Getting advice seems to be a problem from the moment we are born. Well, not so much getting advice, but listening to it. Parents warn their children not to run with scissors, put on a jacket, wash their hands, and STOP HITTING YOUR BROTHER. As children get older, the advice gets more serious: look both ways crossing the street, drive slower, STOP HITTING YOUR BROTHER (that one never seems to change). This advice seems pretty self-explanatory, though children always seem to argue about it. But other things we tell children need to be explained: why it's stupid to smoke, why it's necessary to put on your seat belt, why you should STOP HITTING YOUR BROTHER. And then there is some advice that just shouldn't need to be given. It is so easy to understand and so damned obvious that it shouldn't even need to be mentioned.
Like "Don't put things in your butt."
Since I just mentioned it, it clearly needed to be mentioned. To Jack (not his real name™) in particular.
Now before I continue, yes this is another rectal foreign object story, and yes I just posted one a couple of weeks ago. But this one is just Too. Damned. Good. So here it is for your reading pleasure and distinct anal discomfort.
My RFO patients have thus far all been men, and Jack was no exception. What makes him slightly different is his age. All of the other men in whose rectums I've spelunked have been in their late 30s or early 40s. In other words, old enough to know better than stick something (Coke bottle, butt plug, dildo, etc) in their asses. Jack, on the other hand, was in his late 60s. So WAAAAAY old enough to know better than to stick something in his ass.
Jack came in around midnight complaining of, you guessed it, a pain in his ass. Apparently he wasn't satisfied with the variety of toys available at his local sex shop, so he decided to make his own. Now a quick perusal of Google will reveal a wide variety of do-it-yourself sex toy kits. Yes, I checked. For science, really. These evidently were also not good enough for Jack and his, uh, needs. No, instead of some commercially available silicone toy kit, he decided wax would be better.
Vanilla-scented wax, to be precise.
I walked into Jack's room to see an elderly-looking man in Standard RFO Position - somewhat on his side with a grimace on his face. I decided not to beat around the bush.
Me: OK, what did you put in there?
Jack: *grunt* It's a candle.
Me: . . .
Me: And why did you . . . Ugh, never mind. How long has it been in there?
Jack: *grunt* Two . . .
Me: Oh, just two hours?
Jack: . . . days.
Yes indeed, Jack had melted down a vanilla-scented candle, molded it into an apparently pleasing shape, and inserted it into his rectum. Two fucking days ago. He had been trying in vain (obviously) to remove it manually. He had tried an enema. He had tried stool softeners. But last I checked, none of those things can melt wax.
The object was easily palpable in his rectum, but it felt fucking huge. There was nothing for me to grasp, no way for me to remove it easily. So off to the operating theatre we went.
Once he was asleep I could do a more thorough exam. Unfortunately the exam was exactly the same. It still would not come out. Most foreign objects can be grasped with some special graspers and will slide back out the way it went in. But not this goddamned thing. There was no lip, no flap, no anything on which to gain any purchase.
So I did the next best thing: I crushed it. That is not hyperbole or exaggeration - I literally put the grasper in his rectum and closed the jaws around the thing, crushing whatever part of it I could into bits. I then removed those bits and went at it again.
The next 20 minutes of my life consisted of breaking off another small piece and removing it (along with some of the plastic wrapper which he had not bothered to remove), all the while taking care not to grab any portion of his rectum (that would be considered bad, as you can imagine). Finally it was small enough to remove the remainder, and everyone in the room breathed a large sigh of relief. I think I even audibly grunted in Jack's place when it came out.
The next morning Jack felt much better. I gave him his discharge instructions, as well as what he could expect over the next several days. And predictably I also gave him a bit of advice that should never actually need to be spoken aloud:
1) Don't EVER stick anything into your rectum ever again.
2) If you decide to ignore #1, don't wait two days to seek help when you can't get it out.
Stories about general surgery, trauma surgery, dumb patients, dumb doctors, and dumb shit from the dumb world around us.
Monday, 22 August 2016
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So...question, for the sake of...science. Wouldn't peristaltic action of your GI tract eventually push the mass out...?ReplyDelete
If it's that big and caught under the sacrum, no.Delete
Remember I wrote on your last RFO story about the old guy with candle up his butt. This was in 1972, and I was a new nurse 18 years old. I don't remember how old he was, 50-60 yrs old. This was back when a patient stayed ages in the hospital. But he escaped before I was able to take his vitals again. We never got to know what scent the candle was.ReplyDelete
They do make toys specifically designed not to get sucked inti the abyssReplyDelete
Yes they do. I've pulled several of them out of the abyss.Delete
makes me wonder if some of them get caught using it and try to hide it.Delete
There are many poorly designed butt toys that simply don't have a large enough flange to prevent the suckage. Smaller narrower toys have smaller flanges. Bigger toys can have larger flanges but because the toy is larger and things are now the great wide open, it can still suck in the flange if it's not at least twice the diameter.Delete
I was watching a video some years back at an screening sponsored by a local adult toy shop that used to host various community events (which is how I ended up meeting Ron Jeremy and being hit on by Annie Sprinkle, but not at the same event...yes, I know some strange people); this particular event was called "Mystery Sin-ema 2000", and featured a compliation of amusing porn film clips. The clip in question featured three gentlemen and a very large toy of the type described above; the anal contractions of the fellow using the toy were such that it kept being sucks in and out to a truly alarming degree, and I really expected to see it disappear completely at some point...so no, I'm not surprised that Doc has encountered them in the course of his career.Delete
(I'm also guessing that, had Jack come in immediately, the candle probably could have been removed either intact or in large pieces rather than piecemeal, and that body heat and normal daily movements helped mold it such that, combined with its size, this was impossible given the amount of time that had passed. Does this sound about right?)
Robin, that's what I was thinking too. Body heat won't completely "melt" the wax into a liquid that would easily run out, but it could have softened it to a degree of flexibility that would have ended up molding itself into conformance with the shape of Jack's lower regions.Delete
I've also heard tell of the guys who decided that an enema using concrete sounded like a terrific idea until they couldn't get it out again; it eventually was removed (non-surgically, IIRC), and showed in exquisite detail all the various features of the recipient's colon. (Have you ever noticed that most of the time it's guys doing this kind of thing? Sexual orientation doesn't necessarily matter, either; testosterone seems to be the deciding point. This seems to be yet another of those things I'll just never understand about men, kind of along the lines of why they all seem to like the Three Stooges. *shakes head*Delete
Robin - it did seem somewhat molded to his rectum.Delete
Were you a little concerned that the stool softeners might have taken effect, and you were uncorking a shit geyser?ReplyDelete
I was ready for a literal shit storm. Fortunately it didn't happen.Delete
I wonder if Jack thought the pleasure was worth it after this experience. Doc, do you get "repeat offenders" for RFO removal, or do these guys learn their lesson? (I would doubt it.)ReplyDelete
I'd think if he had repeat customers for this sort of thing, he would have already told us. Keep up the great stories doc! These ones always bring a smile to my face. And disgust but still.Delete
What I want to know, is, what happened to these people before modern medicine? Did our ancestors die of ass obstruction on the regular?ReplyDelete
Quite possibly, or bowel perforation, depending on what went where--a former hairdresser of mine used to tell tales of his rough youth in New Jersey, where gang member friends would carry sharpened umbrellas for doling out justice; they'd stuff the umbrella where the sun don't shine and then *open it up* as much as possible. Don't know if they ever killed anyone that way, but it can't possibly have done them any good. (How the hell this guy ended up in northern rural New Hampshire giving Dorothy Hamill cuts in the late '70s, I'll never know.)Delete
A fine question. I haven't any idea.Delete
On a totally different and far more serious note: little Israel Stinson has finally been allowed to pass away peacefully; a Superior Court judge in Los Angeles lifted the restraining order keeping him on life support, and the hospital disconnected him today. http://hosted.ap.org/dynamic/stories/U/US_BRAIN_DEAD_BOY?SITE=AP&SECTION=HOME&TEMPLATE=DEFAULT&CTIME=2016-08-25-21-55-57ReplyDelete
(If someone knows how to fix/shorten this link, please feel free to do so; I hate cluttering up Doc's page like this.)
The parents, of course, are both devastated and furious, but little Israel is at peace, and at least he won't become the main attraction in the kind of sideshow in which poor Jahi's continued existence (because it sure as hell isn't any kind of "life") has been featured. Losing a child is horrible and heartbreaking (as my parents are all too aware), but being trapped in that twilight between life and death is no place for anyone, patient or family, to be--you *have* to grieve and go on, as hard as it is, especially if you have other children. May they all find peace...and may Jahi eventually find it, too, sooner rather than later, for her sake. (Sorry to natter on, but it's kind of an emotional topic for some of us.)
and much of the media is buying the family story that he died, today.Delete
See here: http://www.docbastard.net/2016/08/bad-journalism.htmlDelete
Ok, so I'm probably going to go to hell for saying this, much less thinking this but I'll say it anyway. If Jahi McMath is at home in the care of her family, I hope a storm knocks out power to their house for about an hour. For Jahi's sake.ReplyDelete
And before I get roasted I've just spent 60 days with a good friend who lost her 22 year old to a drowning, and was by all definition brain dead, except her heart was beating and she was breathing, erratically. Without somatic support. Apparently, all but the tiny bit in her brain stem was dead which kept her from ever recovering ever, but still allowed her to breath and heart to beat. Mom accepted this with lots and lots of phone calls between us, Mom chose comfort care, removed the feeding tube, and IV, moved her to hospice and she actually died, like dead dead 14 days later at 68 pounds, from the day she actually died at 118 pounds.Delete
Yeah sometimes "withdrawing life support" literally means "starve the patient to (full) death". I often think it would be more humane to just give them a morphine overdose and be done.Delete
We have to deobstipate constipated cats far too frequently... If enemas, IV fluids, and massage don't help we anesthetize them and manually remove poop as well. Gauze forceps = turd tongs. WORST smell... GAGReplyDelete