Friday, April 23, 2010

countdown to done-ness

I have to admit, I'm struggling to find things to write about from my current medical life because I kind of don't have one. Radiology is just SO DAMN CHILL (and yet they drink coffee nonstop) that I don't have a ton to say about it. Really, there are only 5 days left till DONENESS WITH MEDICAL SCHOOL (although graduation doesn't come till later in May). So instead, I'm reaching into the archives of my mind to bring you...


This story comes from a Brooklyn hospital, where I did a surgical sub-internship last fall. It was later in the afternoon when one of the residents got a call from his senior, saying he needed to do an admission on a young guy with a foreign body. The resident stayed on the phone, asking for MR number, last name, etc then suddenly burst out laughing and couldn't stop for a few minutes. He hung up the phone, and I asked him what the case was. "Uhhh, this dude stuck a dildo inside his butt, and now he can't get it out. A DILDO."

I admit, it was pretty funny. We saw the x-ray, which looked something like this, and it was really hard not to lose it completely.

Not so much when we saw the patient, as he was unfortunately a sweet guy in a significant amount of discomfort (and was utterly humiliated to boot). His story was that he had placed the dildo inside his rectum, and not been able to retrieve it. He waited a full day hoping that a bowel movement would force the dildo out, but instead had no movements at all and began to get more and more distended and uncomfortable. The resident tried to have a feel inside to see if he could yank the damn thing out, but the patient was just in too much pain, so the decision was made to take the guy to the OR and sedate him a bit.

The anesthesiologist seemed to have a better understanding of how hard this would be, because the chief resident's assurances of "Oh, this will only take a few minutes, go ahead and use an LMA if you want" was met with extreme yet quiet skepticism. The idea, which seemed simple at the time, was to have one person place a hand inside the rectum while a few of us pushed on the abdomen, forcing the dildo back out. SIMPLE, RIGHT?? ~sigh~ Well, it was not. I am not exaggerating when I say that I pushed on that damn belly for 2 and a half hours while no less than 3 different surgeons tried their hand at grasping the dildo. And by hand, I mean hand plus wrist plus forearm plus beyond the elbow. Yes, folks, three people were past their elbow inside the patient's rectum and STILL could not grasp that dildo.

(For those of you out there interested in the mechanics of the dildo problem, this was a skinnier dildo that did not have a base shaped like testicles. So there was nothing to grab onto, and the surgeons could only feel it with the tips of their fingers before it slipped beyond the sigmoid colon.)

We tried using clamps, graspers, even the scary Ob-Gyn surgical tray to grab the dildo. We tried propping the rectum open with a weighted speculum. We tried pushing from every angle imaginable to try to push the dildo around the colonic curve it was stuck on, all to no avail. I don't know when it started, but each time a surgeon placed an arm inside, it came out just POURING nice fresh blood.

The result: the guy wound up getting intubated, sliced open (yes, an actual exploratory laparotomy) and the dildo was pushed back out the rectum by squeezing it from the sigmoid colon like toothpaste from a toothpaste tube. Except that his butt was not minty fresh goodness, let me tell you.

The best part? This guy was the second one in two weeks to show up to the emergency room with the same exact complaint.

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