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.