Welcome to Gray Matters, the podcast where we unpack how medical management is

rarely black or white. I'm Jason Freed and I'm a hematologist of Beth Israel

Deaconess Medical Center. And I'm Allie Trainer and I'm a pulmonary

and critical care fellow at the Harvard Combined

program at MGH and Beth Israel Deaconess.

So Jason, I had this case during my residency that I still think about because we made what

seemed like an appropriate decision, but it had a really unexpected outcome.

Ooh, what happened?

It started like any other Monday morning in the ICU, long rounds, dehydration.

Oof, that's why I didn't go into critical care.

You know, every field has its pros and cons, but yeah, so I met her when she was in the

ICU, but she was one of those patients that we see all the time who's chronically ill and comes into the hospital for one thing but then ends up having multiple other issues while she's in the hospital.

I know what you mean.

So this patient was a woman in her 50s, had cirrhosis from ongoing alcohol use, and initially came in actually because of a 20 pound unintentional weight loss.

So she was on the general medicine service, and while they were working her up for her weight loss she was found to have

portal hypertension with a citis, a plural effusion, and an AKI. And so she was getting treatment and

work up for all of these when she developed this massive verisial bleed.

So they tried to do an EGD and banding,

but there was just too much bleeding

and they were unsuccessful.

So she was intubated for airway protection

and went to IR for an emergent tips.

...