A 58 yo male came to the ER accompanied by a scantily clad female in high heels. He was complaining of excruciating lower back pain that began suddenly in his hotel room. The married business man (very honest guy btw) was in town for a conference and was apparently lonely. He said he picked up a prostitute, and she was on top of him during sex when "his lower back when out." He stated the pain was ripping and causing his right lower leg to feel cold and numb.

When I evaluated him, he was diaphoretic (sweating) and unable to move is right leg. His right leg was cold without distal pulses. We immediately suspected that the prostitute ripped him from the inside causing a ruptured abdominal artery. However, the CT scan illustrated a Type A aortic dissection that ripped from the chest all the way down to the common illiacs (the aortic seperates into two vessels at the bottom of your stomach). This is a deadly thing to have. Though he was still communicating, the blood supply to his spinal canal, one kidney, and heart were being compromised.

When I told him the bad news and that he would need life saving surgery, he called his wife at home to tell her that "his big vessel in his chest and belly were tearing. " Of course, he left off the major story of how it happened! The patient was admitted to the ICU and was scheduled for an aortic repair, but died of cardiac failure shortly after admission.

When I was leaving the ER, one of my fellow collegues said "Hey, did you get that lady's number? I hear she can really f**k!? I shook my head in sadness for everyone that day.