Have you ever been so overwhelmed with a stranger's perfume or cologne that you got downright nauseous, the pit of your stomach wrenching?
Welcome to Room 31. I walked into the treatment room to find a pleasant-appearing, tightly-permed, elderly Christian woman who had decided to pay us a visit after Sunday morning mass. She was alone. She was lying on the bed, her gown on backwards, her two stocking-covered legs, still capped by her sensible shoes, poking out. Her floral dress was neatly folded on the counter.
To her belly, she clutched a worn, black patent-leather purse. I imagined its precious contents--a change purse, a lace-bordered handkerchief, a decade-old lipstick tube, a rosary, some hairpins, and a brown prescription bottle with an assortment of expired pills. Probably some sugar and jelly packets taken after her last restaurant meal. And a little bottle of perfume.
Make that an empty bottle of perfume. Her room smelled like a Macy's perfume counter during the holiday season. It was thick and heavy and flowery, and it was giving me a headache.
"Hello, Mrs. Brown," I said, introducing myself, "I'm Dr. Jim, and I'll be taking care of you." I struggled with the words, desperately trying to breath in through my mouth and not my nose.
She responded kindly, before proceeding to share that she had not been feeling well since awakening that morning. "It's probably nothing, dear," she said in a sweet, chirpy voice, "but I think I might have a little..." Here, she paused, lowering her voice to a whisper before leaning in to where I stood, "...diarrhea." Clearly, by her flushing cheeks, saying this word had embarrassed her. The dreaded "D" word.
I asked my standard questions. Any blood? Any antibiotic use? Fever? Abdominal pain? Were the stools watery? A certain color? And so on. With every question I asked, I felt my lungs burning and my eyes stinging. I worked hard to be thorough but brief in my questioning.
After every question I asked, she answered with a grandmother's grin and shake of her head. "No." She seemed very content and comfortable. "Dear," she summarized, "they were just a little loose, that's all."
Before moving on to her physical exam, I held out my hand. She knew what I wanted. She handed over her purse and I took it from her. It was surprisingly heavy. I added four rolls of quarters to my imagined content list. "I'll set it right here on the counter for you, okay?" She nodded, glancing over to make sure it was in her clear view.
Her vital signs were stable, without a fever. Her full-body exam, also normal. Focusing on her abdomen, I couldn't elicit any pain or abnormal findings. She looked darn good. Maybe going to church had cured her symptoms.
I explained her stable physical exam to her. Her blood work, ordered by a proactive nurse, had returned with stable blood counts and electrolytes. All that was left to do was a rectal exam. "Oh, dear," she muttered. I reassured her that it would be quick. "I'm just checking to see if there is any blood, maam."
I stepped out of her room. I took a deep breath of hallway air. Glorious, recirculated, air-conditioned hospital air. I forcefully exhaled before gulping down another big breath, washing the perfume from my lungs. Unfortunately, I still tasted it.
I found Mrs. Brown's female nurse, asking her to accompany me during the rectal exam. In training, I was taught to always have a female nurse during a pelvic or a rectal exam of a female patient. Good advice.
Before walking back into Mrs. Brown's room, the nurse commented on how strong Mrs. Brown's perfume was. "I know," I said, "I can hardly breathe in there."
The nurse was ready. From her scrub pocket, she pulled out a face mask. "How's this?" she asked, chuckling. "Or this?" she continued, pulling out an ammonia capsule. She wasn't done. "Or maybe some of this?" She held up a small container of Vick's Vapor Rub. "A small dab of this under your nose will save your sense of smell, you know." I thought she was joking, but I swear I saw some glistening ointment just above her upper lip. I passed on her offers, as tempting as they were. I would tough this one out, since the bulk of my treatment was done. I pocketed the ammonia capsule, though, just in case.
We walked into Mrs. Brown's room together, the nurse and I, and, as expected, the smell of her perfume attacked us, its invisible fingers clawing at our eyes and ripping at our noses. And there sat Mrs. Brown, smiling her sweet, innocent smile. Clutching her purse tightly against her abdomen. Again.
"Hey," I said, "how did you get your purse off the counter." An aide had come in, she explained, and she asked "the handsome young man" to hand it to her. "He was quite a dear," she added.
While I prepared for the exam (gloves, hemicult cards, lube), the nurse covered Mrs. Brown with a blanket before having her roll to her side and dropping her drawers. "If you don't mind," Mrs. Brown said, lying in her compromised position, "I'll just keep my purse right here with me."
We now interrupt this post while Dr. Jim performs a rectal exam.
Whew, I'm back with good news. Mrs. Brown's rectal exam was uneventful. No blood, no pain, normal stool color, good tone, no abnormal smell (because of her perfume, I can't be 100% sure on that one, although I think her shit smelled like, well, shit). She passed with flying colors.
We discharged Mrs. Brown with instructions to follow closely with her family doctor and return if any symptoms changed or worsen. I also wrote on her instruction sheet, "Do not wear perfume. Ever again. And don't ever let go of your purse. If you do, someone will steal it." The nurse made me delete that line, though.
Upon discharge, her trail of perfume followed her down our ER hallway and into our waiting area, where a friend was waiting to take her home.
Although I thought her perfume would linger for hours afterwards, housekeeping was able to clear the smell out pretty quickly. The secret weapon? Our heavy-duty, industrial strength, apple-scented room deodorizer. Of course.
I took the ammonia capsule from my pocket. And used it.
As always, big thanks for reading. Next post will be Friday, March 26. See you then...