Wednesday, March 24, 2010

Perfume And A Purse

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...


Heather said...

Your nurse gave away the oldest nursing school trick in the book: VICKS!

it's true. You put some under your nostrils and you can't smell a darn thing. I haven't smelled a GI bleed in YEARS! ;)

Empress Bee (of the High Sea) said...

you know any time i smell ANY perfume, this is what it is like to me. i live on the 19th floor and getting in an elevator with someone wearing perfume is awful. trying to eat in a restaurant where someone has on perfume is nasty. i just hate the stuff!!!

smiles, bee

rlbates said...


kate said...

Orange-scented air deodorizer is my best friend around desk in our clinic is right next to the bathrooms (which also happen to be right next to the GI cinic).

Karen said...

The head of our volunteer ministry team at our hospital was a sweet woman who had a hug for everyone she met. If I saw her from afar, I would alter my path to my destination to avoid the cheap, heavy odor of her perfume that, after a hug, hung on my clothes for the rest of the day!

Maha said...

I love perfume but there's a distinct difference between a dab on the neck and marinating in it all night. Loved the description of the vapours clawing at your eyes and nostrils! And vicks seriously works like a charm. I have a stash in my pocket and I use it liberally before starting smelly tasks.

Constance said...

I kept waiting for you to write that she was defecating into her purse and covering the scent with the perfume. Does that make me a bad person or just a frequent reader of ER blogs?

Cal said...

A city where I previously lived has a ban on perfume! Or any strong smelling personal grooming products, such as deodorant, aftershave, etc. Even strong scented laundry detergent. And if you work in a public space such as the hospital or the university you are really strongly advised against wearing any scent. It sounded a bit extreme to me, but once you get used to the lack of perfume trails, once one hits you in the face again it really packs a strong punch! I actually really liked it and now hate being assaulted by a scent cloud. When you get a letter in the mail scheduling a doctor's appointment it comes with a reminder to not wear any scents. Since you work in an ER it would be difficult to schedule people's visits and remind them not to wear perfume though.

Anna said...

Coffee beans work too. If you ever in the perfume store, I doubt now, lol, they sometimes have cup of coffee beans for you to smell between the perfumes. Many clinics here in Canada do not allow perfumes, they actually have notices, but then if someone comes to ER then you have no choice I guess. Excellent post again. Anna :)

Katie said...

I think your blogger's messed up... this is tomorrow's post that posted itself today (3/23). I just spent five minutes check my calendar making sure it wasn't just me who was confused. I finally concluded I'm not crazy but rather that I am seeing a blog post from the future! I won't read it until tomorrow, though because I'm really not supposed to be on blogger right now. :-)

<>< Katie
PS: Mine did the same thing last week.

coulrophobic agnostic said...

While the ban on strong perfumes sounds awesome, the ban on scented deodorant sounds worrisome - if I use unscented, I might as well not bother, and I'm pretty sure the baby powder scent is more appealing than someone smelling like they haven't bathed in a year.

littlepretendnurse said...

Hadn't thought of Vick's. I should get a bottle for work. Good-smelling lotion rubbed just under the nose works well in a pinch.

Webster said...

I'm wondering what she stole and stuffed into her purse.

Anonymous said...

Vicks works like a charm in the lab~!

What about the people in the waiting room who are allergic to apples? LOL

thecatsmeow said...

Yikes...I was just about ROTFL, because I have some hospital experience and it was the smells that unfortunately stayed in my memory banks. I think the worst one was the lady with the needed-a-change colostomy bag; the stench just about made me pass out. (For reasons I don't quite know, that seemed even worse than the usual bathroom sorts of stink; I always tried to make it a point to get up and walk the hallways when this was being attended to.)

The perfume story made me think of my former job where we'd get the LOLs with the heavily floral perfumes that I always had to back away from. It was good that they didn't stink badly (yeah, we had them too), but sometimes what is a decent scent in small quantities can be stinky if it's overdone.

t. said...

Would I rather smell the parfum, or poo?

Sometimes these are the most difficult of decisions...

SeaSpray said...

Great post.

Sweet how she called you Dear. :)

I had an elderly lady refer to me as Child and I loved it. :) From her 90 yr old perspective ..I guess I was.

I find I'd rather breathe odors than inhale because I feel like the particles are getting trapped by nasal hairs instead of going right down. Of course you can still smell it later.

When one wears a perfume often they become desensitized to it and tend to wear more so they can smell it..but unaware how strong for others.

My mother always wore Tabu ..a very strong one and I had to open the car window more than once.

I like that vicks idea.

My mother would have a couple of rolls of quarters in her purse at times. You could've been right.

And I'll bet even the hankie in her purse wreaked of it.

Not sure why she was there tho if it was only a little of the "D" word. ?

Hobbes said...

So what is an ammonia capsule and how does it work?

Jabulani said...

Oh dear heaven... ROFLMBO on these occasions: "thorough but brief"; "Maybe going to church had cured her symptoms."; "its invisible fingers clawing at our eyes and ripping at our noses." (fabulous imagery!); "We now interrupt this post while Dr. Jim performs a rectal exam."; "although I think her shit smelled like, well, shit" (spat out coffee at this point too! BAD Dr Jim!!); "The nurse made me delete that line, though."

Hilarious. Thank you so much for the morning giggle. I am now ready to go clean loos. Or maybe just write a post of my own ... :)

Hope you have a great day. S

Katie said...

"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."
I LOVE the imagery of this sentence!

I totally understand the overwhelming perfume stench. One of my current suitemates and my roommate freshman year wear the same perfume. Even one spray and I feel like I'm going to die. Way to trigger the gag reflex, ladies.

I'm sorry this kind woman gave you a odor-enduced headache. I'm the same way.

Another great blog, Jim.
<>< Katie

girlvet said...

Anna is right. Only we use coffee GROUNDS.

I will never understand why some people have to take a bath in their cologne or perfume.

新車 said...


Anonymous said...

do yoy like med stusents or do you find them annoying

Tonjia said...

I was going to suggest an N95 mask! sounds like your nurse and I have the same idea. LOLOL

I am also very sensitive to "old lady perfume". I learned a long time ago to breathe through my mouth and
turn off my sense of smell. And it has become very handy when I am in contact with GI bleeds, gangrene,
C-diff, etc. but it seems like that perfume just penetrates, kind of like nerve gas. :-)

you did good doc, I wonder what was in that purse???

Stephany said...

Well, maybe she sprayed too much on before Church because of how her bathroom smelled!

Anonymous said...

Old lady perfume lingers and lingers and lingers. Nothing worse than that nasty rose perfume.

Anonymous said...

My first thought about that purse was that Granny is packin' heat. That would explain the weight as well as her unwillingness to let it out of her sight. She was a bit too protective for it to be a few rolls of quarters.

Anonymous said...

I don't blame granny for protecting her purse. From time to time there is a little blurb in my daily paper about a little old lady being the victim of a purse snatching. Sometimes it results in injury to the victim. It is enough to make one's blood boil. If she was ever a victim of this crime then that could also explain her overprotectiveness.

Smalltown RN said...

Yes those dear sweet ladies and their Yardly's scents...just about enough to kill you. I too can't stand strong perfumes...I work with a retired nurse who has this very strong's nauseating...I should tell her as I am very sensitive...but I don't want to hurt her feelings...I know she wears it partially as she is a smoker and tries to cover up the cigarette smoke, when it fact it just makes the stale cigarette smoke smell worse.

Another great read doc!

WWWebb said...

Oddly enough, considering the content of this post, an old EMT trick is to use cheap cologne (and the cheaper, the better) to mask the smells of dead folks who have gone a bit ripe, burn victims, stinky winos and the like. You rightfully have a place in my RSS feed so whenever you post, I know about it. Thank you.

WWWebb said...

Reading the syntax of that last post, I feel that I should clarify: we put a dab under our noses to exhaust the nerves, not apply it to our patients.

DBenzil said...

I would love perfume to be banned from all public places. I know I have a particularly sensitive nose which makes my choice of surgery perhaps a little odd. Ironically, I find I am much less sensitive to natural smells than artificial ones. Bleach particularly does me in. Cute story.

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

LOL, yep, Vick's and a mask, one of the oldest nursing tricks in the book! I'm currently doing my clinicals for my CNA certification and my instructor told us that when it came time to change a colostomy bag for the first time, she'd give us a dab of Vick's to cover the smell and a mask to hide our grimace :P And on second thought, I think I'll wear a little for my next clinical, after having lost my appetite and having the smell of feces cling to my nose for the better part of a couple days last week. If there's a CNA student walking around your nursing home smelling like Vick's, it's probably me :)