Monday, December 14, 2009

What Do I Know?

One of the hardest parts of being a physician is that people expect you to know everything about everything. And I have to be brutally honest here. That ain't me. But, thanks to a great residency and medical school, I do know my medicine.

Heck, though, I'll be the first to admit that I've never known much about plumbing. Or electrical work. Or car engines. Or how to cut an onion without crying. Or rectal foreign bodies.

Whoa, back up! What did I just say?

Yes, you heard me right. Rectal foreign bodies. As in having something in your behind that shouldn't be there. If you need to squat over a mirror to look, then chances are something is wrong back there. Seriously wrong.

So, imagine my surprise when, in my first year of residency, I discovered that our hospital's ER, being centrally located among several prisons, got it's fair share of rectal foreign bodies.

"Wait a second, people," I wanted to scream out, "I didn't sign up for this part of the job!" As long as I was making a list, I didn't sign up to do internal pelvic exams on eighty year-old ladies with blue hair, either. Unfortunately, though, in the ER you simply don't have a choice. Besides, I was a first-year resident. That's about as low as you go on the medical totem pole. Who would have listened to my concerns?

I remember well my first "something's stuck back there" patient. One of my favorite teaching physicians, Dr. Z., held a chart out for me. "Hey, K.," he said, "there's a patient in Room 12 I'd like you to see." Looking back now, I should have known his snicker was not all that innocent.

I walked into the room to find a regular Joe sitting on his cot, his feet and legs dangling off the side, looking a little uncomfortable.

Hmmm, not a prisoner. So far, so good.

"Hello, sir. I'm Dr. K. What can I do to help you today?"

"Well," the patient stammered, "I had an accident."

"What kind of accident?"

"Well," he started, his eyeballs almost rolling up into his brain to recite his rehearsed story, "I was at the gym and after working out, I got a shower. After I was done, I walked back to my locker wrapped in a towel and as I went to sit down on the bench, the guy next to me put his hairspray bottle down and I sat on it. It was an accident."

I promise you, he did not even crack a smile. It's amazing how distracting ass pain can be, I guess. Even as a first-year resident, I knew a good story when I heard one. The storyteller in me wanted more.

"So," I said, "did the bottle scratch your skin? Leave you with a bruise? What happened to it?" I, in some twisted way, wanted to hear him admit to me that as we were talking, a Clairol hairspray bottle was still missing.

He looked at me incredulously. "Look," he said, "you're new here, right?"

"Actually, yes, I am. Why?"

"Because, I've been...," he blew out an exasperated breath before continuing, "let's just say that this isn't the first time this happened to me." That explains Dr. Z.'s smile. And what gym has multiple hairspray bottle accidents in their men's locker room?

It turns out this guy had several "accidents" in his past that brought him to the ER. And, of course, they didn't really happen at the gym. He was a local celebrity of sorts. It was my privilege to finally meet someone famous, although a few years prior, I had met Cyndi Lauper. That should count, right?

I listened to the patient's heart and lungs with my stethoscope for way too long, hoping against hope that my shift would end before I had to do the rectal exam. No such luck. After feeling his abdomen, it was time "to look back there." I stepped out of the room to bring Dr. Z. in with me. After all, he was my teaching physician for the shift (plus, he dragged me into this case).

Dr. Z. walked in. "So, Joe, I see you met Dr. K., one of our new residents. He treating you okay?"

Great, Dr. Z. and Joe were buddies. "Yeah," Joe said, eyeing me up, "he'll do."

This is where my learning curve took off.

"Okay, Joe," Dr. Z. said, "you know the routine." Dr. Z. had Joe get on all fours on his cot (yes, my mouth was gaping open, too) and, after several layers of gloves, we inspected Joe's backside poking out of his gown. No scratches. No bruises. Then we tried to manually (unfortunately, "manually" meant using my fingers, not Dr. Z.'s) grasp and remove the hair spray bottle. Although I could feel the bottom of the bottle, I was unsuccessful.

I was filled with shame from my failed attempt. I had wanted this story to have an ending where I saved the day, where all the nurses would cheer for me, a measly first-year resident, and my unlimited brilliance as I walked out of Joe's room holding up the Clairol bottle like it was some sort of treasure trophy.

Dr. Z. tried his best to cheer me up. "It's okay, K. Really. This is what residency is for--to learn how to successfully pull a hair spray bottle from a patient's ass. There'll be more." Funny guy, that Dr. Z.

We sent Joe to x-ray. Abdominal films revealed to us that, just as Joe had said, there was a stuck hair spray bottle. Just beyond our reach. I blacked out Joe's name on the x-ray and made myself a copy to frame and hang over our fireplace, but my wife refused. "Don't you even think of taking down our wedding picture!" Sometimes I wish she could be a better sport about this stuff.

Unfortunately for Joe, the bottle would have to be removed in the OR. We tried one last hurrah by using a special rectal speculum and graspers, but no such luck. Yep, Joe was heading to the OR.

While under anesthesia and completely relaxed, the GI team was able to use a scope to retrieve the missing bottle from Joe's backside. I can only hope that they got the round of applause that I had dreamed about.

I often wondered what Joe told his family and friends about his hospital visits. I mean, really, what if one of them wanted to send flowers? What do you write on that card? Please let me know if you have an idea about that--I'm blanking out.

I still don't know much about plumbing or electrical work or peeling an onion without crying. However, I'm proud to say that so many years later, I know all I need to know about rectal foreign bodies.


Thanks for reading...and enjoy your day. The next post will be Wednesday, December 16.

16 comments:

AtYourCervix said...

I cannot begin to imagine how many objects can be inserted rectally.

And then get stuck and need to be extracted in the ER/OR.

(To be a fly on the wall.......or maybe not!)

Old Geezer said...

"I hope everything comes out all right at the hospital!" for the flowers card.

WrightStuff said...

There was something about that post... I mean you know that what's coming up is not going to read pretty, yet somehow you just can't quite stop yourself reading can you? And then... wondering what else you've had to remove over the years!

rheumablog said...

"I'm behind you all the way, Joe! Get well soon!"

How do you keep a straight face?
-Wren

SeaSpray said...

Card from someone who knows him well:

Hope you'll be feeling better ASS soon ASS possible!

Bottoms up! :)

I try to understand this and know it has something to do with the prostate..but still..doesn't it hurt going in? I am really serious. Perhaps not for a public forum but seriously?!

With insurance declining pre-existing conditions, never events, etc... do they repeatedly pay for ED/OR trips caused by the patient's behavior? How is that coded? Does a flag go up in the med recs?

Onions? - goggles. (I read that)

Or fan behind you to blow the odors away from you. I did this by accident during a party once.

I was cutting the onions for tacos and a fan was in the kitchen. Unbeknownst to me all my guests in the family room were tearing up until someone asked me if i was cutting up onions because all their eyes were burning. OOPS! :)

Great writing style! :)

Rositta said...

I don't think I'm going to be able to look at a can of hairspray without thinking of that story for a while, LOL... I keep wondering how and why...ciao

mommy-medic said...

We had a dad drive up to the ambulance bay of a local hospital with his 15 year old son in the back seat- and a shower curtain rod up HIS back side. Not sure who was more mortified!

Then I once dropped a patient off at the VA hospital and a small older oriental doctor asks my partner and i if we "want see sumpting cool?" Sure, I'll bite....
He pulled a curtain and there was a patient, prone on the bed, out cold. The doc lowered the covers, spread the cheeks, and light shone out. Not sure that's what maglight had in mind.....

IrishPoet said...

pretty funny doc...kinda reminds me of the first time in nursing clinicals I had to do urethral catheterization on a 300 LB woman, only it wasn't nearly as funny as your story (almost quit nursing school right then!)

Toni said...

Now, now - what's another ole wrinkly ass? I've been an RN x 35+ years, and it all comes down to just one more wrinkly ole ass. Reminds me of the time when I worked the ED, and a guy waited for hours for an enema. Constipation wasn't his problem.He had completely normal bowel pattern. While we nurses were drawing straws, teasing each other about who would be the lucky one, the ED Doc we were working with just told the guy, "I'm afraid tonight is not your night for an enema, my friend, perhaps another time." The guy accepted that and left. Apparently he was a "regular."

There are many times when I can hardly contain a smile, saying to myself "Can you freakin' believe this shit?" Nobody would. But truthfully - I signed up for it all, and have literally loved every minute. Can't see myself doing anything else.

satishsoli said...
This comment has been removed by the author.
satishsoli said...

well my friends Its better to join good Medical Training

Cal said...

Well, although I haven't a great deal of experience in these matters, I would instinctively think that what goes in, would also be able to come out... If it fit going in, must also fit on its exit! But, as your story exemplifies, and given the number of many others along the same lines, this is not necessarily true, and to be honest, it puzzles me.
Good writing, as always; Have been enjoying reading your posts a great deal.

Maha said...

It's always an 'accident' or 'I sat on it'.

Perhaps you could have placed the framed xray near a bathroom for an interesting conversation piece for those awkward moments? :P

Marcy Hall said...

HA HA HA HA HA HA!!!

that's all i got. too funny for words!! :)

Diana said...

Here are 2 ideas-

Roses are red,
violets are blue.
We removed the bottle,
so you can poo!

and

Roses are red,
water is wet,
the best shaped bottle,
is some old Hair Net.

Anyhow, came across your blog today, and I am addicted. You have a wonderful sense of humor. Thank you for giving me a "get out of house work" free card!

Ashley said...

"Hope all's well in the end."

:)