- You are about to have surgery - it's important for the anaesthesiologist for your stomach to be empty when you are put to sleep
- You have an infection in your abdomen
- You have an obstruction in your intestines
- Your intestines aren't functioning properly
- Your surgeon hates you
I admitted a man in his 50's with what appeared to be a bowel obstruction. This is most commonly caused by scar tissue in the abdomen from prior surgery, and the usual treatment for it is IV fluids, inserting a tube through the nose into the stomach to decompress the GI tract, and the dreaded NPO, and the obstruction usually goes away by itself. We did exactly this for this man, but he immediately pulled the tube out of his nose. The nurse reinserted it, and he immediately pulled it out again. This cycle repeated itself several times, and he continued to be generally uncooperative and obnoxious. Finally I realised that I wasn't going to win this battle, so I decided to keep the tube out, but the NPO order stood. Despite my orders he kept asking for something to eat or drink, and I told him repeatedly that he couldn't.
When I came to see him the next day, he had taken matters into his own hands. Overnight he took his IV bag down, unplugged the IV tubing from it, and had poured his bag of saline into a cup so he could drink it.
Sometimes people get better despite their own best efforts to derail the process, rather than because of our best efforts to make them better. Luckily this guy got better and went home a few days later.
I made sure the nurse gave him a cup of coffee on his way out so he didn't try licking a puddle in the parking lot.