A 60-year-old man was brought in by ambulance; they walked him in. He complained of "not feeling well" with some dizziness and nausea that had been going on for a few weeks. There were some suspicious stains on the front of his shirt.
When asked about his medical history, he said, "I've never been sick a day in my life, and I've never been to a doctor." He told me he didn't smoke, and "had a few drinks" every day.
You can see where this is going, right?
As I was finishing up his triage, he said he felt like he was going to vomit. I gave him a basin, and URP! Up came almost a liter of blood and blood clots. I called for some help and immediately started placing a large-bore IV.
I asked him if he had ever vomited blood like this before, and he said yes, all the time. When I asked him if this worried him, he said no--"because I always feel better after I vomit!" and then he asked to go home.
Yeah, that's not going to happen. (btw, his hemoglobin was 5.2. Oh, and those "few drinks"? A liter of vodka every day after work.)