All Bleeding Stops Eventually: A Lenny Moss Mystery

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I tried to remember when I first heard the phrase. It might have been during my surgery rotation in medical school, or it might have been while learning image-guided procedures during radiology residency. Or it might have been another time entirely. The wisdom of this phrase lies not in its literal meaning, which is like most medical sayings- one part reassurance and two parts dark humor. For those who have never heard the phrase, it has two meanings. The surface meaning is this; be calm, because you will follow your training, and stop the patient’s bleeding, saving the day. The “humorous” second meaning is that the patient will run out of blood, his heart will stop beating, and the bleeding will stop that way. Obviously, that is not an acceptable outcome for us. Ideas may be deeply embedded in the interactions and reactions of your character; they may be in the music and poetry of your form. You have thoughts and you generate ideas constantly. A play ought to embody those thoughts and those thoughts can serve as a unifying energy in your play. In all your plays be sure to write at least one impossible thing. And don't let your director talk you out of it.

Live is giving over 11 hours of output to their audience - to tell us about their experiences of the NHS - good, bad and future concerns. If realism is as artificial as any genre, strive to create your own realism. If theatre is a handicraft in which you make one of a kind pieces, then you're in complete control of your fictive universe. What are its physical laws? What's gravity like? What does time do? What are the rules of cause and effect? How do your characters behave in this altered universe? Tactical Combat Casualty Care Guidelines[ http://www.health.mil/Libraries/Presentations_Course_Materials/TCCC_guidelines_090204.pdf] Which leads me to another of my favorite old medical phrases: Tincture of Time. A tincture, for those of you who are not pharmacists in the 1910’s, is a concentrated liquid herbal extract, made from soaking plants with assumed medical properties in alcohol. So, Tincture of Time is the “medicine” of just waiting for a patient to heal themselves. Sometimes, that’s the best thing to do. Or the only thing to do. If you’ve already tried all the actual medicines.Florence dedicated her life to helping those in need. She was a trailblazer who led a group of nurses to care for wounded soldiers during the Crimean War and developed revolutionary views about hygiene and sanitation. Hailed as a heroine by Queen Victoria and the British people upon her return from the front, Florence Nightingale went on to establish the Nightingale Training School for Nurses and despite chronic illness, continued in her efforts to reform healthcare at home and abroad from her London salon.

This thought only appeared for the briefest instant and I was able to keep my steely resolve, to focus on the task at hand, mostly thanks to my years of experience, but also in part due to that old mantra. The final criticism, which often comes from professionals, is that we can’t expect “lay people” or “civilians” to do these things, let alone do them correctly. They, rightly, point out that out of people who learn CPR, only a percentage of them will actually perform CPR if the time comes, and only a small percentage of that group will do it correctly. This is true, but it is all the more reason to give better training to more people to increase the numbers of people who know these skills, choose to do them when needed, and do them correctly. A play must be organized. This is another word for structure. You organize a meal, your closet, your time -- why not your play? Even professionals fumble and make mistakes, or freeze entirely, especially the first time they do something in the field. This is why medical training consists of repeated simulation practice and then graduated, supervised, practice in real life. Further, it’s worth noting a lot of physicians and medical professionals are spectacularly bad at skills they rarely or never use in their practice. A dermatologist, despite his MD, is not going to necessarily be any better at using a tourniquet than a janitor who went through a stop the bleed seminar. A veteran nurse who works in a pediatrician’s office is not necessarily going to be any better at CPR than one of the college students I trained this fall. If professionals like me go into this exercise thinking “regular people will never do this”, then regular people certainly will not. If we breed helplessness, and tell people there’s nothing they can do, just wait for help, then helplessness is what we’ll get. However,if we go into this thinking “this is a skill regular people can master and will use in an emergency, and save lives” then there is a chance they will, and that, is a chance I am willing to take.

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But to teach someone a skill is not to terrorize them. Teaching someone a skill, showing them how to fix something, is empowering. Every child (and certainly every adult) should know how to use a tourniquet and do CPR from the point they’re physically strong enough to do those skills. It’s not ‘normalizing’ violence or injury, it is empowering people to be masters of their own fate. Yet, I couldn’t exit the room. The blood was now up to my knees and the liquid applied pressure to the door preventing me from opening it. At least that’s what I suspected; physics had never been my strong point. There was a high probability of other forces at work against me for the door could not be removed from its hinges either, even with the assistance of a scalpel handle.

Push emotional extremes. Don't be a puritan. Be sexy. Be violent. Be irrational. Be sloppy. Be frightening. Be loud. Be stupid. Be colorful. Comedian and broadcaster Dr Phil Hammond's How I Ruined Medicine draws on his own experiences to ask if his investigations into medical malpractice have done more harm than good for healthcare overall. If you took the average body temperatures of the folks that end up in this hot tub, you’d get a reference point of about 98.6 degrees Fahrenheit (37 degrees Celsius). Give or take. It’s a stoic viewpoint that allows you to take a deep breath when the blood keeps coming and time is running out. Whatever happens, you must remember: “all bleeding stops eventually”. Fly-on-the-wall documentary inside a GP practice in Gateshead as it faces increasingly heavy demand. Radio 5 LiveCharacter is the embodiment of obsession. A character must be stupendously hungry. There is no rest for those characters until they've satisfied their needs. Of course, the bleeding did eventually stop. I would like to take credit with my clever use of pressure, ice, epinephrine, etc. But, I think the credit goes to the ago-old aphorism; “All Bleeding Eventually Stops.” Well, that and the patient’s natural clotting process. Rossaint R, Bouillon B, Cerny V, Coats TJ, Duranteau J, Fernández-Mondéjar E, Stahel PF, Hunt BJ, Komadina R, Nardi G, Neugebauer E, Ozier Y, Riddez L, Schultz A, Vincent JL, Spahn DR, Task Force for Advanced Bleeding Care in Trauma: Management of bleeding following major trauma: an updated European guideline. Crit Care 2010, 14: R52. 10.1186/cc8943