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...

ER Tupperware

I am only going to warn you once, so please pay attention. Beware of any patient carrying Tupperware or Gladware in the ER. Chances are slim at best that they are carrying food in those containers. What is in them, then? Oh, my friend, I could write a book on what people have brought us using those containers.

It happened again to me last night in the middle of my overnight shift. I should have known better, but I must have been tired.

A very nice elderly woman, a retired government worker, presented to the ER for complaints of two days of coughing with phlegm production. She had no fever, no difficulty breathing, no difficulty speaking, stable vital signs, and no change in her daily routine. She just thought that she needed "checked out" at 5 a.m. while a snowstorm raged outside our ER doors. She came by ambulance.

"I've had the cough for a few days, doctor, and wanted to make sure it wasn't pneumonia. I never had it but heard it can get pretty bad."

"Well, maam, do you feel bad?" I asked, trying to get to the root of her buried complaint. Sometimes you have to dig and dig and dig to find that complaint and, still, all you're left with is an empty hole.

"Oh no, not at all. I feel great." Her words were followed by a sweet, innocent, old lady smile.

Hmmm, I thought, scratching my chin after performing a perfect exam. 5 a.m. Raging snowstorm. Feels great. What oh what should I do.

I sent her to x-ray for a quick two-view of her chest that, of course, came back negative.

After she returned from radiology, I repeated a brief exam, still stable, and explained the results of her negative chest x-ray to her. She nodded her head in agreement with my words and after I was done speaking, she stood up, went to her room's counter, and pulled her Samsonite purse from it. She carried the purse back to her cot and sat back down, opening it. She pulled out her wallet, two books, a rosary, a red Jolly Rancher, and a paper-clipped bundle of papers before finding what she was looking for.

"Oh, yes dear, here it is."

I watched her with excitement, wondering what she was going to pull out to show me.

Slowly, she began pulling her hand from her bag. Was she going to show me a winning lottery ticket, a rare signature from Abraham Lincoln, or heck, maybe even some banana-flavored Laffy Taffy?

I held my breath. As her hand lingered in the purse, teasing me, my tension mounted. Finally, she pulled out the object.

Nooooooooooooooo! I wanted to scream. And run fast.

She held up a blue-tinted disposable plastic Tupperware container for me.

The best defense is a good offense, of course, so I didn't waste any time. "Is that a snack, maam? Did you bring some leftovers to eat in our ER tonight while you were waiting?"

"Oh no, doctor, I think you really need to see what I've been coughing up." She tapped the lid as she spoke. How could I refuse this little old lady's request? I couldn't.

I stepped forward as she peeled the lid off the container. There better be a gold nugget in there, I thought to myself. But no, not even close.

"See," she said, "isn't that just awful?"

I peered hard into the container to see what she was seeing. I couldn't see anything awful, just a string of clear spittle beautifully draping the inside walls of the container, like garland around the front door. Her partial upper plate sat smack on the bottom, a small puddle dispersed around its edges.

"Oh, there you are," the woman said, snatching up the wet partial and plopping it into her mouth. I made a silent plea with God. Please, dear God who is all kind and good, if you can get me out of this room in the next minute, I will shovel my neighbor's driveway. Or shave my head. Or never make another bowel movement joke again.

Now the woman held her breath in anticipation of my exam of her spittle.

"Oh yes, maam," I spoke, choosing my words carefully, "I see what you mean. That's some mighty clear phlegm you got there. Isn't that something how it sticks to the sides like that?"

"Yeah," she nodded, somewhat panicked, "tell me about it. Does that mean something? Is it bad when it sticks to the sides? Am I going to be alright?"

I answered her. "Yes, maam, you are going to be alright. Spittle clinging to the side doesn't mean anything more to us than usual spittle. And more good news. Everything about your visit looks okay--nothing we need to worry about or treat with antibiotics. Just work hard to keep bringing up that extra spit and if you get a fever or worsening symptoms, you can always come back for a recheck."

She seemed happy enough with that. But I knew one more question was coming my way.

"Um, doctor," she spoke, holding out her container, "do you want to keep this and send it to lab or something?"

Well, heck yeah, I thought to myself. I would like to keep your container and send it to lab, maam--if it were April Fool's Day. But otherwise, no, I don't feel any overwhelming urge to keep your container.

"Do you want me to throw it out?" I asked, reaching for it.

She pulled the container back towards her. "Oh no," she said, emphatically, "I'll take this home and reuse it."

I may have swallowed back a little phlegm of my own, thinking of what she would store in there next. A piece of lasagna? Leftover baked beans? Pennies from 1982? Jelly packets from a restaurant? Tomorrow morning's bowel movement? You know, the constipated one that she could slice like a stick of pepperoni?

I wonder if this is what Tupperware and Gladware had in mind when they marketed these useful containers.

The kind woman packed up her container and put it back in her Samsonite. She repacked her other things, too, which made me kind of sad. I had been eyeing up that Jolly Rancher.

"Well then, maam. You take care of yourself, okay? And again, always feel free to come back or visit your family doctor if you need to."

She reached out and shook my hand. "God Bless You, Doctor."

What a sweetie-pie, yes? After helping her out of her room, I looked down at my watch. More than five minutes had passed since my plea-bargain with God. There would be no extra shoveling for me when I got home that morning.

As always, thank you for reading. Next post will be Wednesday, January 6. Stay warm...