
posted by saltypup at 1:55 PM on April 14, 2020 [2 favorites]

Most syncope is caused by dehydration, which yeah, you'd get a liter or so of fluid and get you on your way, not a great use of ED resources especially in the middle of a pandemic.

Syncope caused by active GI bleed is different. Very different. Unless you know where to get him a pint or two of packed red blood cells, the hospital is exactly where he needs to be right now, first to be stabilized and secondly to figure out the source and treat appropriately.

You did the right thing.

Fingers crossed the ED he's at gets him treated appropriately.
posted by basalganglia at 2:28 PM on April 14, 2020 [8 favorites]

Have you tried calling his regular doctor? If his doctor is affiliated with the hospital, it's possible that he/she could directly admit him or at least pave the way to ensuring that he gets treated more quickly. This obviously depends on his relationship with the doctor, the type of medical office it is, which hospital he is at, etc., but it could be worth a try.
posted by scalar_implicature at 3:34 PM on April 14, 2020 [2 favorites]

Response by poster: @basalganglia -- They are stabilizing him and releasing him without figuring out the source and treating it. The ER is so overwhelmed that it seems they do not have the resources to figure out the source and treat it.

Any thoughts on how to find a gastroenterologist that will perform a colonoscopy in NYC in the next few days? We have tried reaching out to two gastros directly (left messages with both) and have left a message with his primary care physician. We spoke with a telemedicine doctor who said she would refer us to someone, but we didn't receive the referral after the videochat.

Thanks again to all of the people pulling for us.
posted by saltypup at 4:35 PM on April 14, 2020

I just want to say I'm sorry that you and your family have to endure this. It's stressful and sad (from all perspectives) that your father is unable to quickly get the medical care he needs.
posted by Everydayville at 10:04 PM on April 14, 2020 [2 favorites]

Sent you a PM. You're doing the right thing to keep finding help and getting attention. Treat this as serious.

You could also try a different hospital system.
posted by Miko at 9:02 AM on April 15, 2020

Response by poster: Thanks, everyone. My dad was finally admitted based on some concerning EKG results. Scary, and high risk for COVID transmission, but we're very glad to not have to try to monitor and firefight this at home.

To give a picture of what it's like on the ground in NYC: It seems like very few gastroenterologists are currently performing colonoscopies or endoscopies ("scopes") in NYC. Because of COVID, most facilities for performing scopes are closed. If you describe an emergency situation (like a stomach/GI bleed) to a gastro's office, they will tell you it's an emergency and they can't treat you (i.e. go to the hospital).

If you go to the ER, they will likely stabilize you and tell you to go home because (a) they don't have capacity to fix you, and (b) they don't want you to catch COVID. Testing--especially invasive testing like scopes--put the GI team and the patient at high risk of contracting COVID. They are also extremely short-staffed because health workers are getting sick with COVID at alarming rates.

How did my dad get admitted? An ER doctor told my dad he needed to "outpatient" a scope (get it from a non-hospital setting), and my dad asked who he could go to because we couldn't find anyone. The doctor said he would call around. Once he did, my dad was admitted--presumably because they couldn't find anyone and realized he'd be right back at the ER without further care. I also inquired about some possibilities MeFites messaged me about (a strangulating hernia and a camera endoscopy), and I'm sure that pushed them a bit.

Thanks again to everyone who has been messaging and contributing. It's been immensely helpful.
posted by saltypup at 6:14 PM on April 15, 2020 [24 favorites]

Thanks so much for the updates, its a relief to know things worked out. Best wishes to you, your father and family!
posted by xm at 8:19 PM on April 15, 2020 [1 favorite]

I'm so glad he's getting care. I will be thinking of you and hoping for the best outcome.
posted by Miko at 8:54 AM on April 19, 2020