Orifice Day

Today there was an unusual amount of foreign bodies to be retrieved.

Patient 1: a young woman who stuck a kitchen sponge inside her vagina and couldn't get it out. I took a look, and sure enough, a small piece of sponge was there, lodged near the cervix. I didn't ask why it was there -- I never do. One, I don't care why; two, who am I to judge? Three, the question gives the appearance of judgment, and I don't want to make the patient uncomfortable. The closest I ever came to asking "why?" was when during a routine pelvic exam, I found a leaf inside a patient's vagina. I simply held it up and said, "Did you know this was in there?" "Nope," was all she said. And that was that.

Patient 2: Another foreign body in vagina. This was acutely more painful. A young woman was using a vibrator in the shape of a penis, and the head BROKE OFF and got lodged. (No, it was not still vibrating.) But it had electrical parts to it. Danger, Will Robinson. I had to give her valium to get her to relax so that I could pull it out with forceps. Unless it's infected, I always offer to let the patient keep whatever I retrieve. "No thanks," she said, "and my boyfriend is totally going to get an ass-kicking now, this was his idea, you know." Go girl.

Patient 3: 94 year old dear woman with a big ol' protruding belly. She was almost completely deaf and she was shouting as if everyone else was too.

"I HAVEN'T SHIT IN TWO WEEKS," she yelled.

I thought that if I whispered, she would get the hint. "Really?"

"WHAT? YOU HAVE TO SPEAK UP SONNY, I CAN'T HEAR A WORD YOU'RE SAYING."

Now we were shouting at each other for the whole ER to hear.

"WHEN WAS YOUR LAST BOWEL MOVEMENT?"

"I SAID TWO WEEKS AGO."

"REALLY? FOURTEEN DAYS?"

"SINCE ONE WEEK IS MADE UP OF SEVEN DAYS, THAT WOULD BE A 'YES'."

Sharp as a tack, old as dirt.

"LET ME DO A RECTAL EXAM AND SEE IF THERE'S ANYTHING THERE. YOUR BELLY COULD BE SWOLLEN FOR A DIFFERENT, MORE SERIOUS REASON."

"DO YOUR THING, DOC."

So I have an aide hold her onto her side, and I glove up, put some lube on my finger (don't ever forget to do that part), and poke a finger in. Gobs of doo doo greeted me. And when that happens, you know what you have to do: manually disimpact. It is my least favorite thing to do, but it's THE most gratifying thing for a patient, hands down. They always heave a HUGE sigh and say "THANK YOU!!!" after it's all said and done. So with two fingers, I'm shoveling out turd after turd. It was disgusting. And I found out that this procedure has a higher billing rate than either CPR or intubation, can you believe it? I told the aide helping me: "I spent $150,000 to go to medical school to learn how to shovel shit. That's some bang for your buck." But here's the really twisted part: after collecting it all, I weighed it on a scale, just out of sheer curiosity. OVER FOUR POUNDS.

Patient 4: Prisoner came with police escort who said he swallowed a ring. And though I said I never ask why someone shoves something up their butt, I *do* ask why they swallow stuff.

"Cuz someone would steal it from me if they saw it on my finger. It's gold with a diamond in it."

I'm sure he wasn't lying about someone wanting to steal it in the joint.

X-ray confirmation: a ring in the rectum. So I gloved up and fished it out. Fake gold, fake diamond. I gave it back and said he should find a better place to hide it.

Orifice Day

Today there was an unusual amount of foreign bodies to be retrieved.

Patient 1: a young woman who stuck a kitchen sponge inside her vagina and couldn't get it out. I took a look, and sure enough, a small piece of sponge was there, lodged near the cervix. I didn't ask why it was there -- I never do. One, I don't care why; two, who am I to judge? Three, the question gives the appearance of judgment, and I don't want to make the patient uncomfortable. The closest I ever came to asking "why?" was when during a routine pelvic exam, I found a leaf inside a patient's vagina. I simply held it up and said, "Did you know this was in there?" "Nope," was all she said. And that was that.

Patient 2: Another foreign body in vagina. This was acutely more painful. A young woman was using a vibrator in the shape of a penis, and the head BROKE OFF and got lodged. (No, it was not still vibrating.) But it had electrical parts to it. Danger, Will Robinson. I had to give her valium to get her to relax so that I could pull it out with forceps. Unless it's infected, I always offer to let the patient keep whatever I retrieve. "No thanks," she said, "and my boyfriend is totally going to get an ass-kicking now, this was his idea, you know." Go girl.

Patient 3: 94 year old dear woman with a big ol' protruding belly. She was almost completely deaf and she was shouting as if everyone else was too.

"I HAVEN'T SHIT IN TWO WEEKS," she yelled.

I thought that if I whispered, she would get the hint. "Really?"

"WHAT? YOU HAVE TO SPEAK UP SONNY, I CAN'T HEAR A WORD YOU'RE SAYING."

Now we were shouting at each other for the whole ER to hear.

"WHEN WAS YOUR LAST BOWEL MOVEMENT?"

"I SAID TWO WEEKS AGO."

"REALLY? FOURTEEN DAYS?"

"SINCE ONE WEEK IS MADE UP OF SEVEN DAYS, THAT WOULD BE A 'YES'."

Sharp as a tack, old as dirt.

"LET ME DO A RECTAL EXAM AND SEE IF THERE'S ANYTHING THERE. YOUR BELLY COULD BE SWOLLEN FOR A DIFFERENT, MORE SERIOUS REASON."

"DO YOUR THING, DOC."

So I have an aide hold her onto her side, and I glove up, put some lube on my finger (don't ever forget to do that part), and poke a finger in. Gobs of doo doo greeted me. And when that happens, you know what you have to do: manually disimpact. It is my least favorite thing to do, but it's THE most gratifying thing for a patient, hands down. They always heave a HUGE sigh and say "THANK YOU!!!" after it's all said and done. So with two fingers, I'm shoveling out turd after turd. It was disgusting. And I found out that this procedure has a higher billing rate than either CPR or intubation, can you believe it? I told the aide helping me: "I spent $150,000 to go to medical school to learn how to shovel shit. That's some bang for your buck." But here's the really twisted part: after collecting it all, I weighed it on a scale, just out of sheer curiosity. OVER FOUR POUNDS.

Patient 4: Prisoner came with police escort who said he swallowed a ring. And though I said I never ask why someone shoves something up their butt, I *do* ask why they swallow stuff.

"Cuz someone would steal it from me if they saw it on my finger. It's gold with a diamond in it."

I'm sure he wasn't lying about someone wanting to steal it in the joint.

X-ray confirmation: a ring in the rectum. So I gloved up and fished it out. Fake gold, fake diamond. I gave it back and said he should find a better place to hide it.

The Nursing Scuffle Shuffle

Last night, a Chinese woman who spoke no English came with several relatives to the ER. It was obvious that something was wrong with her left ankle. It was deformed, swollen, blue and purple. My immediate guess was that she had some type of accident and fractured her ankle.

I got her on a stretcher and used the translator phone to determine that my assumption was correct -- she was a bit elderly, was walking to dinner, tripped in a pothole, and down she went. She said it didn't hurt that badly. I told her I was going to give her some pain medicine, and she declined -- she said, via the translator, that she just didn't want any medicine right now. Fine, I said, let me know when you do.

Five minutes later, the nurse Sandy came up to me and asked why I was letting this old lady sit around and cry in pain.

First of all, let me tell you about Sandy -- she's one of the old guards of this old hospital, and has been around for a long, long time. Today was her last day, and she was retiring. Bottom line: she's nasty, has a terrible attitude, is awful to patients and to doctors, and often fails to carry out orders in a timely fashion. In addition, she's loud, obnoxious, and universally unpopular except to her contingent of other old-guard bad-attitude nurses that are her friends. For some reason, many people are afraid of her. They don't want to get into an argument, they don't want confrontation with her, they simply just want to avoid her altogether.

One time, she had (finally) done an EKG on a patient who was triaged for chest pain. An hour after that EKG was done, the patient's clinical picture had changed, and he was having active chest pain. I asked Sandy to do a repeat EKG on the patient, and she cocked her neck to one side, put her hand on her hip, raised one eyebrow and said, "what for?"

"Because his clinical picture is changing. He is now having worsening...."

And she rolled her eyes and walked off (but did the EKG). No matter how you slice and dice it, that was just RUDE. And very few things make me more upset than being rude and wrong at the same time with an air of superiority about it.

"Just let it go," said my attending who saw that exchange. "She's getting the EKG."

That's the problem. Everyone lets it go. Sometimes I guess I do too, but I was not in the mood for it that night. So I ran right up to Sandy after she did the EKG (and I made sure it was benign) and said, "Look, you can ask any question you want to, I'm fine with that. But what I'm not fine with is when you walk away during the answer. If you don't want to know the answer, don't ask. You KNOW that was rude and there's no excuse for that."

She said nothing, but I know she knew I was right.

So back to this particular story (and I'm still getting riled just recollecting the events).

"Why are you letting this poor lady sit there and cry in pain?? Give her something!"

"Sandy, I JUST got off the translator phone with her and she refused ANY pain medication. Now that the situation has obviously changed since she's crying, I'm happy to reassess her and give her anything she wants to control the pain."

Not good enough for Sandy. She said, "I mean, for goodness sake," and her voice is rising and patients and their families are noticing, "you give any fucking alcoholic in here as much morphine as they want, but you won't give a lady with a broken ankle any fucking morphine? That's bullshit! But what do I know?? YOU'RE the doctor, right?"

"First of all, did you hear anything I just said? Second, if you don't think I'm treating a patient's pain appropriately, you say, 'hey doc, I think your patient is having worsening pain, can you re-assess her or give her more medicine?' Third, I think we can all agree that there is NO need for that kind of language in any setting, much less in an ER in front of patients, families, nurses and doctors. That is completely inappropriate and out of line and you know it. I'll deal with you later but right now I'm going back to the patient."

So I doped up the patient with plenty of vicodin and went back to Sandy.

"Come here, Sandy, I want you to hear this." I had her stand in front of me while I picked up the phone and called the Director of Nursing. While the phone was ringing, I said, "Sandy, I want you to hear exactly word for word what I'm telling Lorrie, that way you can tell her if anything I'm saying to her is inaccurate in any way."

So I told Lorrie exactly what happened. She came downstairs in less than one minute.

"Sandy, is this true?" she asked.

No answer.

"Sandy. Is what he's saying true? Did that happen? Did you say those things?"

"Yes I did."

"Go home."

Call me an asshole, but I got her sent home the day of her retirement before her retirement party. I don't regret any of it, and different doctors and nurses alike who witnessed this whole event kept saying that more people should have spoken up to her and combatted her bullying much, much sooner. And that's exactly how she's been acting to many people over the years -- like a bully. I wish her the best in her next endeavor whatever it may be, but I sure hope it's in an administrative role inside a cubicle.

Brief political foray

It's no secret I'm quite left of center, but not, say, Berkeley left. Just slightly.

I couldn't be happier about the midterms for the most part. Frank Rich got it right -- this was the rise of the moderates. Most Americans are quite centrist in their views, and they were sick of the GOP being beholden and hostage to ultra-right wing political cronies and undue influence. No better was this illustrated than in South Dakota, where most republican voters struck down the sweeping anti-abortion law ever seen since Roe v. Wade. It, like government under Bush, went too far, and voters finally recognized that. And they came to see an old axiom come to life: absolute power corrupts. GOP control of the presidency and legislature was, in the past 8 years, a slap in the face of the Constitutional framers. Make no mistake -- a vast majority of the voters said that this vote was about national issues and a referendum on Bush. And it was a stinging rebuke of the presidency and his perceived incompetency on national and international issues. Let the moderates rise.

But -- did anyone else notice that the former darling of the right wing Ann Coulter was conspicuously absent from the entire political landscape during the midterms? What happened to her?

Let's hope bipartisanship can work -- and that the new in-power in-vogue Democrats can put populism on par with ideology.