If you haven’t already, listen to self-proclaimed “hottie” Liz Crowe, social worker from the Mater, delivering a blistering smaccTALK on ‘swearing your way out of a crisis‘.
I met up with her just before the session for a bit of advice on swearing before my own smaccTALK; she did suggest that gratuitous use of the c word in the checklist debate would be better re-phrased as ‘C U next Tuesday’. I think I managed to weave this into the debate…listen yourself when the Checklist debate is put out to air (unless it gets edited)…
Liz gave a hilarious talk, not least because she acknowledges the use of humour & swearing in medicine – as a form of metaphorical armour, as a psychological re-set mechanism and way of stepping back from the horror of critical care. She also made repeated reference to an unfortunate episode of rectal Babushka dolls …
Which made me remember a story on rectal FBs of my own.
I have deferred putting this story out for some time. It refers to the issue of rectal foreign bodies…in particular, one memorable episode. Of course this incident happened in a hypothetical hospital to a hypothetical patient. If it DID ever happen, it was certainly in a different country…and over 10 years ago. And of course I was NOT involved.
So…hypothetically…here is the infamous ‘Barbie Doll’ story.
Somewhere in an ED many years ago
I am a big fan of triage nurses and paramedics. They are generally hard-as-nails types, unfazed by adversity and have ‘seen it all’. Which is why this particular Friday was odd. I was the Emergency Registrar on, and became distracted from the hassles of simultaneously managing seven acute patients and supervise the RMOs queueing up to discuss their cases. There was an audible kerfuffle going on over at triage…
So I ambled over. And there was Jude, the tough-as-nails Kiwi triage sister, doubled up in tears of laughter. And the cool-as-cucumber ambos were similarly giggling. Laying between them was a young chap, face down on the barouche.
“What the?” I mumbled. “Is this what I think it is?”
RN Jude nodded vigorously…still laughing.
Pulling a curtain around, we moved the barouche into the resus room. Things like this don’t come up every day. With good light and 360 access, I performed a careful examination…
Sure enough this unfortunate chap had managed to wedge a Barbie Doll up his arse. Head first. All that was visible were poor Barbie’s feet…and with every painful spasm of his sphincter, Barbie’s legs would waggle as if to say “Get me out of here!”
Attempts to pull Barbie out with some sedation were unfruitful – pulling on the legs caused Barbie’s two arms to extend, rather like a fancy corkscrew device. She was embedded.
We rang the surgical registrar who was, of course, scrubbed in some abdominal horrendectomy and not going to be available for at least another 2-3 hours. This was not untypical. The Surgical Registrar on duty that day had a reputation as a “bit of a cock” – generally obstructive to referrals, usually uncontactable in theatre and usually very brusque with ED. There was bad blood between the Surgical and ED tribal leaders that day…
Meanwhile we placed the poor chap in a side cubicle and carried on with our work, enjoying the humour of the occasion. By this stage the poor chap had become the “butt” of all our jokes (groan). X-rays were taken, conversations were had and general humour was enjoyed.
Finally, getting on towards midnight, the surgeon appeared. He refused to listen to the elaborate but somewhat sarcastic verbal referral that I had been crafting all shift, but instead disappeared behind the curtain.
“I’ll sort this out myself if you amateurs in ED can’t” he announced to the ED.
“Wanker” I muttered, whilst the assembled registrars, RMOs, RNs, ENs, orderlies and students assembled behind the curtain to listen.
Bugger me! The usually terse surgical registrar took a crisp, concise surgical history. He EVEN took an anaesthetic history! He explained in calm and non-judgmental words the nature of the problem, the need for surgical removal and the potential complications. His clerking was a model of empathy, concern. I am not 100% certain, but I am pretty sure he even used #HelloMyNameIs, a good 10 years before this meme became a phenomenon…
By now we were all pretty chastened. I was feeling very guilty about the earlier behaviour and inappropriate humour of the ED team.
On the plus side, our patient had certainly brightened up – after several hours of being the focus of everyone’s attention and the laughing stock of the shift, here at last was a doctor who was prepared to take him seriously…thank heaven for the professionalism of the surgeon!
And then the denouement…
“Well Mr X” said the Surgical Registrar “I have explained what we need to do – I’ll push your trolley upstairs myself…the anaesthetist is ready…we’ll have you fixed up in no time. Do you have any questions?”
Dumbfounded with gratitude the poor lad just stammered “No…thank you…for looking after me”
“No worries” says the surgeon “Just one LAST question….I can see what you did with Barbie….but where’s Ken?”
With that the assembled masses in ED erupted with laughter. The surgeon emerged, grinning, pushing ahead of him the poor lad on the trolley. That day the surgeon became a hero to us all – from then on the surgical and ED tribes were at peace.
Wanna learn more about rectal FBs?
Well, I daresay there is always Google….but that might not be safe for work! Perhaps better to stick to the journals. Try this classic :
Management of Rectal Foreign Bodies from Coskun et al (2013) World Journal of Emergency Surgery
Rectal Foreign Bodies from Goldberg & Steele (2010) Surg Clin N Am
I daresay there are more. More importantly, listen to Liz Crowe’s talk on humour and swearing from smaccGOLD. It’s a beauty.
See you next Tuesday!