Trauma call at a busy trauma center

[TexasTriathlete]

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I don't really have a great feel for how this works, but I was wondering...

Have any of you, students/residents/attendings, ever lost a patient on the table, and then had to get right back to work on another patient? Just curious how you handle a situation like this.

By the time you get that far, have you already come to grips with the fact that you're going to lose some, and you can stay pretty composed when it happens?

 

[Blade28]

Are you asking about a trauma patient that dies on the OR table? Or during a "normal" non-trauma case?

I've had both happen - I've been involved in three ER thoracotomies, and of course these guys didn't make it off the OR table. But each time, we basically had to just clean the room and get ready for the next trauma ex-lap. There have also been some bad traumas that died on the OR table - usually from massive blood loss and the "deadly triad" of coagulopathy, acidosis, and hypothermia.

I've only been involved in a couple non-trauma cases where a patient has died - both times, it was the last case of the day (given the long duration) and the rest of the day was spent discussing the case. (Read: Anesthesia and Surgery yelling at each other.)

 

[Drogba]

Are you asking about a trauma patient that dies on the OR table? Or during a "normal" non-trauma case?

I've had both happen - I've been involved in three ER thoracotomies, and of course these guys didn't make it off the OR table. But each time, we basically had to just clean the room and get ready for the next trauma ex-lap. There have also been some bad traumas that died on the OR table - usually from massive blood loss and the "deadly triad" of coagulopathy, acidosis, and hypothermia.

I've only been involved in a couple non-trauma cases where a patient has died - both times, it was the last case of the day (given the long duration) and the rest of the day was spent discussing the case. (Read: Anesthesia and Surgery yelling at each other.)

A surgeon I'm shadowing actually performed a total of one successful thoracotomy while he was a GS resident. A classmate stabbed his patient in the heart with a pencil.

 

[Blade28]

A surgeon I'm shadowing actually performed a total of one successful thoracotomy while he was a GS resident. A classmate stabbed his patient in the heart with a pencil.

A normal thoracotomy? Or ER thoracotomy?

 

[Drogba]

I think it was done in the bay, so that would constitute ER right? I'm not sure though. Are many thoracotomies taken up to the OR? I thought they were relatively last ditch procedures that needed to be done quickly.

EDIT: Well I guess this might not be true depending on the indication, but I'm way outta my league here.

 

[TexasTriathlete]

They would rather not crack the chest in the ER unless they have no choice.

 

[Castro Viejo]

I think it was done in the bay, so that would constitute ER right? I'm not sure though. Are many thoracotomies taken up to the OR? I thought they were relatively last ditch procedures that needed to be done quickly.

EDIT: Well I guess this might not be true depending on the indication, but I'm way outta my league here.

Thoracotomies that need to be done are done wherever, and that's usually in the Trauma Bay in the ED. Eventually, though, they're all supposed to end up in the OR for a definitive repair of whateve was bad. Just like in the movies... Only more of them end up dying in the ED before the OR.

 

[Castro Viejo]

I don't really have a great feel for how this works, but I was wondering...

Have any of you, students/residents/attendings, ever lost a patient on the table, and then had to get right back to work on another patient? Just curious how you handle a situation like this.

By the time you get that far, have you already come to grips with the fact that you're going to lose some, and you can stay pretty composed when it happens?

I think over a couple of years of dealing with this kind of stuff, you grow a little numb when a patient expires. You sort of need it as a defense mechanism, otherwise, if we all got so broken up over a patient dying and needed time off because of it, who would fill in for us? It's the same kind of numbness that allows you to get things done. It's needed.

I can only think of a handful of times where a patient crapping out and expiring really scared the bejesus out of me, but these were often unexpected things. Like a young girl who returned to the ED complaining of back pain that was persistent and a surgical consult was called this second time: "Persistent back pain." Not truly a General Surgery issue, but I made my way down there after seeing some more urgent-sounding patients. As I was talking to her she went out. We ended up coding her. Someone thought her belly was distended. We got an abdominal ultrasound that showed fluid everywhere in the belly. She was taken up to the OR emergently, got a laparotomy, and was found to have a ruptured visceral artery aneurysm. She ended up dying on the table despite being in the "safest place in the world."

Young people really shouldn't die -- that's the rule, but a visceral artery aneurysm rupturing over a couple of days really makes that hard to be always true.

 

[TexasTriathlete]

What causes something like that?

 

[BlackSails]

What causes something like that?

Almost all bad things in young people are the result of bad luck.

 

[Blade28]

Or genetics. Or peer pressure. Or, in the case of trauma, sometimes it's due to poor decisions.

 

[SoCuteMD]

I don't really have a great feel for how this works, but I was wondering...

Have any of you, students/residents/attendings, ever lost a patient on the table, and then had to get right back to work on another patient? Just curious how you handle a situation like this.

By the time you get that far, have you already come to grips with the fact that you're going to lose some, and you can stay pretty composed when it happens?

I don't have as much experience with this as many people in this forum but I do have some.

Trauma deaths: have not witnessed any. My chief has completed a CC fellowship, however, and he said that he has a much easier time with trauma deaths than with others. Usually they come in obtunded and stay that way. You never get to know or care for them the way you do other patients.

Table deaths: witnessed one a few weeks ago. Long-shot surgery for a guy with terribly quality of life who was fully appraised of the risks. Regardless of all that, it still felt like crap when he was pronounced. There was no yelling, no fingerpointing, just a general feeling of "this sucks" amongst all present in the OR - the anesthesia people, the surgeons, and the nurses.

The hospital I'm at for my surgery rotation isn't a big trauma center, but it is in the middle of a rough town, so we get our fair share. I've heard stories of the attending being in the middle of an urgent appy and getting a page for a Level I trauma (which means the attending has to show up within a certain number of minutes of arrival). Usually this doesn't happen, as the ED is supposed to go on divert when the trauma surgeon on call is scrubbed. However, only two EDs in the area are qualified to handle trauma so they occasionally have to negotiate who gets to go on divert.

 

[Drogba]

Thoracotomies that need to be done are done wherever, and that's usually in the Trauma Bay in the ED. Eventually, though, they're all supposed to end up in the OR for a definitive repair of whateve was bad. Just like in the movies... Only more of them end up dying in the ED before the OR.

That was my impression.

 

[TexasTriathlete]

I don't even mean so much the effect of the death itself on the surgical team.

An analogy: you're in a high school basketball tournament, and its double-elimination. You drop a close game, and this puts you in the loser's bracket. This means you have to turn around and play again in 30 minutes, despite the fact that everyone is a little disappointed and tired.

Does that make sense?

 

[Blade28]

An analogy: you're in a high school basketball tournament, and its double-elimination. You drop a close game, and this puts you in the loser's bracket. This means you have to turn around and play again in 30 minutes, despite the fact that everyone is a little disappointed and tired.

Does that make sense?

Makes sense.

I don't know how to explain it - I guess you just have to pick up and carry on. The other patient deserves no less, right?

It's like in the SICU rotations here when we'd frequently stop in the middle of rounds to code a dying patient. Right afterwards, no matter what the outcome, the team would continue to round to see the rest of the patients.

Except for the one person who has to stay behind and fill out the death packet, and dictate.

 

[lord_jeebus]

Or genetics. Or peer pressure. Or, in the case of trauma, sometimes it's due to poor decisions.

In the case of trauma, it's often these two dudes. Don't blame a patient who's simply standing on the corner; they're just minding their own business.

I hope we catch them someday

 

[Blade28]

In the case of trauma, it's often these two dudes. Don't blame a patient who's simply standing on the corner; they're just minding their own business.

I hope we catch them someday

Ah yes, the most dangerous thing to be doing is "minding your own business."

And you're right, it's always "two dudes."

And how much was the patient drinking? Just "a couple of beers."

 

[smq123]

I don't really have a great feel for how this works, but I was wondering...

Have any of you, students/residents/attendings, ever lost a patient on the table, and then had to get right back to work on another patient? Just curious how you handle a situation like this.

By the time you get that far, have you already come to grips with the fact that you're going to lose some, and you can stay pretty composed when it happens?

You focus on one patient at a time. The patient in front of you is the only patient that you have at the time, and deserves your full attention.

Most patients don't care about what happened to you 10 minutes ago, which can be frustrating, but fundamentally, they're right. They don't deserve anything less just because something tragic happened 10 minutes ago. As hard-hearted as it sounds, that's the way it is.

Plus, speaking as a med student, trying to remember that patients deserve your total concentration and best efforts can help in a lot of situations. Especially after your 2nd Whipple of the day (not uncommon at my hospital!), and you're the one doing the sub-q skin closure - even though you've spent most of the past 7 hours staring at the glare off of the resident's head light, and can't see anything without squinting. (And you haven't been to the bathroom in the past 7 hours either!)

EDIT: It's not just trauma or surgery where this happens. This happens in the ICU a lot, where you can have two patients have a major crisis within 5 minutes of each other. It also happened on my OB rotation. One patient was just lying in bed in one of the delivery rooms, felt the baby move restlessly, then...nothing. The baby just stopped moving. 2 residents and a bunch of nurses came rushing in, tried frantically to find a fetal heartbeat, but were unsuccessful. Right after that, though, one of the patients had a placental abruption (where the placenta prematurely pulls away from the uterus), and everyone in the room had to rush out and go to the OR for a stat c-section - as if nothing had happened to the first patient. You just keep moving.

 

[Winged Scapula]

For those of us who wear our hearts on our sleeves, it is my personal experience that it gets easier with time.

Just as others above have said, the next patient deserves no less than all your concentration, training, intelligence and empathy. And while yes, it might be hard after telling a teenager she has cancer or witnessing an unexpected death, to walk into another room and listen to a patient with a minor disease process overestimate their problem by about 300%, they do not care what came before nor what will come after them. And they shouldn't have to.

So sometimes you squeeze a few tears out or heave a heavy sigh and walk to the next patient's room.

 

[DoctorMunchkin]

For me. It really depends on the situation.

For the trauma patient, if they come in dead and stay dead, it doesn't really bother me that much. I don't particularly enjoy telling the family, but there wasn't anything I could do to change the outcome.

For the trauma patient that looked like they had a chance, if you take them to the OR, do the emergent ex lap and find a large laceration that has basically bisected the liver and gone through the bifurcation of the portal vein, again, not really a lot I can do. The patient didn't look great initially, but there was some hope. However, once you realize what is truly going on, your options run out very quickly, and I can come to terms with that OK.

I have had a week or so where, every night I had some sort of trauma death. That started to bother me. I don't think there was anything I mismanaged or could have done differently, but, a run like that really gets you down. The coronors office started to get to know me and I am fairly certain they will be sending me a Christmas card this year, because we have become so close!

The ones that really bother me, are the completely unexpected deaths. Like the old lady, a few weeks post-op from a right hemicolectomy. Undergoing work-up for a possible stress ulcer, who aspirates one morning and dies. That one took me about an hour to tuck away. This is not to say that after that hour, I was fine. I still think about it, and am still evaluating where I could have taken a different course that may have changed the outcome. That's part of how we imrpove in surgery. But from an emotional standpoint, this makes me feel a little sick.

As everyone else has said, all of your patients deserve your total concentration. Learn to tuck things into the back of your mind, concentrate on the immediate and revisit things at a later time, when you have time to process things and evaluate where you could have done things differently.

 

[RajMahal]

Ah yes, the most dangerous thing to be doing is "minding your own business."

And you're right, it's always "two dudes."

And how much was the patient drinking? Just "a couple of beers."

I had one guy who was, "walking home from church, minding his own business, when these two dudes jumped him"

the Chief said, "You were walking home from church at 2 a.m. on a Tuesday night?" to which he replied without missing a beat, "It's a great religion, doc."

I couldn't help but laugh out loud.

 

[Blade28]

I had one guy who was, "walking home from church, minding his own business, when these two dudes jumped him"

the Chief said, "You were walking home from church at 2 a.m. on a Tuesday night?" to which he replied without missing a beat, "It's a great religion, doc."

I couldn't help but laugh out loud.

Yeah, forgot to add that the whole "minding their own business" activity ALWAYS takes place at 2 am!

Like whenever you read about a traffic fatality in the news...if they mention a bad one-car wreck, or head-on collision, or a bunch of teenagers, you can almost certainly bet the accident happened at around 2 or 3 am.

 

[gasnewby]

For the trauma patient that looked like they had a chance, if you take them to the OR, do the emergent ex lap and find a large laceration that has basically bisected the liver and gone through the bifurcation of the portal vein, again, not really a lot I can do.

why, just pop in an atriocaval bypass, my lad!

 

[DrDawg]

I saw a quasi interesting study in one of those throw away journals, or maybe it was JAMA. Anyway they showed a bunch of docs painful images, and a bunch of nonmedical types the same imagines. Apparently our brains no longer respond the same way. The author said he stopped short of showing actual surgery/trauma because he didn't want to make the lay people sick.

Im my opinion, its not the loss of the patient that hurts the most. Its breaking the news to the family. But Im still relatively new at that

 

[Winged Scapula]

I saw a quasi interesting study in one of those throw away journals, or maybe it was JAMA. Anyway they showed a bunch of docs painful images, and a bunch of nonmedical types the same imagines. Apparently our brains no longer respond the same way. The author said he stopped short of showing actual surgery/trauma because he didn't want to make the lay people sick.

I believe it. I hadn't realized how desensitized I was because when showing a patient my "breast cancer diagnosis" Power Point presentation, she practically fell out of her chair at the one surgical picture, which was a close-up of a blue sentinel node. Not bloody at all, no body reference points, etc. I certainly wouldn't have thought it was upsetting, but I guess I'll have to stick in one of those AMPAS warnings, "content may not be suitable for all viewers" in the slide before!🙁

Im my opinion, its not the loss of the patient that hurts the most. Its breaking the news to the family. But Im still relatively new at that

That's really hard, especially when its a child or an unexpected (ie, trauma death). I am still haunted by one when I was a Chief resident which involved several teenagers, 3 from the same family. It was almost harder because the parents were trying to be stoic for their remaining children.🙁

 

[sleeping]

why, just pop in an atriocaval bypass, my lad!

I thought those had really gone out of favor?

 

[gasnewby]

yeah, i was just kidding...i think it gets talked about way more than it's ever performed. retrohepatic ivc is a pretty lethal injury. pringle ain't gonna help you.

 

[Winged Scapula]

yeah, i was just kidding...i think it gets talked about way more than it's ever performed. retrohepatic ivc is a pretty lethal injury. pringle ain't gonna help you.

And in that vein, its a board question.🙄

 

[San_Juan_Sun]

Or, in the case of trauma, sometimes it's due to poor decisions.

Or chemicals.

 

[Drogba]

I saw a quasi interesting study in one of those throw away journals, or maybe it was JAMA. Anyway they showed a bunch of docs painful images, and a bunch of nonmedical types the same imagines. Apparently our brains no longer respond the same way. The author said he stopped short of showing actual surgery/trauma because he didn't want to make the lay people sick.

Im my opinion, its not the loss of the patient that hurts the most. Its breaking the news to the family. But Im still relatively new at that

I wonder how much of it is desensitization and how much is self-selection. I'm certain both play are a role to a large degree and vary from person to person. I bet a lot of people start with a pretty high baseline for gore tolerance.

Speaking from personal experience I've not come anywhere close to becoming sick even though my first exposure to a medical gruesome procedure was a thoracotomy (which is pretty dramatic in my opinion). I've been exposed to a fair amount of large, smelly gaping wounds and have never had a problem.

Maybe somewhere down the line there will be something that really gets to me. I've always wondered how I would react to a severe crush injury, large amputation, extensive full thickness burns etc. I'm assuming less well than I have in the past. I think that many people shy away from medicine or never consider it because they find the work to be physically repulsive so whoever's left is at least comfortable with the gore in theory.

 

[SoFlaKnight]

I just wanted to say, I've really enjoyed reading this thread...Thanks to the seasoned vets for the anecdotes and the input, they are much appreciated👍

 

[Blade28]

Speaking from personal experience I've not come anywhere close to becoming sick even though my first exposure to a medical gruesome procedure was a thoracotomy (which is pretty dramatic in my opinion). I've been exposed to a fair amount of large, smelly gaping wounds and have never had a problem.

An ER thoracotomy, or one electively performed in the OR?

Usually there seems to be two categories of operations that make people faint:

(1) Disgusting, smelly ones - lots of pus, necrotizing fasciitis, gangrene, diabetic wounds, stool, etc.

(2) "Emotional" ones - kids with mangled limbs, crunching of bone-on-bone, etc.

And coupled with the warmth of the OR, stifling gowns, lack of a good breakfast, dehydration, etc. and that'll make your vagus work overtime!

 

[Castro Viejo]

An ER thoracotomy, or one electively performed in the OR?

Usually there seems to be two categories of operations that make people faint:

(1) Disgusting, smelly ones - lots of pus, necrotizing fasciitis, gangrene, diabetic wounds, stool, etc.

(2) "Emotional" ones - kids with mangled limbs, crunching of bone-on-bone, etc.

And coupled with the warmth of the OR, stifling gowns, lack of a good breakfast, dehydration, etc. and that'll make your vagus work overtime!

Vomit. I HATE vomit. It makes ME wanna vomit when I see it, smell it, or see someone barf.

And oily hair.

 

[Blade28]

Vomit. I HATE vomit. It makes ME wanna vomit when I see it, smell it, or see someone barf.

And oily hair.

I'm not squeamish, so I'm OK with everything EXCEPT bad Fournier's. Anything else? Poop? Vomit? Diabetic foot ulcers? Nec fasc (elsewhere)? Pus? Bring it on!

But Fournier's? 😱

 

[Drogba]

An ER thoracotomy, or one electively performed in the OR?

Usually there seems to be two categories of operations that make people faint:

(1) Disgusting, smelly ones - lots of pus, necrotizing fasciitis, gangrene, diabetic wounds, stool, etc.

(2) "Emotional" ones - kids with mangled limbs, crunching of bone-on-bone, etc.

And coupled with the warmth of the OR, stifling gowns, lack of a good breakfast, dehydration, etc. and that'll make your vagus work overtime!

ER thoracotomy on someone 2 years my junior who subsequently died. A nurse or tech proceeded to show me how to locate the aorta pointing and telling me to feel for the structure that "felt like thick linguini."

I've seen/helped care for a lot of number 1 (minus the stool) none of this has bothered me in the least. I've not seen any ridiculous NF where someone has lost half their face though. Number two is what has the potential to get me I think.

It's hard to say, I just know nothing I've seen up until now has come close to causing the slightest physical reaction in me. In fact I was finishing my 3rd $1 menu cheeseburger as I was walking into the trauma bay for the above mentioned thoracotomy. I've also noticed few people are interested in hearing about my experiences, especially when I start recounting them over food.

EDIT: I really wan't to shadow a surgeon on trauma call. I wonder how likely, or possible, it would be for a GS to let me take call with them... What do you think?

 

[DoctorMunchkin]

Vomit. I HATE vomit. It makes ME wanna vomit when I see it, smell it, or see someone barf.

And oily hair.

Vomit, no problem.
Poop, no problem. (as long as its fresh).
Blood, just hold pressure. All bleeding stops eventually.
Greasy hair -- used to date a guy like that. (Poor judgement on my part. A very long story for another day)

There are two things that get me.
#1 - the old homeless man that comes in with OLD poop all over him - you know like stuck in his pants, and in his hair, and coated all over his nasty, saggy, wrinkly old scrotum. Mixed with the aroma of old urine. Mmm good. Sorry, no rectal exam without full body gear!

#2 - head lice - just gives me the heebie-jeebies and makes me want to scratch.

The gore doesn't bother me. I think of gore as horror movies and HATE those. Can't, won't, don't watch them. (Maybe its the dark room and the scary music.)

Trauma is just trauma. Its just like Christmas (or a box of chocolates), you never know what your gonna get.

 

[BlackSails]

Blood doesnt bother me but poop...? ugh.

 

[Winged Scapula]

I'm with Castro...vomit does me in. I try and psych myself up but hearing someone retch and especially smelling it, I cannot help but start to retch myself.

Blood ok.
Poop ok.
Mucus, eh..ok.
NF, Fournier's..ick, but no visceral response.
Diabetic feet with maggots? Interesting enough not to be icky.
First time you get out the amputation knife and saw off a leg? Yeah that's sort of icky. Mostly when you are holding the leg for the circulator.
Feet facing backwards in the trauma bay?😱 THAT was weird.

The WORST of all?


MY BLOOD. I'll get vasovagal almost anytime there is a large amount of it (ie, when being drawn).

 

[Castro Viejo]

Actually, come to think of it, in additioin to vomit and oily hair, delivery of a child makes me nuts.

Especially when the chick craps all over herself pushing that demon out -- that's the worst (so I thought)! That is, UNTIL THE PLACENTA IS DELIVERED!

 

[Winged Scapula]

Actually, come to think of it, in additioin to vomit and oily hair, delivery of a child makes me nuts.

Especially when the chick craps all over herself pushing that demon out -- that's the worst (so I thought)! That is, UNTIL THE PLACENTA IS DELIVERED!

But the miracle of childbirth is beautiful!

How about watching your dog have puppies and seeing her eat the placenta? That's gross. My mother tells me one of our dogs tried to eat one of her pups; thank God I have blocked that from memory.

 

[Castro Viejo]

But the miracle of childbirth is beautiful!

How about watching your dog have puppies and seeing her eat the placenta? That's gross. My mother tells me one of our dogs tried to eat one of her pups; thank God I have blocked that from memory.

Your dog must've been Chinese. 😆

 

[Winged Scapula]

Your dog must've been Chinese. 😆

Them Chinese love those coagulated blood balls so placenta must be just as tasty.

 

[smq123]

Actually, come to think of it, in additioin to vomit and oily hair, delivery of a child makes me nuts.

Especially when the chick craps all over herself pushing that demon out -- that's the worst (so I thought)! That is, UNTIL THE PLACENTA IS DELIVERED!

Really? I thought that delivering the placenta was the best part! (Being absolutely serious here.) 😳

It's kind of disgustingly satisfying to deliver this huge bag of tissue...particularly the slight "plop" as it lands in the bucket. It's sort of like popping a big pimple...disgusting, but satisfying.

I know that you don't often see this in a trauma bay, but c. diff poop is the worst. Poop by itself isn't pleasant, but c. diff poop is awful.

On my ENT rotation, they did a trach on this woman who was in the IMRICU. After they had finished and pulled down the sterile drapes, they found that a) she had had a BM, and b) she was enteric. Fabulous.

 

[Castro Viejo]

Them Chinese love those coagulated blood balls so placenta must be just as tasty.

I was really referring to the fact that your dog wanted to eat a dog. But the placenta thing works out too!

 

[Castro Viejo]

Really? I thought that delivering the placenta was the best part! (Being absolutely serious here.) 😳

It's kind of disgustingly satisfying to deliver this huge bag of tissue...particularly the slight "plop" as it lands in the bucket. It's sort of like popping a big pimple...disgusting, but satisfying.

I agree. Popping a zit is great fun.

Watching a chick basically having this ginormous menstrual period in front of you is just frickin' disgusting. Quick, break out the pads WITH the wings!

Do you like "running the red light?" Most people I know find it repulsive, and I believe this is partly the reason why. Even my dancing banana has to say, "That's nasty, yo."

 

[Winged Scapula]

I was really referring to the fact that your dog wanted to eat a dog. But the placenta thing works out too!

I thought Vietnamese ate dogs, not Chinese! 😉

Never mind, all you guys eat weird stuff. I got a bird's head in my dinner at an HK wedding.

 

[Castro Viejo]

I thought Vietnamese ate dogs, not Chinese! 😉

Never mind, all you guys eat weird stuff. I got a bird's head in my dinner at an HK wedding.

This is beginning to remind me of that episode of "King of the Hill" where an Asian guy moves into the neighborhood and he gets blamed when one of the neighbor's dogs goes missing.

Americans and their silly xenophobia.

 

[Castro Viejo]

Really? I thought that delivering the placenta was the best part! (Being absolutely serious here.) 😳

It's kind of disgustingly satisfying to deliver this huge bag of tissue...particularly the slight "plop" as it lands in the bucket. It's sort of like popping a big pimple...disgusting, but satisfying.

Oh, and don't tell me that menstrual period blood is "just blood, so what's the big deal?" It's not JUST blood. It's period blood. Period blood is especially nasty and the world generally agrees.

Remember that scene in the movie "Superbad?" Where the fat kid is dancing with some chick in a mini-skirt who grinds his leg and leaves period blood on his pants? There's a natural repulsiveness men have to period blood.

And then that smell that comes along with it...

Sorry... Feeling the urge again.

 

[Blade28]

I was really referring to the fact that your dog wanted to eat a dog. But the placenta thing works out too!

I thought Vietnamese ate dogs, not Chinese! 😉

You two are silly. Everyone knows that's the Koreans that eat dogs! 🙂

CV, you should know this!

 

[Blade28]

Oh, and don't tell me that menstrual period blood is "just blood, so what's the big deal?" It's not JUST blood. It's period blood. Period blood is especially nasty and the world generally agrees.

Remember that scene in the movie "Superbad?" Where the fat kid is dancing with some chick in a mini-skirt who grinds his leg and leaves period blood on his pants? There's a natural repulsiveness men have to period blood.

Menstrual blood is especially bad because of what's in it (sloughed membranes, etc.).

You guys are so squeamish! 🙂