WhiteCoat

Poopmeister

Don’t read this post if you’re eating, if you’re planning to eat, or if there is any possibility you may have undigested food in your stomach. Now I know what CrankyProf feels like.

A physician once told me during my training that the plumbing and the sewage system are two body functions that no one appreciates until they stop working.

To get the “sewage system” working when it is “backed up,” one of the more unappealing things a doctor has to do is to “disimpact” someone.

Some docs just flat out refuse to do it. They admit the patients and make someone else do it or they send the patient home with an enema and tell them to do it themselves. The problem is that then the patients suffer.

I won’t understand why someone waits two weeks without a bowel movement before deciding there’s a problem, but I do know that once the problem is there, being unable to have a bowel movement is an agonizing thing. Sometimes an enema will relieve the impaction, but the longer the stool sits in the colon, the more fluid the colon absorbs from the stool. Eventually, the stool sitting in the rectum turns into almost a clay consistency. The body adapts to some degree by liquefying the stool so it can pass around the impaction – called “paradoxical diarrhea.” Once the stool turns to clay, the only way it is coming out is for someone to stick their multiply-gloved fingers up there and to dig it out. For those of you who took my advice, are not eating anything, have not vomicked, and are now totally enthralled with the topic of constipation, see this link for more exciting information.

The start of a long shift was a man who had no bowel movement in 8 days. He felt the urge to defecate, but was unable to do so and was very uncomfortable. And he just happened to have paradoxical diarrhea. Not high on my list of enjoyable things to do, but we’re in the business to help people, right?

Well, when I walked into the room, it looked like a couple of monkeys had been in a poo fight. He had stool all over his clothes. He had placed his clothes on the chairs and the counter, so there was collateral contamination all over the furniture, too. Even though one of the nurses had placed a commode in the room, the patient was standing up and straining so that liquid poo was dripping onto the floor. I did a survey of the room. There was poo on the bed frame, on the handles of most drawers, on the curtain, on the front of the sink, on the otoscope (why would someone with constipation mess with an otoscope – never mind, I don’t want to know), on the nurse’s call light, and on the doorknob leading out of the room.

For a good ten seconds I stood there dumbfounded. It was me standing in back of a door I had just closed, mouth ajar, staring at a man half-squatting over the floor in a soiled gown who stared back at me with an equally dumbfounded look.

Then I seriously thought that I was the subject of a practical joke. I looked for an uncontaminated part of the linen drawer, opened it without touching its handle, grabbed a towel inside, and used the towel to pull the handle on the door out of the room. Fresh air hit me in the face. When hospital air smells like Liquid Downy, you know something stinks.

I was half expecting to see everyone laughing at me when I walked out of the room, but the scrunched up faces of the staff, their demands to “hurry up and shut the door”, and the strong smell of deodorizing spray proved me wrong.

I got the stool out of this poor guy’s bottom, but the odor lingered in the room for hours to come. I kept smelling stool on my clothes to the point that I had to change my shirt.

And I thought the lice were bad.

23 Responses to “Poopmeister”

  1. medrecgal says:

    EEEWWW…that has to be one of the grossest things I’ve ever read on a medical blog, and I’ve got a pretty strong tolerance! That’s beyond nasty… I’d be showering for three days after an episode like this one!

  2. lpnmon says:

    It’s the residual smell that gets to me. It kinda follows you around the rest of the day. Kudos to you for doing the disimpaction. As an LPN, I’ve gotten lots of orders to do it, seen many nurses do it, but you’re the first doc I “know” to do that. Granted, I’ve yet to work in an ER, so maybe that’s a doc thing there?

  3. Doctor Bee says:

    On the OTOSCOPE?!!! That, my friend, is what I call TALENT.

    Wow. That’s some serious backup. Here’s to hoping you have a less excrement-smelling day tomorrow!

  4. SeaSpray says:

    I feel for all of you! If the patient is of sound mind I feel most of all for him. Can you imagine being the one that did all that…the embarrassment? I probably would insist on cleaning it myself. I feel sorry for housekeeping!

    I have heard that when we smell odors that we are really breathing in the particles. Lovely thought. I wonder if they attach to the nasal hairs? As well as sit on the clothing.

    I had an experience where I had to go to someone’s house to install a Lifeline and there was dog excrement and newspapers everywhere and little dogs underfoot..barking. I had to carefully choose my steps like I was playing twister so I could land in between the stuff and all the while be gracious and supportive. Birds..she had birds too. Not a good environment. Fortunately I didn’t have to go into the bowels of the house as the hook up was just a room away. I felt sorry for the person as they had poor eyesight along with other health issues and suggested that there were agencies that might be able to provide assistance but she said she had help. It was raining that day and I purposely walked through the shallow puddles even though I had good shoes on. And like you, the odor STAYED with me and I couldn’t wait to rip my clothes off and shower when I got home. But my day was just beginning.

    One last thing. I am freaky about skunks. You know how your just relaxed and casually driving somewhere but then a skunk is in the area and so the car vents suck the odor in? When that happens I yell SKUNK and shut everything off. I could also yell “i-n-c-o-m-i-n-g!” because it feels like an assault. I hate that. One night a lab tech came in for the 11-7 shift and she was upset because the skunk odor came into her car and landed on her pants. I could smell it on her. She had to change into scrubs.

    You definitely have the worst pooh story I have ever heard.

  5. Nurse K says:

    Last time I saw a MD disimpact a patient? Wait for it….wait for it…..okay, never…

  6. GuitarGirlRN says:

    In our hospital, the RNs are not permitted to disimpact patients. YAY!!

  7. Tiny Shrink says:

    I just wrote a post about this: http://tinyshrink.blogspot.com/2007/11/medical-student-lore.html

    Two med student friends of mine disimpacted a patient who had constipation since February, and by doing so avoided coding the patient, who was so full they were almost ischemic.

    Your story made me crack up. How awful for that patient, but seriously, the otoscope? Was he trying to dig it out with the otoscope? That is seriously impressive.

  8. jerry says:

    Nurses do lots of things but for some reason do to the culture (or policy) of the hospital it is beneath them to disimpact a patient. Us ER docs do it all the time. It is the fastest way to get the patient better. It is a really shitty job to do and I think there should be a CPT code for it that is worth a thousand dollars. I mean there is a CPT code for CPR that pays well and never does the patient any good.

  9. びっくり says:

    So, I just have to ask: “Do you make this stuff up?”

  10. jonscott2008 says:

    And I thought that politics was a disgusting business.

    To the doubters: I used to work as a counselor… I’m quite sure that this is not made up… Trust me.

    JPS

  11. thebutton says:

    Wow, I came here because I used to have an obession with my infant son’s poo until I was told that breastfed babies don’t always poo every day.

    I can appreciate this story, I was a CNA in a retirement home once. There was a fellow who was digging back there with his fingers. I begged a nurse to give him a suppository. Most of the way into my shift and several changes of the sheets and his gown later, she gave him one. Did that stop him from digging? No. I wanted to scream and just have the RN deal with him, but that wasn’t happening since I was a lowly aide.

  12. SeaSpray says:

    This stuff is real. I briefly entertained the idea of becoming a nurse when I first started working at the hospital but I quickly realized that I didn’t want to routinely deal with projectile body fluids if I didn’t have to…although I suppose I have developed an appreciation for whizzie winkles over the last couple of years. ;) That being said, I wouldn’t hesitate to help anyone if necessary, just not choosing to be in the trenches. God bless all of you that are though and thank you. We all have our strengths. :)

  13. nocturnal rn says:

    Grody!!!! a poo war zone

  14. ali says:

    well we just confirmed i’m a seasoned nurse! i read that post while eating chocolate ice cream-didn’t bother me in the least! oh-and been there-particularly the part where the entire room is covered in poo. 15 minutes before my shift ended!

  15. ali says:

    jerry-i’ve actually done it( i’m an rn on a medical floor) but i got into trouble after-apparently it’s policy that nurses don’t we could cause harm.

  16. Kat says:

    So just out of curiosity, why didn’t you administer an enema instead of manually disimpacting the patient?

    Props to you for doing that…

  17. WhiteCoat says:

    I agree that there ought to be a special CPT code for doing this in the ED. Wishful thinking.
    Oh, do I wish I had the creativity to make something like this up. I could have sent you the shirt I used, but it went straight from plastic bag to bleach in the washer.
    In my experience, enemas just don’t remove the “clay” stool. Work great for soft impactions, but not much help for hard impactions.
    As far as making the nurses do it – if they wanted to, I’d let them, but I haven’t had many takers to this point. I might joke around about it, but I wouldn’t force something like this on them. They have enough to put up with.
    It was funny, though when I walked out of the room and told the nurse that the room needed to be cleaned down, the nurse called the tech in to do it. The tech promptly picked up the phone and called housekeeping. Housekeeping arrived and just gave me the scowl – like I was the poo-flinging cause of all of this!

  18. SeaSpray says:

    Ali what you said about being a seasoned nurse is so true-earing amidst the gross stuff.

    One night while watching a detective show in the 80′s with my husband (before I worked in the hospital)the two detectives bought hot dogs from a street vendor in the city and then started eating them while discussing a horrible crime. I blurted out to my husband “OH…HOW could they DO THAT?” It didn’t take me long after working with the ED (exposed to the physical situations) and being in on the conversations or the cafeteria conversations at mealtime before I could disassociate the act of eating with the conversations. I was eating when white coat warned me and continued through the story. Of course if I was actually there with the ambiance of the moment…I doubt I could. That really is “the” worst poo story ever!

    What gets me in the blogs is when I am drinking something and someone throws in a surprise exquisitely funny one liner. :)

    Boy…like I said poor housekeeping.

  19. I hadn’t eaten, but I darn near spewed my tea when I read “Well, when I walked into the room, it looked like a couple of monkeys had been in a poo fight.”

    I’m with you…Why on earth do they wait to do something for that long? I don’t miss those days of removing those! I hope you don’t mind if I add you to my blogroll.

  20. misspudding says:

    Dude, that’s awesome! Okay, I don’t mean really, but…damn. How can the body not get rid of something like that?

  21. Steve says:

    Did it once as an intern. Never again. Poop is my anti-Christ. I order a liter soap suds enema, usually does the trick.

  22. Felix Kasza says:

    LOL! Reminded me of Head Nurse who, in 2004, posted a story titled “Head Nurse: Now With More Poop” at http://head-nurse.blogspot.com/2004/10/ill-get-to-it-i-swear.html.

    I mean, with phrases like “If the government is ever looking for a cheap, easy way to put people into low-earth orbit without a spacecraft, I recommend magnesium citrate and a hose”, what’s not to like?

  23. Okay, now I definitely know that I’m suited for forensics(which stinks!), since I read that while eating chicken soup, and didn’t even blink.

    Strangely enough, I can tolerate all sorts of stank from dead people. It’s when living people stink that I get the dry heaves. So I do not envy you, but you earn a medal(without brown tint) for helping this poor man.

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