Working the night after a holiday is always a bummer, especially Thanksgiving. I usually eat so much turkey, dressing, mashed potatoes, and pumpkin pie that I start to resemble the unfortunate bird himself. All I want to do is take a long nap, watch some football, and then go to bed early. But my wife always drags out the Christmas decorations to get a head start on the next season. Every other year I’m spared from this duty as it is my turn to traipse off to the hospital for another shift. Thankfully, it’s usually quiet. I guess most people are laying around stuffed like I was. But a few make it in to the ED with the usual complaints.
My first patient was an elderly female with lower abdominal pain. “I think I ate too much,” she said right after my introduction. Do you suppose, I thought sarcastically. Her abdomen was rock hard, just like the stool in her rectum. I made a half-hearted attempt at a disimpaction just so I could say I tried. I saw the horror on the face of the nurse as she read the order: “Please do digital disimpaction followed by triple H enema. Thank you.”
“Thank you” she mouthed to me with fire in her eyes.
The next patient was a middle aged man who had also stuffed himself with turkey. Wild Turkey. He was so drunk I ordered an NG tube to suck out all the remaining booze. He could have several more hours of alcohol waiting down there to be burned off, I reasoned. His nurse didn’t see it that way. He wasn’t hurting anybody. She knew what was about to happen. As soon as the NG touched the back of his throat with the tube, he exploded with foul smelling emesis, all over himself, the bed, and the nurse.
“That’s two strikes, big guy,” the charge nursed warned me, as she passed with an armload of towels to sop up the mess. “You write another order like that tonight and you’ll be carrying it out by your lonesome.”
“Sorry,” I said with an embarrassed shrug.
So with that history, I was a little nervous as I entered the room of an 85-year-old man whose chart simply noted “abdominal pain.”
I was pleased to find, however, that the patient was lying in the bed without any seeming discomfort. At least his belly wasn’t distended and he wasn’t drunk.
“Hello, Sir,” I said respectful of his age. “I’m Doctor Plaster. How can I help you tonight.”
“I have something stuck,” he said rather blandly.
“Stuck? Are your bowels all bound up?” I feared that this might be another constipation after all.
“It’s a Christmas tree light.”
He had me with that comment. “Did you eat a light bulb?” I asked in amazement. I had a sudden flashback to my college days, watching a fellow student eat a light bulb just to intimidate the incoming freshmen. He was a heavily tattooed ex-Marine who’d just returned from Vietnam. I thought he was the toughest kid I’d ever met. I’d often wondered how he digested the glass.
“No,” the old man said, interrupting my reminiscence. “I stuck it up there.”
“You stuck a Christmas tree light up your butt?” I blurted out before thinking. There was an awkward silence in the room. “Well, OK then,” I said slowly after a long pause. “Let’s get it out.”
This shouldn’t be too difficult, I thought, trying to regain some semblance of clinical composure. “I’ll be right back.”
I stepped out of the room and almost ran into the charge nurse, who was standing quietly holding a tray with the lighted anoscope, some K-Y jelly, and a pair of ring forceps. The nurses were all attempting to appear busy, but it was clear that they all knew what I was up to.
“I don’t suppose I could get a little assistance?” I asked. She silently handed me the tray with a defiant look. “I didn’t think so.” I replied to myself.
Returning to the room, I did a cursory exam of the patient before assisting him into the knee-chest position. Sliding the scope into his anus I thought of my usual technique of easing the tension in the room, which was to hum a little tune as if what I was doing was all routine. But my mind was suddenly stuck on Christmas carols, which I didn’t think would go over big with the patient. Suddenly a large metal object became visible. This was unlike any blinking Christmas light that I’d ever seen. There, in view was a full sized bulb base.
“I thought you said this was a Christmas tree light,” I responded.
“It’s a light shaped like a Christmas tree. He held his hands up in the air making a triangle with his two thumbs and index fingers.
“Like a bulb that would go in a lamp?” I queried incredulously. “Did you try to sit on a lamp?”
“No,” he roared. “What kind of pervert are you? My doctor told me I could treat my hemorrhoids this way. I’ve done it for years.”
“Really?” He was so convincing that I was reluctant to challenge his story.
Returning to the clinical hurdles this new information presented, I momentarily thought of attaching a lamp to the bulb to give me a grip on the base. But I quickly abandoned this plan. I made several attempts to pull out the bulb with the ring forceps. But each time I moved the bulb down, as it got harder to pull, I would lose my grip. Then I would watch helplessly as the bulb simply slide back inside. I hesitated to ask the patient to push because I didn’t know how much Thanksgiving turkey was behind that bulb. I needed something to break the suction of the bowel proximal to the bulb. Voila! I spotted a nasogastric tube hanging on the wall. Sliding the NG tube around the bulb, I was able to use a 60 cc syringe to insufflate the sigmoid, thus pushing the bulb as I pulled from below.
That time it worked. The bulb started to move down just as I remembered to get my head out of the line of fire. It soon popped out of the anal orifice and was quickly followed by a huge gush of insufflated air. It sounded like one of those vuvuzelas from the World Cup. I could hear the entire nursing staff give a collective “Ahhh” of disgust. They were all obviously gathered in the nursing station hoping that I would step out of the room covered with you-know-what.
Instead, I slowly finished my paperwork making small talk with the patient. Stepping out of the exam room to confront the gawking nurses, I calmly handed the charge nurse the tray with a surgical towel covering the removed foreign body.
“Can you send this to the path lab for identification?” I said with an air of routine job completion.
Lifting the towel to inspect the specimen she said, “You want the pathologist to identify a light bulb? What do you want, the wattage?”
“No,” I whispered. “I had to come up with some reason he couldn’t have the bulb back.”
Merry Christmas everyone.