20. Haemohalter
Patient: Aqsa Hakim, Human
Date: 11/1/2733
Patient ID: 2754839
Presenting Complaint: Nosebleed
It was the Ecchus Chasma of nosebleeds.
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Transcript
[MUSIC: The Vesta Clinic Theme Tune]
[SOUND: Doors open, footsteps, doors close, footsteps, packet rustles, squeaky sounds of cleaning]
[SEC: start up sound]
FAYE
Ah! Hello! One minute, please!
[SEC: typing on screen]
Huh? No! Nothing!
[SEC: questioning ping, typing on screen, questioning ping]
No, no. Well.
[SEC: negative ping, questioning ping, typing on screen questioning ping, typing on screen]
Your screen just - needed a little wipe.
[SOUND: further squeaky cleaning sounds]
[SEC: typing on screen, questioning ping, typing on screen, questioning ping]
Are you sure you want to know?
[SEC: affirmative ping, typing on screen]
[SOUND: footsteps,bin open and close, footsteps]
There was just . . . a little - tiny, really - splash of um . . . blood on you.
[SEC: negative ping, typing on screen, negative ping, questioning ping]
[SOUND: chair]
Yep. Well, such is life.
Do you want your screen saver changing back from the ‘DO NOT TOUCH ME’ warning?
[SEC: negative ping, typing on screen]
Gotcha. Wouldn’t mind one of those myself to be honest.
[SEC: typing on screen, questioning ping, questioning ping]
Oh, the blood? Not forgetting that easily, are we?
[SEC: negative ping, typing on screen]
You missed some drama while you were snoozing.
[SEC: questioning ping, questioning ping]
Don’t worry, I’m about to recount it for you in exquisite detail.
[SEC: typing on screen, questioning ping]
A letter.
You know, the talks were actually going really well!
[SEC: typing on screen, questioning ping]
Yeah, so Xael somehow managed to wrangle us a deal where our much-needed engineer would arrive with a pharmacy rep and, if we made it through their endless presentations they’d cover the costs of our repairs. There were an excessive number of slides but we were behaving ourselves!
Xaelest, obviously keen for us not to lose this deal, sat with perfect posture throughout the first few hours, I could tell from the glaze in her eyes that she was not fully listening, but, Europa’s freckles, it looked like she was eating it up. Rai had slumped into a thinker’s pose, spine arching as he propped his chin up. My personal source of entertainment was how the presenter stumbled over his words every time he caught Rai staring at him.
[SEC: typing on screen]
No, no, it’s relevant!
One of the products our rep wanted to sell us was a new anti-haemorrhage device, a foam which sets into a polymer-like sponge. It - apparently - absorbs bleeding, tamponades and contains pan-clotting factors for a number of sentient beings.
[SEC: typing on screen]
Yeah! I mean, I was mainly there to please Xael, and for the free lunch. But I was following along okay. It’s been a while since I’ve watched a lecture.
The presenter had just moved on from a graph-crowded slide to a repeating clip of the device in use. At this point, I will admit, my eyelids were getting a little heavy, but I jolted awake as the door slid open to admit our new patient, her face smeared red with blood. We were on our feet in seconds. [Laugh] For someone peddling haemostasis, the SPSO pharmacy rep went green at the sight.
Our patient didn’t seem too distressed, despite the coppery tang in the air and the rusty stains down the front of her overalls.
‘Sorry to interrupt, guys.’ She said and briefly unclamped the fingers which had been pinching the bridge of her nose, revealing the source of her bleeding. ‘Any doctors in the house?’
[SEC: typing on screen, questioning ping]
Oh yeah, hah.
[MUSIC: begins]
Date: 11/1/2733
Patient: Aqsa Hakim
Patient ID: 2754839
Um, it was a pleasure to attend to this 6.5 Vesta year old, or 24 Earth Year old human today who presented unexpectedly with a torrential nosebleed -
[SEC: typing on screen]
With torrential epistaxis - thanks.
[SEC: affirmative ping]
Both myself, Dr Adra and Dr Solari immediately attended to the patient to provide medical assistance. I noted that she was trying to stop the bleeding by tilting her head back and pinching the cartilaginous bridge of her nose. As such, a fair quantity of blood was dripping into the back of her throat.
She coughed up a splattering of blood, which stained her teeth red and narrowly avoided the gathered medics. In the chaos of the subsequent profuse apologies, she managed to release her nose again and a small clot plopped onto the carpet. At this point, the rep fainted and Dr Solari excused himself to check on him - that’s just, a fun fact - don’t - it shouldn’t be in the letter.
[SEC: affirmative ping]
Thanks.
We gently guided Aqsa into a seat and encouraged her to lean forwards and put pressure on the fleshy part of her nose to better stop the bleeding.
[SEC: typing on screen, questioning ping]
Uh, no. Not even a little bit.
Um, these simple measures were unsuccessful. The bleeding didn’t stop. Unfortunately, we were in the Clinic’s afterthought of a seminar room, with no immediate access to medical equipment except -
[SEC: typing on screen, questioning ping]
Yep. The patient verbally consented to the use of - ugh I’m gonna to have to put the name in the letter, aren’t I?
[SEC: affirmative ping]
‘Haemohalter’.
[SEC: typing on screen]
My thoughts exactly.
By verbally consented, I mean, Aqsa went: ‘Ooh! Use the stuff! Use the stuff!’
Xaelest looked at me with a raised eyebrow. It meant she also wanted to use the ‘stuff’ we’d just spent twenty minutes learning about. None of this is for the letter, obviously, but I should also point out that, from his position in front of the screen, Rai sang out: ‘It’s not going to work’. He had the pharmacy rep’s legs hiked over his shoulders to raise his blood pressure, and the leech in a suit blinked awake.
We used the stuff.
[SEC: typing on screen, typing on screen, questioning ping]
It - it made things worse?
At first I thought we must’ve done something wrong, but the instructional video was still playing out on the screen and we followed each step. We sprayed the foam into the dripping opening of her nostrils and -
[SEC: questioning ping]
On the video, right, it coalesced into a thick foam. Our - I mean, it did thicken up. There was a brief pause where it looked like her blood considered clotting. Then she started bleeding again. Worse.
[SEC: typing on screen]
Right. Thank you. Yes. The patient verbally consented to the use of [sigh] Haemohalter. However . . . I have to be careful how I phrase this . . . However . . . it did not appear to alleviate the bleeding.
Is that fair?
[SEC: typing on screen, affirmative ping]
Dr Adra collected a chair for the patient and we carefully hovered her round into a clinic room.
[SEC: questioning ping, typing on screen, questioning ping]
Yes! Your clinic room. We had to use this one because the fluidiser had been fixed in here.
[SEC: typing on screen, questioning ping]
I’m sure she didn’t do it on purpose! But, yes. Blood did get . . . on most surfaces as we transferred her over to the exam bench.
[SEC: typing on screen]
Sec, I cleaned you twice!
[SEC: typing on screen, affirmative ping]
Aqsa perched on the examination bench, keeping her nostrils clamped between her fingers and head tilted forwards. I noticed her poking at the holes in the bench’s surface with a curious grin.
‘Troglodan?’ She asked before swallowing thickly.
‘Ceresaur . . . And others.’
‘No way!’ She looked between the puncture marks and my face in disbelief but silently acquiesced as I gestured for her to tilt her head back. A few dabs at her nose with a handful of gauze revealed a bleeding vessel in the anterior arterial plexus in the right nostril.
Xaelest appeared with a stick of silver nitrate and pressed it into my gloved hand before disappearing with an instruction to -
[SEC: typing on screen]
Call her if assistance was required, yes.
[Laugh]
For the letter - examination revealed a bleeding vessel in the right anterior arterial anastomotic plexus -
[SEC: typing on screen]
Rolls off the tongue I know.
- Which ceased bleeding with cauterisation using silver nitrate. Post-procedure observations showed a normal heart rate and blood pressure.
Once the bleeding was controlled, I was able to gather a history.
Aqsa told me that heavy nosebleeds were a part of daily life for her and she usually managed them using a device of her own design which inserts tampon-like wads of tissue into her nostril to stop the bleeding. She reported that this works so effectively that she had never seen a medical professional for the bleeds.
She unfortunately had left the device on their shuttle for her shift today. Which was a shame, I would have loved to have seen it.
I was concerned about the reported frequency of her nosebleed attacks and enquired about other types of bleeding. She found it difficult to say whether or not she bruised easily because much of her work as an engineer involves squeezing herself into tight spaces and persuading machinery to work through brute force.
‘Sometimes you literally do just have to run into the thing to make it work.’ She told me with a shrug.
I asked her about her menstrual cycle and she told me that her periods are regular and usually last for 7 days. She uses 4-5 tampons a day and often notices clots. She often has low pelvic pain which she manages with pain killers from the satellite’s pharmacy. I asked her if she had ever seen someone for this either and she looked at me with confusion.
[SEC: typing on screen, questioning ping]
Yeah! I mean, normal is a spectrum, but that’s definitely on the heavier end of the spectrum.
[SEC: typing on screen, questioning ping]
I suspected so, yes.
Other than that, Aqsa reported no other medical issues. She had never had surgery and does not take any prescribed medications. To her knowledge, she is not allergic to anything.
I asked whether anyone in her family had ever had any issues with nosebleeds or any other bleeding issues and Aqsa shrugged. She told me that she was adopted and had no contact with her biological family.
[SEC: typing on screen]
[Laugh] Uh, yes. I didn’t tell her that, though.
In terms of the rest of her social history, she was born and raised on the Solar Proximity Satellite Organisation and attended school and university there. She is saving the funds to complete a doctorate in - and this is so cool - Inventive Mechanical Recycling, to further her abilities in turning one machine into another with as little waste as possible.
[SEC: typing on screen, questioning ping]
I would imagine so! The satellites lie roughly between Earth and Mars but aren’t governed by either so there’s a strong ethos of . . . self-sufficiency.
[SEC: typing on screen]
No! No. Well. There’s a feeling, maybe, held by some people on Earth and elsewhere that the messages which reach us from the SPSO sometimes come across a little bit, uh, condescending. But I’ve never met an individual from there who wasn’t easy enough to get along with. So, I don’t know.
[SEC: affirmative ping]
Um, yeah. But I imagine Aqsa will be in great demand in her future career if she chooses to stay and work in the SPSO.
Uh, she does not drink alcohol or take other substances.
I informed Aqsa that her frequent nosebleeds and heavy periods might indicate an underlying problem with her blood’s ability to clot or the vessels in her nose and obtained consent for blood tests to investigate this further.
Do you have the results - ?
[SOUND: Door opening, footsteps]
XAELEST
No, Rai, I just wish you’d let him finish a talk without interrupting. You’re prolonging the agony.
[SOUND: door closing]
DAKARAI
You invited him! I love healthy scientific repartee.
XAELEST
Do you have any idea how much a full mechanical service costs? Mr Hakim was invited because, that way, Hygienanine would pay for it. Not for you to have someone to flirt with.
DAKARAI
Healthy. Scientific. Repartee.
FAYE
Can I help you both?
XAELEST
We’re taking a break. I needed to get out of that room.
DAKARAI
What do you reckon, Faye? Should we invest in some Haemohalter for the clinic?
FAYE
The product that makes people bleed more? I don’t think so.
DAKARAI
It was never going to work!
[SOUND: footsteps, machine creak, beep]
XAELEST
Rai, don’t sit on the Fluidiser, it has just been fixed!
DAKARAI
[Sigh]
[SOUND: machine creak]
If you’d paid attention to the demographics of the phase III haemohalter study, you may have noticed that, though humans were recruited to the study, almost all of the drop-outs were human . . . we can make some inferences as to why . . .
With the drop-outs, the study was underpowered to detect an improvement in acute bleeding and it doesn’t look at long-term complications of using the foam.
FAYE
I feel bad for using it.
XAELEST
[Dismissive] You didn’t make the decision and no harm came from it. Anyway -
FAYE & DAKARAI
[Groan]
XAELEST
What?
FAYE
You want to tell us something that we don’t want to hear and we don’t want to hear it.
[SEC: typing on screen]
And neither does Sec.
XAELEST
Have you looked at the report from the engineer?
DAKARAI
She went back to work?
FAYE
Yeah, what a trooper.
XAELEST
It was only a nosebleed.
FAYE
And a new diagnosis.
DAKARAI
It was the Echus Chasma of nosebleeds.
XAELEST
The report from the engineer is concerning. Both fluidisers were out of warranty, the Child of Da Vinci had been damaged . . . somehow.
DAKARAI
We know how.
XAELEST
The temperature control in the Greenhouse and the pharmacy stores was broken and, three - three - dispensary units in the pharmacy store were inaccessible. What would we have done in an emergency situation if we couldn’t retrieve the necessary medications?
The surgical assistant function of the Child of Da Vinci is going to be out for weeks.
DAKARAI
Not that you want to use it . . .
XAELEST
No! No, I don’t want to use it! Half the Clinic’s equipment is broken or about to break - how can we be confident that we can deliver NOSL11’s baby safely?
DAKARAI
Not a doctor, don’t look at me.
FAYE
Yes, you are. I hear you - I do. But . . . I mean, the equipment is getting fixed as we speak! Once the Child of Da Vinci is ready -
XAELEST
You can’t do gestational retrieval with a Child of Da Vinci.
FAYE
Right . . . um, why?
XAELEST
It’s only licensed for minor surgery and biopsy.
FAYE
I didn’t know that. I assumed the surgical robot would do the surgery.
DAKARAI
Nope. But not to worry because we’re lucky enough to have an ex-surgeon at the clinic who’s just so, so excited to get her gloves bloody again!
XAELEST
May I emphasise the ‘ex-’?
[SEC: negative ping]
FAYE
Right . . . Right! But you worked on Pasiphae? So your patients will have been mostly Adrilaen. You must be used to anatomical variation as - as standard! You’re better equipped to operate on NOSL11 than you realise!
XAELEST
I don’t think you appreciate quite what you’re asking me to do. You want me to perform an operation I’ve done once before on a biologically unique individual with no assistant and no anaesthetist.
DAKARAI
We never said no anaesthetist!
FAYE
[Overlapping] I’ll be your assistant!
XAELEST
[Drily] Really?
FAYE
I’ve . . . held a retractor before . . .
DAKARAI
If you need an abdomen to practise on, I have one of those.
XAELEST
You’re both -
DAKARAI
Insane?
XAELEST
Annoying.
FAYE
Look, you’re right. We’re not ready and we really need to work this out. But I don’t think NOSL11 will go anywhere else -
[SOUND: bleep, zipper, bleep buttons]
XAELEST
Stars, that’s just . . . perfect.
Faye, I’m coming back to use your Fluidiser if this patient needs bloods.
[SOUND: footsteps, door open]
Call me if you need me.
[SOUND: door close]
DAKARAI
I can’t believe it took you so long to learn that she used to be a surgeon when she behaves like this.
FAYE
[Laugh] We love a dramatic exit. What - um - what surgery did she used to do again?
[SEC: typing on screen]
DAKARAI
Like the boss said, General Paediatric.
FAYE
Stars.
DAKARAI
It - um.
[SEC: typing on screen]
Yeah, like Sec said. She - uh - She didn’t have -
[SEC: typing on screen]
Yeah.
You’re right, Sec, she would hate it if she knew this conversation was happening. Uh, ask her about it sometime.
[SEC: typing on screen]
Carefully.
FAYE
Okay?
DAKARAI
Anyway! Don’t let us interrupt your flow! I’m going to see if Mr Big Pharma’s got any significant p values for me.
[SOUND: footsteps, door open]
Catch you later.
FAYE
Bye, Rai.
[SOUND: Door closing]
Uhh, where did we get to?
[SEC: typing on screen]
Oh, yeah, thank you. Did you have the results?
[SEC: affirmative ping, file attached]
Thanks! Right.
Please find the relevant blood results attached. Of note is the mild microcytic anaemia - likely due to frequent bleeds - and significantly low HPAF.
[SEC: questioning ping]
Uh, it’s like a clotting factor. But like, on the platelet itself.
Other clotting factors were normal. Platelet count was normal. Um, the vasculitis panel was negative. And, um, in line with the 2730 Human Haematology Guidelines, the results and clinical picture were enough to diagnose Hereditary Platelet Adhesion Factor Disease.
I explained the diagnosis to Aqsa and reassured her that the condition was common and simple to manage.
Firstly, I have recommended a course of iron to help treat her anaemia. She should have her bloods taken again in 2 standard ten-days to monitor for improvement.
There’s no cure for her condition, but I explained that bleeding symptoms are often improved by the use of cyclokaprine once daily. She can expect less frequent nosebleeds and lighter periods. However there is a slight increase in the risk of forming blood clots. I have advised her of the importance of staying hydrated, active and ensuring that she wears pneumatic compression stockings on, uh, shuttle flights - uh, especially during cryo sleep.
[Laugh] When I showed her them she looked disgusted.
‘That is so not cute.’
‘Neither is a pulmonary embolism.’ I told her. And she couldn’t argue with that.
Given Aqsa’s skill and interest in invention, I shouldn’t have been surprised when the topic of conversation turned to the nasal cautery I’d performed and the possibility of her supplementing her tamponading machine with a device which could self-cauterise bleeding points.
[SEC: typing on screen]
I know! I advised against this for several reasons. Firstly, because of the obvious risk of damaging her nasal mucosa with incorrectly placed cauterisation. If the heating power was too great she would risk burning through the nasal septum. If used too frequently without a chance to heal, the nose may lose some of its blood supply. At best, this might manifest as a cold nose tip, at worst, it could become necrotic and require excision.
[SEC: typing on screen, questioning ping]
No, excision of her nose!
Furthermore, repeated cautery is likely to result in nasal crusting and aberrant new vessel growth, increasing the risk of further bleeding in the future.
I could practically hear the cogs whirring in her mind as she took this in. I’m not sure how much of my advice was sticking and how much was being discarded. She adjusted her hijab and smiled, innocent, then laughed when I reiterated the point that self-cautery was not a good idea.
I offered to have a discussion about contraception as starting hormonal contraception may be helpful in managing her heavy periods but she declined this today. She intends to discuss it with -
[SOUND: Door opens, footsteps]
XAELEST
Ignore me, I’m just borrowing your fluidiser.
FAYE
Oh, sure. That was quick?
[SOUNDS: fluidiser starts up, XAELEST loads the samples]
XAELEST
He’s only here for drug concentration monitoring.
FAYE
Oh, right.
[SOUND: the fluidiser starts processing samples]
[Pause]
You know, um, I always forget that you did surgery. You don’t talk about it much.
XAELEST
What do you want to know?
FAYE
Everything.
XAELEST
[A pause] Don’t you think it’s strange that the alarms in the lab weren’t actually broken?
FAYE
[Confused] What?
XAELEST
The reason the engineer came in the first place was because the lab alarms were broken. But they’re not.
[SOUND: samples finish, XAELEST takes the report]
I’m done with these. Call me if you need me.
[SOUND: Door opens, footsteps]
[SOUND: Door closes]
FAYE
Yep.
[Pause]
[SEC: questioning ping]
Well . . . I think that went really well.
[SEC: negative ping, typing on screen, questioning ping]
I don’t know. It’s not like Rai would lie about an alarm malfunction.
[SEC: typing on screen]
Yeah. I don’t know. Do I ever know? With Xael?
[SEC: typing on screen, typing on screen]
[Sigh] Yeah.
Right. Where were we?
[SEC: typing on screen]
Right, yes. We didn’t talk about contraception.
I did inform Aqsa of the importance of telling future medical professionals about this new diagnosis, particularly if she requires surgery or dental procedures.
Um. Despite the nosebleed, Aqsa was keen to return to work and we at the clinic are very grateful. She plans to speak to her own doctor back on her Solar Proximity Satellite for further cyclokaprine prescriptions. She is aware to seek emergency care in the case of further uncontrollable bleeding.
Signed -
OH! And, to reiterate, she has been STRONGLY advised against cauterising her own nose!
[SEC: typing on screen]
Engineers will be engineers.
Signed,
Dr Faye Underwood,
The Vesta Clinic
[MUSIC: The Vesta Clinic Theme]
This episode ofThe Vesta Clinic was created by AMC. I starred AMC as Faye Underwood, Kamen Cooley-Greene as Dakarai Solari, Ruby Campbell as Xaelest Adra and Sec as himself
Music by AMC and Ruby Campbell. Please check out our show notes for content warnings, transcripts, and your prescription of: any balloon creature you can imagine. If you enjoyed this episode and would like to help the show reach more ears, please tell someone who loves podcasts to check into the Vesta Clinic. You can also follow us on your social media of choice at @vestaclinicpod!
A huge thank you to our Patreon supporters. We hope you enjoy this week’s bonus story and bloopers like this one:
Kamen: Insane . . . insane
AMC: The way you said the first one was like . . . oh my god what’s that [swear]
Kamen: Oh the ‘Lebron James’
AMC: YEAH! [they laugh]
Kamen: That did sound like that, actually.
AMC: It did! It was good though.
Content Warnings: Blood (nosebleeds and other types of bleeding); menstruation mention; squeaking, cleaning sounds at the start of the episode; character makes jokes about own mental health condition
