It started as a dribble of blood from my left nostril, and swiftly became a rich torrent.
I hastened to the bathroom; it had been years since I had last had a nosebleed, but I vaguely remembered something about putting your head back and pinching the bridge of your nose.
This I did.
Within seconds the back of my throat had filled with foul ferric flavour, and I knew at once I was not cut out to be a vampire. Worse still I was in imminent danger of drowning in my own blood. I coughed violently, sending a scarlet arterial spray over various bathroom fixtures and fittings. (When I examined this in more detail, during the mopping up operation later, I was impressed to see that it was of sufficient volume and scattering to have given the good folk of CSI plenty to mull over. I would imagine that some axe murderers create less carnage.)
Time, I felt, for Plan B.
Plan B was to hang my head over the sink under a stream of cold water, hawking and spitting away the reservoir that had built up in my throat, while allowing the blood to pump freely into the sink. Due to the perverse configuration of the taps, this plan was far more easily conceived than executed. There was very little room to fit my nose between the tap and the bowl, and the whole thing was only possible by jamming my cheek hard against the side of the sink. For ten minutes I remained stooped in Quasimodo-esque communion with the tap, and for most of that time Plan B seemed likely to end in death by exsanguination. Little by little, however, the flow slackened. I turned off the tap and watched hopefully as the drips became ever more widely spaced. Eventually they stopped altogether, leaving a stalactite of brown-red goo pendant on the tip of my nose.
Gingerly I stood up and examined my bloodied reflection. Reassuringly it seemed that a tittivating wash would restore normality, although my sinuses seemed to be packed with something gruesome, presumably a close relation to the jelly adorning my nose tip. Other than that I felt in good fettle. I washed and spruced up, then turned my attention to the Hansel and Gretel trail of crimson droplets that I had scattered hither and thither. The trail led back, ultimately, to the computer, where the whole affair had started, and life resumed normality.
Four hours later it happened again.
By midnight it had happened twice more.
At four o’clock in the morning I spent another unhappy half-an-hour with my face wedged between the tap and the sink.
By the following day I felt I should present myself before a doctor, and so rang my local surgery for an appointment. The receptionist was a tough negotiator. There were, she explained, no slots to be found for me; however, she could get a doctor to call me during a quiet moment, would that do? I agreed and awaited the call.
In the meantime I looked up various pockets of expertise on the internet. It turned out that, far from putting your head back during a nosebleed, you should always tilt your chin down towards your chest so that the blood does not run down your throat. Plan B was part-vindicated. I also discovered that many people believe pinching the bridge of the nose does the trick, whereas, this being predominately bone, it has no effect whatsoever. Any pinching, advised the savants who contributed to the sum of nasal knowledge, is best done with the soft fleshy folds below the bridge of the nose. Specifically, these should be pinched for a timed fifteen minutes. Okay, so Plan B hadn’t covered that one, but, on the other hand, it had involved lots of cold water, and the various sites were united in their view that an ice pack applied to the nose would greatly assist matters. I gave Plan B half a mark for being in the right ballpark on that score. Better still, I found out that the plain old nosebleed has a proper medical term: epistaxis. There is something terrifically reassuring, knowing that a condition is serious enough to have a proper medical term. It immediately elevates you above those people suffering from hangnails.
Needless to say, the doctor rang me at the exact moment I had been forced to put these discoveries (Plan C) into practice. Head over the sink, pinching my nose and with a bag of frozen garden peas welded to my face, answering the phone was tricky, but I eventually managed to wedge it between my shoulder and my left ear.
“Hello,” he said. “I hear you’re having nosebleeds.”
“Yeb,” I said. “Ib bact I’be abbig one dhow.”
“Dear me. Well whatever you do, don’t put your head back. Keep your chin down so that the blood doesn’t run down your throat.”
“Good, good. Now…this is very important…don’t pinch the bridge of your nose. Everybody thinks you have to pinch the bridge of your nose, but that is just bone. You must pinch the soft fleshy part beneath the bridge.”
“I’be pigging thab.”
“Okay. Excellent. Now, you need to time the pinching for fifteen minutes. Don’t stop to see if it has worked, just keep pinching. Then once it has stopped go find yourself an ice pack, cover it in a cloth and compress it against your nose and cheeks.”
“I ab peag.”
“Froben peag. Od by dobe.”
“So when did this start?”
“And how many times has it bled since then?”
“Sebeg or ague.”
“My, my. You’re quite a bleeder…are you on any form of medication? Warfarin, for instance?”
“Well it sounds as if you may have high blood pressure. I want you to come and see me on Monday. Will you do that?”
“Yeb. Bag you, dogda.”
“You’re welcome. Goodbye for now.”
He hung up, leaving me to count down the remaining minutes in solitary contemplation.
At fifteen minutes precisely I stopped pinching, and what can best be described as a deluge of blood cascaded into the sink. Plan C had failed. I applied pressure again for another ten minutes, and I could feel the flow backing up and beginning to trickle down my throat. Clearly the bleeding point was either unimpressed by mere pinching, or perhaps out of its reach. I resorted to Plan B, letting the flow do its thing until it eventually diminished. This is getting silly, I thought. Time for more affirmative action.
Plan D began with a call to the local cab firm, one of whose minions ferried me to the local Accident and Emergency Department. “Nasty things nosebleeds,” opined the driver. “But I hope you brought a good book. You could be there all afternoon.” I nodded; the same thought had occured to me. I couldn’t envisage a nosebleed sufferer being received with quite the same concern as a stroke victim. In the pyramid of care I was marginally above the hangnail sufferers, differentiated only by a proper medical term. I was perhaps halfway through the book when I eventually received the summons. By now I had been over three hours without a recurrence of the problem and I was beginning to hope that a quick once over would be all it would take.
The nurse jotted down some details and took my blood pressure. The reading clearly displeased her. “Is it high?” I asked. “Just tell your doctor ‘one hundred and fifteen’” she muttered darkly. “He’ll know exactly what that means.” Her lengthy homily on the various dangers of high blood pressure, of which nosebleeds were but a footnote, left me in no doubt that it was too high for comfort. If unchecked I could, it seemed, look forward to a future in which kidney damage and aneurisms were constant threats. I sensed the words “lifestyle change” lurking in the undergrowth. To my eternal shame, my first immediate thought was exactly how much less beer would that mean I was allowed. I decided — wisely, I think — that now was not a propitious time to introduce this line of enquiry. “Right,” said the nurse. “Back to the waiting room. We’ll call you when you’re ready to be seen.”
The book was three-quarters read when the next call came. A cheerful young doctor took me into a side room and asked me to sit up on the bed. “I’m sure we can sort you out,” he said. “Let’s take a look…I’m a bit of a whizz with nosebleeds.” My nose, which had hitherto behaved itself perfectly since arrival in A and E, decided that this was an appropriate time to reprise the whole act. “My!” said the doctor, with unfeigned admiration. “You’re quite a bleeder, aren’t you?” He handed me a cardboard kidney bowl and ran through the familiar litany of things to do and not to do when handling nosebleeds. I hadn’t the heart to tell him he was preaching to the converted, although I did offer the opinion that pinching didn’t seem to do the trick whereas letting it flow eventually seemed to work. “I’d like to take some blood,” said the doctor, swabbing my arm. Clearly, the rapidly filling kidney bowl wasn’t what he had in mind, and he extracted a sample from my vein. “We’ll send that off to the lab,” he said cheerily, “just to make sure there’s nothing wrong with your blood. Mind you,” he said, examining the puncture wound, “there’s nothing wrong with your clotting.”
At last the bleed abated and he was able to examine my nostrils. “Hmmmm,” he said at length. “I have a suspicion this is going to be quite volatile.” That was an interesting choice of word, I thought. “What I mean is, that I can’t see anything major that would account for the degree of bleeding. I can cauterise some suspicious patches but I wouldn’t be at all surprised if there isn’t a bleed point somewhere further back that I can’t see. Still, we’ll do what we can and see how we go.”
Some years ago I remember reading a short story by Gerald Durrell in his autobiographical book Fillets of Plaice (an affectionate dig at his brother Lawrence’s more profound work Spirits of Place). In this story Durrell tells of a troublesome nosebleed which requires him to have his nose cauterised and his nasal passages packed with yards upon yards of surgical gauze. If I remember correctly, the procedure then was carried out with a hot wire, which seemed a cruel and unusual form of punishment. The packing of the nose with infeasible amounts of gauze also sent some shivers down my spine as I read of it. So it was with some trepidation that I learnt I was to follow in his famous footsteps. As it turned out, however, I need not have worried; the procedure these days is carried out with a caustic chemical on the tip of a thin wooden stick. It tickles, if anything, and is extremely fast.
“There,”said the doctor. “Let’s see how that holds up. Although to be honest I’m half hoping it will bleed again.” Seeing my quizzical expression, he explained: “It might give me a better clue where the bleed is coming from. Still we can only wait and see.”
Wait we did. My wife arrived part way through the waiting and we waited together for something, anything, to happen. There is something curiously stultifying about hospital conversations. I suppose the patient is not really in the mood and the visitor is forced by polite convention to find interesting tangential opening gambits. As a voluntarily infrequent visitor to hospitals myself, I have to confess that my ability to keep up any form of useful dialogue is usually exhausted within five minutes or so. In the past I have typically found myself making a swift, if guilty, getaway to the liberation of the exit within about ten minutes of first arriving.
Minutes crawled past with no sign of a further bleed. The cheerful young doctor returned with the good news that I could go in another fifteen minutes. So that was it. I had made it through, bloodied yet unbowed. At the allotted hour we gathered our things together, and, with profuse thanks to all and sundry, I made my way back through the waiting room.
I was but seconds from freedom when, with exquisite timing, the nosebleed popped up with a surprise encore. For a second or two I pondered making a break for it, then common sense made me turn back, albeit reluctantly. I could hear the concerned clucks of the nurses who had waved me a fond farewell just moments ago. “Oh dear,” said the cheerful young doctor, handing me yet another kidney bowl. “Well…I think we’ll have to admit you.”
My heart sank. The weekend was beckoning and now I would be spending it in hospital. I had managed fifty years on this Earth without ever once being admitted to hospital, and now a paltry nosebleed had spoiled my record. “We’ll get you a bed in the short stay unit,” said the doctor, “and we should be able to get you onto a ward a bit later.”
My wife disappeared off to collect together a bag for the stay. When she reappeared, two hours later, I discovered I was the proud new owner of a pair of blue-chequered pyjama bottoms. Things, I felt, could get no worse. How wrong I was.
One by one, my companions in the short stay unit were wheeled off to their respective destinations. Reluctant to get into bed for what was only a short stay, I had elected to sit in the chair beside the bed, reading, and thankfully not bleeding too much. By seven o’clock mine was the only name left on the whiteboard, the ward to which I had been notionally attributed having yet to summon me. By half-past seven I had finished my book, and was beginning to get mightily bored, save for the occasional blood pressure test. By nine o’clock I was beginning to feel a bit unloved. “I’ll phone them again,” promised the duty nurse. A quarter of an hour later a guy appeared and had a conversation with her, sotto voce. I saw her cast a swift sympathetic glance in my direction. This was not going to be good news, I suspected.
A few seconds later she was by my side smiling brightly. “Good news!” she announced. “You’re staying with us tonight.”
I received these tidings with good grace, but inside my head the connections were already beginning to form. Friday night in my home city is rarely a quiet affair, invaded, as it is, by the loopier denizens of outlying villages, not to mention entire battalions of off-duty squaddies, all fixed upon having a jolly good time. Having a jolly good time usually involves snorting flaming sambucas and ingesting vodka through an eyeball, and that’s just for starters. The good times really roll when both sides are fuelled up sufficiently to feel that the only proper way to round off a great night out is with bare-knuckle fighting or bayonets-at-three-paces in the local kebab shop. The short stay unit might be quiet now, but the chances of it remaining so all night were frankly minimal.
Luckily my mind was taken off the subject by the return of the magnificent nosebleed. For the umpteenth time that day, I decorated a kidney bowl and much of my clothing with crimson. The nurse made a phonecall, and moments later the cheerful young doctor was back at my side. “Right,” he said, in a business-like way. “Time for some packing.”
I wonder if you have ever stopped, in your more wildly creative moments, to imagine what it might be like if, in the spirit of adventure, you were to take a lady’s extra-large tampon, shove it up your nose and apply water to it. I once had a boss whose favourite party trick was to sniff a condom up his nostril and then pull it down his throat to the horrified screams of his thrilled audience (the very same man performed this trick at my wedding party, much to the surprise of my parents, who had justifiably assumed that his boss would be someone saner and far more mature than their son). I think even he would have baulked at the tampon up the nose thing, but that was pretty much what the cheerful young doctor was now proposing to do to my left nostril. “I’ll just do it quickly,” he said, “and get it over with.” This, I rapidly came to realise over the next few days, was doctor code for “this going to hurt like the very blazes, but best we don’t tell you that or dwell on exactly how much you are going to yelp like a scalded polecat.”
The first push of a few inches was fine, in its own way; it was those extra few inches of nose which I had hitherto failed to realise existed that proved a bridge-of-the-nose too far.
“Oh crumbs!” I said. “Yikes and criminey!”
“Sorry about that,” said the doctor. “The good news is it’s much better coming out than going in.” He applied a syringe of water to the tip of the tampon which inflated, as far as I could tell, to roughly the size of a rugby ball. “There,” he remarked, examining his handiwork with grim satisfaction. “That should hold it.”
I couldn’t help but agree. It felt like a Sherman tank would have difficulty busting past the defence he had put in place. “The good news is,” he explained, “the more you bleed the tighter the packing gets, and that should stem the flow once and for all.”
He taped the dangling threads at the end of the tampon to my cheek, bade me adieu and left for the weekend.
At eleven o’clock there was a change of nursing staff. The new nurse came and introduced herself, much in the manner of a waitress at the Harvester. “My name is Cynthia and I will be your nurse tonight. I need to take your blood pressure now. Oh, and I need to put a canula in your arm. Just in case we need to do a blood transfusion.”
I received this news with a frisson of concern. “It’s just routine,” she said. “We probably won’t need to use it. Saves time later, though.”
At midnight, I decided the time was right to sleep, if sleep were possible in a brightly lit Accident and Emergency ward. I pulled the curtains around me to afford what little privacy there might be and lay there drifting in and out of sleep as the ward began to fill with new arrivals, fresh from their revels. One guy in particular, apparently visiting on holiday, had ingested far more alcohol than was strictly good for him. I have fond memories of his arrival. In his last fleeting moments of consciousness he was just about able to confirm that he knew his own name and that he was in a hospital, although he couldn’t exactly say why. Thereafter every hour, on the hour, the nurse would attempt to awaken him to take his blood pressure and pose the same question: “Brian. Brian. Brian. Wake up, Brian! BRIAN! I’m shining a light in your eyes, Brian. Tell me: do you know where you are?”
I’m not sure she ever got the answer she was looking for, but I suppose it helped to satisfy her that he was still alive. It also meant that I pretty much got zero sleep until four in the morning, which, coincidentally, was the point where my nosebleed, Houdini-like, found a new and interesting way past the tampon and began to flow copiously out of my right nostril.
I called for the nurse, who took one look at me and immediately dialled for emergency assistance. For the first time since my arrival I began to feel apprehensive as more and more blood coursed down my nose and throat. Two doctors arrived, alongside a male nurse; they swiftly assessed the situation, made me take a diazepam tablet to help me calm down, and I was offered a choice. “We can pack the right nostril too, but that might not work, or we can put in a catheter. I won’t lie…that’s more serious, and much more uncomfortable, but it should stop the bleed.”
Through coughs and splutters, I asked the question that was most on my mind. “Is this life-threatening?” Looking back on it now, I guess I didn’t have a great sense of proportion at the time, but, to her credit, the doctor didn’t let me know if she thought so. “At this moment, no,” she said. “If the bleed doesn’t stop, then that might be a different story. I would recommend the catheter.”
“Okay,” I said.
The catheter proved troublesome. Mostly that was because it relied on me not heaving and gagging as it was forced into my right nostril and on into my throat. This I singularly failed not to do the first time, showering the doctor and her companions with a spray of blood that would have made Quentin Tarantino proud had he captured it on film.
“Sorry!” I gasped.
“It’s okay. Calm down. We’ll do it again… “
It worked the second time. The catheter was installed and inflated with water, pretty much sealing off my nose. “We’re going to pack it too,” said the doctor. I watched in stunned disbelief as yet another tampon was inserted alongside the catheter. Who’d have thought there was so much room in one nostril? Not me, that’s for sure. As a nurse cleared away the aftermath of these proceedings, the doctor took my blood pressure and ordered total bed rest. “He’s not to get up or move around. He’ll need a commode. Do we have a bed in the ward?”
The nurse explained I had been kept back from the remaining bed just in case someone who really needed it came in. The doctor grinned at me and said, “Well I think he qualifies now. Let’s get him moved there.”
Thus, at five-thirty in the morning, I found myself being wheeled into the ladies’ section of a longer stay ward. Bloodied, still mostly unbowed, and with a nose chock full of interesting surgical memorabilia. Time, at last, to sleep, aided by diazepam…
…until they woke me up with breakfast at half past seven.
I cannot, in all conscience, heartily recommend eating a bowl of Rice Krispies whilst unable to breathe through the nose. I had managed to swallow perhaps six of the little blighters when I gave up the unequal struggle and opted for a few sips of orange juice instead. Frankly I didn”t feel much like eating, but sleep…oh my, how I wanted to sleep. A hospital, however, has a myriad of ways to prevent this, chief among them being the insistence upon blood pressure testing at any given moment. On this morning there was also the unusual determination of an elderly lady with dementia in the opposite bed to undo the good work of the surgeons by unravelling her bandages and extracting various tubes, which had presumably been inserted for important reasons. This lady had to be watched like a hawk at all times, which was difficult for the nurses given their other duties, so it fell to neighbouring patients to alert the staff to her misdemeanours. A dozen times that morning alone she had to be repaired, and I was lost in admiration for the tolerant good humour of the nurses in such trying circumstances.
A doctor came to see me mid-morning. “We’re going to leave the packing in for the weekend,” he said. “If you have no further bleeding we’ll remove it on Monday.”
“Thanks,” I croaked. Speaking had become a bit tough. The doctor went away and time drifted on, hazily, punctuated by occasional alarms as the lady opposite attempted yet more self-surgery.
When my wife arrived she was visibly shocked by my appearance. I suppose when she had last seen me I had looked pretty normal. Now I was part Cyberman, and she had no inkling of the dramas of the early morning. I decided that I would reassure her. “It may look bad, but they say I’ll be out of here Monday provided there’s no more bleeding.”
As reassurances went, it was pretty good up to the point a few seconds later when blood suddenly began to run down my throat. Oh-oh. This was not good. There should have been no way past the fortress in my nostrils. This was the Terminator of all nosebleeds. I grabbed a kidney bowl and proceeded to lose yet more blood. The curtains were drawn around my bed and an ice pack was applied to my face, another to my neck. After a time the bleeding ceased. The doctor reappeared. “We’re putting you on blood pressure tablets right away,” he announced. “If that stops it, we’ll take a look at you on Monday, as planned.”
The next day I was moved a few yards around the corner into the men’s ward. My blood pressure began a swift downward trend, and such bleeds as I had were infrequent and easily stemmed by the application of an ice-pack.
Monday arrived with a foot or so of snow outside and a happy absence of nosebleeding inside. At nine o’clock a nurse deflated the catheter. At three-thirty I was taken down to the ENT clinic in a wheelchair and, to my great relief, the catheter and both tampons were removed without an ensuing bloodbath (although not without discomfort: “I’ll just do it quickly, and get it over with,” said the registrar’s assistant in perfect doctor-speak). The registrar anaesthetised both nostrils and cauterised some more spots on both sides. Then, as a special treat, he allowed me to see further up my nose than I have ever really wanted to see, courtesy of his endoscope. This was not a pretty sight, but he told me I had a tight septum, which made me feel a whole lot better, even though I wasn’t entirely sure if it was a good thing.
“If there’s no more bleeding overnight,” he informed me, “you can go home tomorrow. Otherwise, the next step is we may have to operate.”
I was wheeled back up to the ward, feeling great. Unencumbered by tampons or catheters I actually enjoyed eating something that professed to be a corned beef salad. The evening came and went with no bleeding. I went to sleep full of hope and awoke at two in the morning still in fine fettle. I dozed off again, only to jolt awake in agony at four o’clock. Somehow my left foot had become entwined in the blanket and trapped in the bottom of the bed. I must have given my left knee a severe twist because it was throbbing like the devil. I sighed. Typical of me to accumulate injuries, in hospital of all places. Still, at least the nosebleed hadn’t returned…
…at four-thirty the nosebleed returned. Suddenly the outlook was bleak once more. I tried to hide what was happening from the duty nurse, hoping it would swiftly abate, but eventually it became clear I would need an icepack. Reluctantly I called for her assistance.
“What a shame,” she said. “You were doing so well!”
With a heavy heart I returned to the ENT clinic the following afternoon, fully expecting to be told that my options were exhausted and that they would now need to operate.
Imagine, therefore, my surprise when the registrar simply cauterised a couple more points and said: “Okay. I’m letting you go.”
“Go?” I queried. “As in ‘home’?”
“Yes,” he said.
I could have kissed the man, but thought better of it.
“Thank you,” I said.
“You’re welcome. Here’s a list of things you need to avoid doing. Your nose has been pretty traumatised, so use the nasal drops I’m prescribing you. You shouldn’t need to come back. Stay off work for two weeks. Make an appointment with your GP. I’ll get someone to give you a supply of your meds. Goodbye.”
I was out of there within three hours. Two years later, to the day, I remain nosebleed free.
God bless the NHS.