The patient’s rate of blood loss reduces within minutes. As the RBCs enter, he looks better. You even see him waving as he goes to endoscopy. They find a bleeding vessel and use thermal coagulation with adrenaline.

Job well done by the endoscopy team, but it wouldn’t have got that far without you.

Six hours later, you are called to see him as he is bleeding again. You listen from round the corner.

“It’s a re-bleeder. We need to take him back.”

“Could it be something else? There was this time someone forgot to add in vitamin K to reverse warfarin when giving prothrombin complex, and this meant that as the prothrombin complex factors (especially VII) got used up, the body hadn’t begun make its own factor VII because it is still warfarinsed, and the patient looks like a rebleeder but they aren’t, and I wonder if we should check…”

“No time for that, who would forget to give vitamin K? Let’s take him to scope!”