Hey, Dr Bernard here. This video has absolutely
nothing to do with anything you may have seen or heard of in the news. It’s to teach
what can happen in a poisoning like this. A Wife Poured Drain Cleaner In Her Husband’s
Coffee. This Is How His Organs Shut Down. PB is a 41 year old man, presenting to
the emergency room with hematemesis, the vomiting of blood. He tells the admitting nurse that
yesterday, when he was taking a dump, he looked into the bowl before flushing, and
instead of a regular stool, he saw a thick dark goo that looked like asphalt in the toilet.
All of this suggesting that over the last couple of days, there had been significant
hemorrhaging taking place in his stomach.
PB had a strained relationship with his wife
Katie. They had been trying for so long to have kids, but things just weren’t happening. This
was just 1 part of their relationships problems. PB and his wife met earlier in their lives. He was
highly educated, and as a young married couple, everything was good, until one day,
PB was suddenly laid off from his job. Stunned and in disbelief, he tried as hard
as he could to find more work in his field, but no one would give him a chance. He tried using his credentials to get companies
to bite on his idea of blockchain to optimize logistics, agriculture, and medicine,
through a company he incorporated himself, but no one would give him the
time of day. When that failed, he tried doing a woodworking business, he tried
making videos and podcasts, but everything he did ended with him needing a loan that he couldn’t
pay back, and Katie would have to bail him out. PB: “Babe, I just need like $5000 to pay off
the tools, and I’ll work double time to make more of these and pay you back and then
some.
I’m just in a tough spot right now” Eventually, he figured out that so long as
he made it look like he was doing something, he could live free with no repercussions, because
his wife would always be there to bail him out. PB: “By the way I was going to ask you for $5000
so I could try to buy you a better personality.” After all this time, they kept
trying to have a child with no luck, and their marriage kept getting strained.
“If he fails at everything in life, no wonder he fails at making
a kid too,” she thought. As the years passed, Katie became more
and more successful in her career. One day while she was on a call for work,
PB was recording a podcast in the back.
PB: “Welcome back to Frankie
Cambo’s super sweet podcast” Katie: I am so sorry about the noise
everyone, my husband is busy being a world famous podcaster. You see, zero,
just like all his life’s successes. Mad at the passive aggressive dig, PB
composited a picture of Katie. In his mind, no kids yet was her fault. He didnt have proof
of it, but he believed she was sabotaging it, taking pills behind his back
to prevent it from happening in an effort to preserve and progress in her
career. “God knows what she’s doing on those ‘business trips,’” he thought as he left
the picture on the table for her to see.
Upset at this horrible depiction, Katie
made up her mind. Her entire married life had been carrying failures of this one person,
who appeared completely unthankful for the fact that she allows him to live the life he does.
In nature, a creature that lives off another, and enjoys itself at the expense of the
other, is a parasite. And a pest as such must be removed to keep one healthy, as she
prepared herself for what she was about to do. PB had had stomach problems all throughout
his life. He had a diagnosis of ulcers, where sores would appear at various
parts of his stomach causing massive pain. Sometimes the hurt would
flare up for unknown reasons. He’d watch his food carefully, but he also enjoyed
things that could aggravate the ulcers. One morning, Katie was making breakfast
for PB before he went off to "work." He liked to drink black coffee, no cream or
sweeteners.
This may have made his ulcers worse but it just seemed to be random at times.
Under the sink was a bottle of drain cleaner, and as PB’s coffee was ready, she
poured some in, and served it to him. PB: Did we get new coffee? Why is it so bitter? Katie: Oh your black coffee
is bitter!? What a surprise! How about you just make your own breakfast
next time then. Have a good day sweaty.
As the day continued, PB felt something was
wrong in his mouth. He had a weird taste, and it felt like there were hairs at the back of
his throat. He felt a sore growing on his tongue, and he really wasn’t sure what was going on. The
bottom of his chest started to burn as he felt uncomfortable throughout the whole morning, as his
stomach ulcer pain started to get worse for days. Eventually, PB went to the hospital because his
stomach hurt so bad, but doctors just gave him more medicines for his ulcers. Because of his past
history, they were pretty sure that this was what was happening. He told them about the spicy and
sour foods that he’d eat, the black coffee and they encouraged him to change and avoid those. He
did stop eating some of those foods, but it wasn’t enough. Katie didn’t pour the drain cleaner in PB’s coffee
every day, but the frequency at which she’d do it, and the amount that she’d put in increased. PB: “You gotta be kidding me right? Is
this coffee or is it toilet cleaner?” One day, PB really wasn’t feeling well.
He
could feel a burning just below his chest. He had no idea what Katie was really doing to his
coffee, despite him thinking something was wrong. As he finally takes one more drink, PB felt a
burn on his tongue and mouth like never before. And he’s brought to the
emergency room where we are now. With a hoarse voice, PB tells the medical team
that he drank coffee, then felt some kind of burn was happening in his mouth and throat.
He remembers the coffee wasn’t steaming, the cup really didn’t feel that hot.
He
said it smelled “clean” like laundry, and he wasn’t sure if the coffee was stale or
rotten or really, what had happened at all. He tells them about the constant indigestion
that he’d been having over the last few weeks, and about his ulcers, but the
more he was talking about it, the more he started to question himself if
everything happening now was all in his mind. At examination, PB appeared to be ok at
the moment. He was in mild distress, but he wasn’t breathing quickly.
His blood pressure
seemed ok, his heart rate was a little elevated, but he was in distress. He had vomited
blood. Typically you don’t want to vomit, and when you do vomit, you don’t want blood,
because that’s not supposed to be in your stomach contents. His stools were black and
tarry. This also means that blood had been in his stomach contents and passed all the way
through his intestines and out of his body, the black color and tarry consistency being the
digested remnants of the red blood cells. All of this meaning that PB has had some kind of GI bleed
happening for at least a couple days now, but why? Drain cleaner is a mix of sodium
hypochlorite, which is bleach, sodium chloride, which is table salt,
and sodium hydroxide, also known as lye, or caustic soda. If the word caustic refers to
a substance that can cause a chemical burn, then we can take a guess as to where the burns in PB’s
mouth, tongue, esophagus, and stomach are coming from. But PB and the medical team don’t know that
drain cleaner was put into the coffee he drank.
The caustic chemicals in drain cleaner
are high in pH. They’re not acids, they’re bases. In some household
cleaners, the basicity is so high, that the cleaner will cause damage on contact
with human tissue. But how does that happen? Human cells are defined by a lipid bilayer.
Lipid referring to fats, which in chemistry is really long chains of carbon,
which is what oils are made of, and bi meaning two. A double layer membrane
made with fats, defining the border of a cell. The chemical reaction happening here is called
saponification. If the drain cleaner that PB drank contains high concentration of sodium hydroxide,
and body cells are lined with a layer of fats, then it means when he drank the
drain cleaner in his coffee, it wasn’t bitter because it was black coffee, but
that it was stripping the lining of his throat, and his esophagus. As it flowed down into his
stomach, it was ripping open the cells on the way down, destroying the tissue, making soap out
of the inner lining of his gastrointestinal tract.
Katie didnt put a lot of drain cleaner,
but she also didn’t mix it well. PB may have gotten what he did in clumps,
as gulps of the drain-cleaner-contaminated coffee would roll down and start lysing the cells,
eating away the tissue and causing caustic burns. And the longer the drain cleaner was in
contact with the same spot in his GI tract, the deeper the wound, because more time would
allow it to react, and penetrate in. Because it wasn’t huge amounts of drain cleaner in his
coffee all at once, the small doses PB would get, could cause damage in the form of ulcers in the GI
tract, but, PB already had had ulcers his entire life. When ulcers become deep, they too can cause
GI bleeds. All of this could explain everything happening to PB. Without knowing about the drain
cleaner, how could anyone tell the difference between the ulcers he had had his whole life,
and the ones caused by ingesting drain cleaner? As the medical team look at the
camera going down his throat, they find that his esophagus was
swollen, inflamed and filled with ulcers. Parts of it had sloughed off,
liquefied like soap and necrosed, consistent with caustic injury that can happen
with ingestion of drain cleaner.
It wouldn’t look like this if PB’s only problem were ulcers.
But it wasn’t the only thing that they found. Doctors find that PB’s lower esophagus has
started to narrow and close up, something called a stricture. When tissue necroses, it sloughs off
like how it did when PB first accidentally drank drain cleaner, a healing process starts to take
place where the injury happened. New blood vessels start to form, and a protein called collagen
started to deposit where the tissue died, forming scar tissue. It’s similar to what
happens when you get a deep cut on your skin, except, caustic ingestion injury happens to a part
of the body that isn’t as robust with protective features like the skin.
The deeper the caustic
injury, the more scar tissue that collects, causing a greater narrowing of the esophagus. All
of this suggesting that whatever’s happening to PB now, has happened to him in the past. That
time he was in the hospital earlier, it wasn’t his ulcers flaring, rather he was correct in
thinking something was wrong with his esophagus because there may have been actual caustic
injuries at that time, and he doesn’t know that. Overall, he appears to be ok in the
hospital, but as the time continues, his blood pressure starts to drop while
his heart beat starts to increase, all of this happening while he’s experiencing a
sharp pain in his abdomen. He’s starting to have a fever and blood tests find that his liver
and his kidneys are starting to shut down. Doctors order scans and find that in his abdomen,
there’s a large volume of free fluid and gas right outside of his gut. Those aren’t supposed
to be there.
So, where are they coming from? Well if it’s a gas, it could be air. When
you breathe, your lungs contain the air inhaled and exchange the oxygen and carbon
dioxide for exhalation. But air doesn’t just flood in to the abdomen in the form of free
gas, so for PB, it’s not coming from what’s he’s breathing. But the GI tract does produce
gas from gut bacteria’s metabolic activity, and stomach acid and food are also fluids.
If this is what’s in his abdomen, then it means that something in his GI tract must have
perforated, and is now leaking its contents out. As the gut bacteria starts oozing out in PB’s
abdomen, his immune system detects this. When you get a cut on your skin, the area becomes
swollen and warm. This inflammation is the immune system detecting the cut, and dilating
the blood vessels so that immune cells can get in to the injured area. But for PB, he
didn’t get a cut, his immune system is reacting to the huge bacterial load flowing out
of his gut.
His blood vessels start to dilate, causing his blood pressure to drop. This makes
it harder for oxygen to get to the organs, as they start shutting down. The kidneys
can’t filter the blood, the liver has problems processing the body’s waste, and then
the brain starts to hypoxic. Hypo meaning low, and ox referring to oxygen, as
he starts to lose consciousness. We know that PB has an extensive
history of stomach ulcers. We also know he has current injuries from
caustic ingestion. Both of these, can cause GI tract perforation, so how can
we be absolutely sure which one caused this? Doctors send PB in for surgery.
When they
look, they find a caustic burn where the perforation happened, suggesting that the
drain cleaner, not his preexisting ulcers, was the cause of his stomach contents leaking out
in to his abdomen, causing shock, and causing his organs to shut down. Surgeons close up
the perforation and drain his abdomen. As he’s sent in to the recovery room, PB seems to
be OK. As the days and weeks pass in the hospital, he’s able to eat food again,
he’s able to get up and walk, with some help. Throughout his entire
hospital stay, he saw Katie once, despite his medical care being covered through
her employer’s health insurance. And as awkward as that arrangement was, PB was able to make
A Recovery, unlike his marriage to his wife. Thanks so much for watching. Take
care of yourself. And Be Well..
