Disimpaction
"Hey scutmonkey," the Chief Resident says. "Know what this is?"
He's staring at me. There are seven of us standing in a semi-circle in front of a view box in Radiology; two interns, two third-year students and two residents.
And the Surgical Chief Resident.
Mrs. Jacobowitz's abdominal x-ray hangs backlit on the box, illuminated like a work of art.
"The abdomen?"
"Nice shot, smartass...NO." He points at something. "THIS."
It's the second week of general surgery internship and I haven't seen a heck of a lot of x-rays.
I stare, eyes squinting, evaluating.
He stabs his finger. "This area of mottled heterogeneous increased density in the midline pelvis."
I rub my chin. The two students and intern study the tile floor.
"Hint," he says, resigned. "Soft tissue density mixed with air. Distending this lumen. Stretching it. Causing poor Mrs. Jacobowitz's problems."
He shakes his head. Finally, "...It's SHIT. Okay, everyone? S..H..I..T. Our lovely patient here is FOS - FULL OF SHIT. She's impacted, loaded to the hilt. Ready to explode. Hasn't moved her bowels in two weeks. Does anyone know what needs to be done here?"
One of the residents straightens up, obediently chirps, like an Army Private minus the salute. "Disimpaction."
"BINGO. Manual Disimpaction. Guess what, Gray. You're up. Ever disimpact someone?"
"No. But I watched Dr. Allen here do it the other day."
"Stellar work," he says, only half serious, whipping the x-ray from the box. "See one, do one, teach one. Go save a life."
I review the chart at the nurse's station. Ida Jacobowitz: 91 year-old female with history of dementia, breast cancer, hypertension, two strokes, status-post hysterectomy, cholecystectomy, appendectomy, right mastectomy and removal of benign bladder polyp. A laundry-list of medications. Now presenting with constipation.
Okay.
"Go away!"
"I want to help, Mrs. Jacobowitz," I say. "I'll remove some stool. You'll feel better."
"I don't need any cookies! Go on. Get back to your mother!"
I realize negotiation is out. Move on. I see restraints on her wrists, tied to the guard rails. At least she can't punch me.
"Move your legs apart ma'am." I place a chuck sheet under her legs, help spread her knees, to access her anus. I crunch the sleeves of my short white coat, mid-forearm, and double glove.
I gaze down and gasp.
It looks like she's crowning a baby, the fecal head bulging out, pushing, splaying the anal ridges, forcing the mouth agape, like a gasp itself, resembling Munch's The Scream.
I poke and pick at the protruding alien fetus head and nothing happens. It's like soft rock and I suddenly think of a yellow mining helmet, chisel and hammer. I pluck at the rock, flick it, and try to get something off, anything, maybe a crumb.
My finger maneuvers its way around the mound, getting beyond the rim of her anus and then it starts. A small chunk pops off and I'm convinced this project will be a success.
Another chunk. Then another. Plick plop poop flink.
I'm making headway, now with two gloved fingers gliding ever so slightly into the rectum, a slight groan from above, and then a solid meaty chunk falls to the sheet. My fingers are bent, forming something of a spoon and now the stool goes from hard to medium soft, the texture of warm clay, like after you've rolled it around in your fist a while.
Now a third finger and a bigger spoon, a ladle maybe, curving, swiping and forcing out chunks and then damn boulders of feces. There's a substantial moist pile on the sheet and I think about getting rid of it, throwing a clean sheet down, but the three fingers turn to four and the hand is sinking deeper and deeper, now up to my knuckles.
I take an arcing swipe and I release something that's the size of an entire small fetus.
The pile is more like a mountain. The stench is powerful, the simmering smoking Everest of waste having fermented for two weeks, aging, maturing into something hideous.
I enter again, my thumb slides in and I'm almost to my wrist and I wave out a chunk and I'm right back in for another. I'm impressed with myself, like I've mastered this whole process and I smile. A big toothy grin.
The stool is getting softer and now it's like slightly boiled tofu and the chunks break off in more of a linear fashion, organized, and I can feel the stool getting warmer, some life coming back, getting deeper, past the rectal vault, into the sigmoid colon.
And that's when I freak out because in my shit-scooping frenzy I realize I can't see my wrist and my forearm is starting to slide in and I think, then cringe, holy hell - I'M FISTING A NINETY YEAR OLD LADY!
I can't get my hand out, I pull, the sphincter choking my wrist and I ease back a little.
The stool has gotten very soft and I wiggle my fingers, push a bit, and I feel as if I've made a chink in the dam wall because I feel trickles of hot fluid running over the back of my forearm and I think I've gotten to the critical level.
I realize I have to get my hand the heck out, reassess the situation, see if maybe she can expel the rest on her own, now with the brick wall violated, and I hear her saying something and her legs start to flail.
I feel a foot hook around the back of my neck and just as I pop my hand out with a SCHLOP she's saying, "Get out of there you crazy person! Get! Get!" and I say, "Hold on a minute, Mrs. Jacobowitz."
I hear some gurgling and her other foot wraps around the other side of my neck and I attempt to stand upright and she slams me, forces me, face-first into the mountain of glistening stool, gushy clay smearing and squishing across my cheeks and I lose balance and I yelp a muffled dead sound, tilting to the side and twisting my face toward the gaping mocking anus and it screams and howls and then there is a massive explosion.
The heavens open up and a wicked angry storm of shit and fluid rains and gushes onto and into my mouth face eyes nose hair shirt coat bed wall floor TV chair tray railing window.....
END
