5. The Red

‘Morning, Mr. Weiss. How are you doing today?’

I had been caring for that patient for a week by then. Jake Weiss was an African American man in his forties but already with completely white hair. I usually didn’t bond very well with patients, or at least not that fast, but he just seemed to love me for no reason. The only thing we had in common was that he had a daughter named Lisa.

‘Dr. Lisa! You look great! How was your day off? I noticed you didn’t come to see me yesterday.’

He was always kind. Especially since he learned my first name.

‘It was good, Mr. Weiss. But we are here to talk about you.’ I said with a smile while I checked his pulse. ‘Did you bleed at all yesterday?’

Jake had a rare disease called Osler-Weber-Rendu syndrome, or Hereditary Hemorrhagic Telangiectasia. It is an autosomal dominant vascular disorder, which can be very mild, with mild epistaxis and telangiectasias on the skin. But unfortunately for Jake, he had it the bad way: major arteriovenous malformations, bleeding, and severe anemia.

Even so, epistaxis was how Jake told me he found out about his condition.

‘You know doc, I like running once in a while. And every time I ran a few laps my nose bled a little bit. It was annoying, my shirts were all red. I wasn’t black anymore, I was always red.’ He laughed. ‘That’s why I went to see a doctor years ago and that’s when I found out.’

The week before that morning he had come in ‘soaking red’, as he described, and was admitted to the hospital to receive blood transfusions. The bleeding was under control but he was still recovering from his hemoglobin of 5.4 g/dL.

He usually bled from his nose and mouth. He told me the doctors had discovered an arteriovenous malformation on his cervical arteries, but there was no way to correct it surgically.

‘I’m used to this already. I only come when I’m too weak to keep doing my things. Otherwise, I would have no life at all!’ He laughed again. His laugh was so contagious.

‘So tell me, Mr. Weiss, did you bleed at all yesterday?’

‘No doc, I was just fine yesterday.’

‘That’s great news!’ I said excitedly.

We talked a little and I started examining him. He was pale, as usual, and had telangiectasias all over his lips and tongue, but his heart rate had improved and he looked a little stronger.

‘You know, Lisa will come today. Maybe you can meet her. You’d like her, doc.’

‘I’m sure I would! I was wondering when I would get to meet her.’

'Oh, well, you know how families are.’ He shrugged. ‘I don’t like it when they see me like this, I only called her today. She gets too worried.’

‘And that’s why I don’t want to have kids.’ I accidentally let this thought escape out loud.

‘What do you mean?’

I hesitated. This was getting too personal. I didn’t know what to say to him.

‘Well, I don’t have the time.’

He turned a little serious.

‘That’s not why.’ he said.

I couldn’t help thinking he was being a little inconvenient. It was a personal question after all. Or maybe I was bothered because I just didn’t want to answer it. I tried changing the subject.

‘Well, I’m sure your daughter would like to know when you’re sick.’

‘Yeah, doc. But no worries, I called her today and told her Mr. Osler-Weber-Rendu paid me a visit this week.’ He started laughing on his own. ‘Rude guy, always comes uninvited.’

He reminded me of my dad, with all these not-so-funny but heart-warming jokes.

‘I’m glad she is coming, Mr. Weiss.’

‘Me too, me too.’ He patted my hand kindly.

‘And I’m happy to see your hemoglobin is rising and that you’re not bleeding anymore. Hopefully, you’ll be discharged soon.’

He gave me a wide smile. Discharging was always the best news, the patients reacted like they just won the lottery.

‘So, when exactly is Lisa coming?’

‘After lunch. She said she’ll come on her lunch break.’

‘I’ll make sure that I come by to meet her then.’ I smiled.

I gathered my stuff, washed my hands, and was almost leaving the room when he called me.

‘Yes, Mr. Weiss.’

‘You would make beautiful babies, Dr. Lisa.’

After taking care of my other patients, there was no time for lunch, but I was used to that already. I went to Jake’s room and saw a young woman inside, his daughter I assumed. She looked a lot like him, but I could see she was mad, not at all smiling like he used to be.

I decided to give the daughter some time alone with her father and waited outside. I could see she loved him very much, and I could also hear some of what she was saying to him. She was mad he hadn’t called her sooner. And he was smiling, as usual.

That’s all I could see from behind the glass door. Then she must have said something funny because he started laughing really hard. Seeing him laughing so much made me smile.

But then, it was all so fast after that. The daughter called out my name, I ran inside the room with two nurses. The three seconds it took for us to get in was enough for everything to be covered in blood.

I started packing his nose and mouth to control the bleeding, while they called for the nearest attending doctor.

Jake was restless. He wanted me to take off the packing so he could speak to his daughter, but I couldn’t do that. I tried to calm him down but it didn’t work.

‘I can’t take it off, Jake. Stay calm, breathe.’

He became even more stressed out that I was preventing him from talking. He eventually bit my hand and I pulled out in reflex.

‘Don’t worry about me, Lisa. I love you.’ He whispered weakly.

I knew he was talking to his daughter but it felt like he was talking to me. I rapidly put the packing back and I could see his daughter crying in the corner of the room.

Later that day, I was sitting on the rooftop looking at the sky. Jane, the nurse, had shown me this place once when I was stressed with something silly, I don’t even remember what it was. It seemed so far away now, and so unimportant.

My shift had ended 2 hours before but I couldn’t leave. The image of a lifeless Jake Weiss in his bed was stuck in my head. I closed my eyes hard and tried to push this image out. Jax had called me three times but I couldn’t bring myself to answer the phone. I still had blood on my shoes.

‘Don’t worry about me, Lisa. I love you.’

He wasn’t saying this to me, but I had heard it before. Years ago, when we talked for the last time. Me and my dad.

…

Want to read more about Osler-Weber-Rendu syndrome?

https://www.ncbi.nlm.nih.gov/books/NBK482361/

Want to read a real case report of Osler-Weber-Rendu syndrome?

https://academic.oup.com/omcr/article/2018/3/omx108/4951581

Clinical Board

 

AD: autosomal dominant; AV: arteriovenous; GI: Gastrointestinal