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"When we finally came to rest, I was spread-eagled
over an obese, senile naked lady in a lake of diarrhea.."
I'm proud of the fact that I'm self sufficient in the ED. And it irritates the fire out of me to see prima donnas,
read surgeons, come into the department and require the entire staff to follow them around to do little things
they could do for themselves.
Perhaps I was taught well by the charge nurse where I did my training. She was a heavy set matronly type with a
ruddy complexion. She still wore her nursing school cap that said St. Francis over her hair that was tightly pinned
and covered with a net. She once came out to the nurses' station to confront me where I was writing a note after
suturing up a wound. Having seen the mess I had left from the procedure, she brought out a whole roll of plaster
casting material, a bucket of water, and a sling and put it on the counter. Deep in thought, I didn't notice her
at first, but her rapid foot tapping drew my attention and I looked up to see her glaring at me.
"What's all this stuff for?" I asked.
"Well, I saw the mess you left," she said. "And I just assumed that both your arms were broken."
"Yes, ma'am," I said instinctively, reaching back into my childhood of groveling. "I'll clean it
up, ma'am," I said as I walked briskly to the room.
"You're damn right, you'll clean it up," she lectured, following me into the room. "Or you WILL
have two broken arms."
"Yes, ma'am," I repeated several times. The scene was a déjà vu of childhood when my mother
would make me select the branch with which she would thrash me. Needless to say, the lesson in self-sufficiency
took.
I learned how to do everything on my own. Of course, my wife is incredulous. She thinks that every time I forget
to take out the trash it's because I have an entourage of nurses following me around at work picking up after me,
handing me instruments, saying "Yes, doctor", and mopping my brow. The reality is that I work for the
most part solo. And if I don't do it, it probably won't get done.
But sometimes trying to do it all without assistance can get me into trouble. Like the other night. I knew as soon
as I arrived that I would be on my own. The waiting room was full and the racks were jammed with charts. Everyone
had their task.
Several hours into the grind, I picked up a chart with a name I recognized. Ethel Barnes was an elderly patient
from a nursing home that I had seen many times before. She was morbidly obese with thinning snow white hair and
skin to match. Unable to walk any more, she was confined to a wheel chair. And despite suffering from severe dementia,
she seemed to have a jolly disposition. She just sat in her chair all day smiling and drooling. Every now and then
she would make a noise that sounded like Chewbacca from the movie Star Wars. The clinical picture was always the
same. Having had multiple abdominal surgeries over the years, her adhesions precipitated multiple episodes of bowel
obstructions. But because of her sunny disposition, no one could tell she was in trouble until her abdomen blew
up.
It was the same story tonight. The nursing home sheet just said "No stool for one week." And I'm sure
they just kept on feeding her, I thought to myself.
There was no other history. The exam was predictable. The vitals were normal as was everything else except for
her massive, distended, silent abdomen. She seemed oblivious to her condition. I ordered the basic labs and an
abdominal series of xrays to rule out another obstruction and dashed off to the next patient.
About an hour later her chart re-surfaced. The labs were all normal. The xrays, too, were unremarkable, except
for the huge amount of stool present in her colon. I went back to the room to make a final check before sending
her back to the nursing home. They can clean out her gut just as easily as we can, I mused. But when I opened the
door I found Ethel still sitting beside her bed in a wheel chair, where the tech had left her, surrounded by a
huge pool of diarrhea. It had overflowed her Depends, filled her seat, run down her legs and formed large brown
lake. She just sat there grinning.
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