Grossest thing I've ever endured:
Yesterday I had a shift in the ER. Normally I try to steal all the pediatric patients off the "To Be Seen" rack before I get stuck seeing an obtunded elderly patient or an obese man with a looming heart attack; but yesterday just wasn't my lucky day.
I had gotten away with a pretty good morning of sprains and feverish toddlers until my preceptor shoved a chart into my hands as I was finishing up the note on my last patient. I could swear that he actually snorted a quick laugh when he said "Ah. Here's your next patient."
I saw the dark cloud begin to form over the ER as I read the info from Triage: 86 yr old female complaining of constipation and abdominal pain for 10 days.
I could let you fill in your own details from there, but why let you have an appetite when I've lost mine for the past 48 hours?
*Warning: this is seriously gross folks. read with caution*
I stepped past the curtain to bed #12 to find an elderly woman lying unresponsive on the bed with her well-groomed, alert and just as elderly husband sitting on the chair beside her. I quickly learned from his history that she had severe dementia, would only respond to people about 25% of the time and had a looong history of constipation. They had been to another ER 3 days earlier, but as the husband explained, "They didn't help her at all! They discharged her without giving her any treatment and she's still in really bad pain!"
I felt so bad for this man. He was so nice and loving to his wife...you could tell he was her sole caretaker, and he hated to see her uncomfortable. At the same time, I KNEW what was going to happen. After doing the physical exam, ordering an abdominal xray and presenting to my preceptor, it was obvious to everyone that I was avoiding something VITAL. After reading an xray that showed compacted stool winding all the way backwards into her intestines I trudged back to my preceptor, head hung low.
"Did you do a rectal Ali?"
"Um...well...no...I know...I know."
"You have to disimpact her Ali."
"Oh geez."
*shuffle* *shuffle* *pretend not to have heard my preceptor*
In plain english, he wanted me to stick my finger in her rectum and scoop out all the hard stool I could in order to get things cleared and moving. But to my even greater surprise...as I inserted my finger, all I got back was lots of mushy stool. About 0.5 seconds away from vomiting, I stepped back outside of the curtain and reported to my preceptor...somewhat happy that the probing was over.
Not so much.
I was then told I would now have to give her a 1500cc enema. It took 4 people to perform the task. The poor woman was groaning and whimpering and couldn't understand that she needed to hold in the water in order for it to work. Finally she got the idea and we finished putting all the water in. Then we propped her on a bed pan and left the room for her to uh...release the rest.
About 3 minutes later I hear screaming from bed #12. I send a shocked look towards my preceptor who immediately says, "Ali! That's your patient! Go take care of it!"
I run to the room to find my patient shaking vigorously and yelling that she can't hold it in any longer! The poor woman didn't understand that she was supposed to be letting it all go at this point, and instead has been torturing herself by attempting to hold in all that water. I tried to coach her by telling her that she had a pan beneath her but she just wouldn't believe me. So the husband, ER tech and I sped her bed out into the hallway, into the bathroom and almost threw her on the toilet bowl.
A nurse came to get me about 10 minutes later and said, "I want you to check if bed #12 can go home."
I marched to the bathroom and opened the door to find a calm, smiling, elderly lady and her husband walking out. They of course left me the evidence in the bowl. I saw about an entire intestine's worth of stool in there. Immediately I flushed the toilet without breathing once.
Seriously, this was the most disgusting thing I have ever been a part of. I discharged that couple within 5 minutes. I don't think I've eaten since then.
Bon Appetit!
Yesterday I had a shift in the ER. Normally I try to steal all the pediatric patients off the "To Be Seen" rack before I get stuck seeing an obtunded elderly patient or an obese man with a looming heart attack; but yesterday just wasn't my lucky day.
I had gotten away with a pretty good morning of sprains and feverish toddlers until my preceptor shoved a chart into my hands as I was finishing up the note on my last patient. I could swear that he actually snorted a quick laugh when he said "Ah. Here's your next patient."
I saw the dark cloud begin to form over the ER as I read the info from Triage: 86 yr old female complaining of constipation and abdominal pain for 10 days.
I could let you fill in your own details from there, but why let you have an appetite when I've lost mine for the past 48 hours?
*Warning: this is seriously gross folks. read with caution*
I stepped past the curtain to bed #12 to find an elderly woman lying unresponsive on the bed with her well-groomed, alert and just as elderly husband sitting on the chair beside her. I quickly learned from his history that she had severe dementia, would only respond to people about 25% of the time and had a looong history of constipation. They had been to another ER 3 days earlier, but as the husband explained, "They didn't help her at all! They discharged her without giving her any treatment and she's still in really bad pain!"
I felt so bad for this man. He was so nice and loving to his wife...you could tell he was her sole caretaker, and he hated to see her uncomfortable. At the same time, I KNEW what was going to happen. After doing the physical exam, ordering an abdominal xray and presenting to my preceptor, it was obvious to everyone that I was avoiding something VITAL. After reading an xray that showed compacted stool winding all the way backwards into her intestines I trudged back to my preceptor, head hung low.
"Did you do a rectal Ali?"
"Um...well...no...I know...I know."
"You have to disimpact her Ali."
"Oh geez."
*shuffle* *shuffle* *pretend not to have heard my preceptor*
In plain english, he wanted me to stick my finger in her rectum and scoop out all the hard stool I could in order to get things cleared and moving. But to my even greater surprise...as I inserted my finger, all I got back was lots of mushy stool. About 0.5 seconds away from vomiting, I stepped back outside of the curtain and reported to my preceptor...somewhat happy that the probing was over.
Not so much.
I was then told I would now have to give her a 1500cc enema. It took 4 people to perform the task. The poor woman was groaning and whimpering and couldn't understand that she needed to hold in the water in order for it to work. Finally she got the idea and we finished putting all the water in. Then we propped her on a bed pan and left the room for her to uh...release the rest.
About 3 minutes later I hear screaming from bed #12. I send a shocked look towards my preceptor who immediately says, "Ali! That's your patient! Go take care of it!"
I run to the room to find my patient shaking vigorously and yelling that she can't hold it in any longer! The poor woman didn't understand that she was supposed to be letting it all go at this point, and instead has been torturing herself by attempting to hold in all that water. I tried to coach her by telling her that she had a pan beneath her but she just wouldn't believe me. So the husband, ER tech and I sped her bed out into the hallway, into the bathroom and almost threw her on the toilet bowl.
A nurse came to get me about 10 minutes later and said, "I want you to check if bed #12 can go home."
I marched to the bathroom and opened the door to find a calm, smiling, elderly lady and her husband walking out. They of course left me the evidence in the bowl. I saw about an entire intestine's worth of stool in there. Immediately I flushed the toilet without breathing once.
Seriously, this was the most disgusting thing I have ever been a part of. I discharged that couple within 5 minutes. I don't think I've eaten since then.
Bon Appetit!