"Do you know there's a guy in the lobby who's bleeding?"

Oops. That would be my patient. That was the pharmacist talking, and I walk over to the door and sheepishly let in the patient.

"¿Está sangrando?," I ask him.

He's a dark-skinned Cuban about 50 years old, and he was in earlier complaining of a "larva" crawling under his skin. He had a wee bump on his back, up near his scapula, with some fluid inside. He said it itched pretty bad and that he felt something moving underneath.

I told him it was probably nothing, certainly not a worm, but that we could sample the fluid inside and send it off for culture if he really wanted. He said sure. I did also say (I swear), that we could do nothing and just wait and see what happened. Or we could put some kind of cream or ointment on it, and see how that turned out. Nope, he really thought there was something IN there, and he just had to know what. O-kay...

So I prepped him, cut a teeny tiny incision (I swear), and swabbed it for culture. I patched him up with some antibiotic ointment, some gauze and tape, and told him to check back in a week for los resultados, the results.

Out in the waiting room, he noticed blood on his shirt and decided to say something, apparently because he didn't want to be accused later on of being stabbed by someone, I guess.

I took a look under the bandage and sure enough there was a trickle of blood. Damn. The patient assured me it was nothing, and that I didn't need to do anything. The guard just over-reacted, he told me. But I'm pretty sure you're not supposed to let your patients slowly bleed to death.

It was at this point that I regretted ever cutting into him, and I really regretted not using lidocaine with epinephrine when I initially numbed him up. Stupid. Dumb. That would have vasoconstricted the blood vessels and probably would have prevented this whole mess.

I tried direct pressure, like the scouts taught us. Still bleeding. I tried steri-strips to close the wound edges. Still bleeding. The preceptor (who is not our usual preceptor and is really more of an administrator) said "let's cauterize it." I gulped nervously and he proceeded to burn this guy's flesh, OH MY FREAKIN" GOD, without numbing him up first. The patient didn't appreciate that, and I started thinking about alternative careers. I could shock chickens to death, my mind flashed.

The patient was the best sport ever, and waited patiently while I injected lidocaine with epinephrine this time, and finally the trickle slowed to whatever is slower than a trickle. I did also hit him with the cautery wand a couple of times just to be sure, then steri-stripped him and built a big pressure bandage over the wound. I taped him up as we chatted in Spanish about Cuba. He was working on a fishing boat, and jumped ship to Mexico one year, gaining his freedom.

I nervously sent the poor guy out the door, wondering how long it would take before I received a phone call letting me know what a complete dumb-ass I really am. But my patient? He was happy as a clam, because he finally found out there was no worm living under his skin.

God Bless America?