Chapter 12: You Put What Where?

WARNING: This post may contain adult content that is not suitable for children.

Any similarity to actual person's or events in this post is coincidental. This is strictly a work of fiction.

When I started working in the ER, I had heard stories of various and sundry items that had been misplaced over the years. I don’t mean someone put them in a drawer, or a box in the garage, for safekeeping. I mean things that ended up in the body that were not made to be inserted there.

It is true indeed that children, especially, will put things that they shouldn’t in their nose, their ears, or their mouth. The nasal route is a favorite of preschoolers. I have seen beans that have sprouted, red hots, chewing gum and M &Ms. There is no end to the things a kid can find that are small enough to put up the nose.

Then of course there is the oral route. Kids will eat anything, except broccoli or spinach. I have seen swallowed pennies, nickels, dimes, and quarters. Mom and Dad, get that kid a piggy bank. This is the reason god made lifesavers with a hole in the middle.

When my son, Aaron, was a toddler, I had a friend visiting when, he came wobbling up to me obviously choking on something. He was not crying but was turning blue and had his arms in the air reaching for help. I grabbed him and threw him over my knee. Before I could do a back blow, a marble shot out. Where he got the marble is a mystery to this day. After I held him for a minute, picked up the marble, and he stopped crying, I turned to my friend and started talking. I picked up right where we left off. She, however, was absolutely freaked out.

“Did you really just do that? Did you just pop him over your knee, and he shot out a marble, that he was choking on, and you’re just like, Hey! So, what’s for lunch? I am never having kids. I mean it. Not ever. Never!”

It is definitely not for the faint of heart.

One little guy, about 3 years old, when brought in from daycare by his mother, had a Lego in his nose. They make them much smaller than they used to. I suggested she get the larger version. Legos are easy to grab with the right hemostat though. They are much less slippery than peas or corn and they remain intact instead of squishing when you pull them out.

His mother asked him, “Why would you put that in your nose?”

His classic answer, “Cause I’m a kid.”

That about sums it up.

The process of removing things from the nose is sometimes as simple as having them block off the other side and blow. Usually by the time they get to the ER they have already tried that. From there we proceed to trying to grab it with some small hemostats, which by the way we can never find when we need them. If they get left out on a tray, they always get stolen by stoners, who want them for a roach clip. If that fails, we get a Fogarty catheter. It is a very small catheter with a small balloon at the end. First you wriggle it past the offending object. Then blow up the balloon and pull it back hopefully removing the object with it, or at least moving it closer to the front so you can grab it and pull it out. If all those things fail, then you call the ear nose and throat specialist. Let them do their thing.

When they come in with something in the ear it has often been there awhile before the child either confesses, or the parent finds out from a tattle tale older sibling. Smaller objects are usually the culprit. but It could also be a critter.

One kiddo about 5 years old came in with a bug in his ear. He was pretty freaked out at first because it was still alive and moving around. It was late on the night shift. It had apparently crawled in where it was nice and warm. When we flushed it out into the little basin it was a small cockroach.

He asked his mother if he could take it to school for show and tell.

Her answer was a resounding, “No!”

I had a young woman come into triage. She was screaming and banging the side of her head. She was wearing a long T Shirt and nothing else, not even shoes. It was obvious to my trained eye that this woman was pregnant. She appeared to be very pregnant.

My first thought was that she is at least 20 weeks which makes her Labor and Delivery’s patient.

I picked up the phone to call Labor and Delivery.

Right before I dialed the number I asked her, “Are you in Labor?” thinking my powers of deduction were freaking amazing.

“No!” she wailed, “I have a bug in my ear.”

This was followed by more amazing dance moves. She was doing some impressive combinations for someone in her advanced state of pregnancy. I finally got her calmed down enough to triage.

The offending, Cucaracha was dispatched to a basin. He was humanely drowned in lidocaine and flushed out using the catheter from an 18-gauge IV set up, in case anyone from PETA is reading this.

Documentation was still done with pen and paper back then, which allowed for some poetic license. I charted her discharge “Patient is discharged to home in stable condition, barefoot, pregnant, and bug free.”

Some of my documentation should have won a literary award.

I know what you’re thinking. You want me to tell good stories, not the ones about kids and Legos. What about the adults? They are much more likely to put things where they, definitely, do not belong. They also don’t put a lot of forethought into it.

I have seen everything. Well, maybe not everything. Every time I say that something even more unusual comes in.

I have seen a, Ice Blue Secret bottle, all manner of vegetables, various types of candy, soda bottle, light bulb, various toys, various tools, and the list goes on. In the interest of keeping this brief enough to be a blog post I will tell you a story or two.

I used to work with a Dr. K. who has since passed away. He was older than me by a good 20 years or more. When I worked with him, he was definitely past the age where I will no doubt retire. He had a saying for everything and was an absolute joy to work with.

One night we had a young couple come in. At first it was difficult to get the story of why they were there. As it often does, it all eventually spilled out. They were married, not newlyweds, but nearly so. In a serious attempt to spice up their love life the husband had brought home a book. In this book were suggestions. These suggestions had been heralded as a source of advice about positions, and devices that could really, “Make your bed rock.”

One of those suggestions was to put a superball, in her vagina before they had sex.

For all you young’uns that have never seen or heard of a super ball, it is a hard rubber ball of the variety that you used to be able to get at the five and dime store, or out of a dispenser at the department store, for a quarter or two. They truly did have a lot of bounce.

They had followed the book’s instructions to the letter. They ended up in the ER at about 2 am. Many things are made to be inserted vaginally. A superball was not.

After hearing the couple’s sad tale Dr. K had me set her up for a pelvic exam. The intent was to remove the ball and send them merrily on their way.

Not so fast my friends. Think about it.

Dr. K set about the task with his usual jovial demeanor. He first attempted to use ring forceps but soon realized that, like Julia Roberts, in Pretty Woman, that was one slippery little sucker. He couldn’t get a grip on it. Ring forceps are used for vaginal exams They are long and have round ends that can be clamped together to hold gauze sponges, or to remove a foreign object without damaging the sensitive tissue. They were not, however, designed to grasp a wet rubber ball.

After failing to get the ball with the usual tool, Dr. K turned to me and said, “Judith Ann, you’re going to have to go to the OR and get me some tenaculums.”

Tenaculums like ring forceps have a long handle and instead of rings at the end it has pointed ends so you can get a hold of something very delicately, like maybe a blood vessel in surgery, or a superball.

I made a run to the OR that was empty for the night and searched around until I found tenaculums. We once again went to work.

This time Dr. K was able to get a secure hold of the ball but when he tried to pull it out it created major suction, which in turn caused major pain.

“Judith Ann,” he said, he always called me Judith Ann, “I think we are going to need some sedation.”

“Yes, please!” the patient wailed as she gave her husband a look that would have sent a lesser man scurrying!

This guy wasn’t the sharpest tool in the shed, ( that saying is credited to Dr. K), but I gave him credit for standing by his wife under some very embarrassing circumstances.

“Dr. K. I believe you’re right.” I said as I hurried to get the IV supplies and permits needed for sedation and set about hooking my patient up to monitoring equipment.

The other problem was how to break the suction. It caused a near vaginal hysterectomy every time Dr. K. tried to remove the ball. He gave it some thought while I set her up for some conscious sedation.

He told me he needed a suction catheter. I got him one.

Once we gave her a little versed, Dr. K inserted the suction catheter so that it went past the ball and thereby broke the suction. Then he grabbed that ball with the tenaculums and removed it, just like that,

“Slicker than snot,” Dr. K. remarked.

The ball was impaled on the tenaculum. I thought Dr. K was going to offer to give it back to her husband as he waved it around in victory. I could see it crossed his mind. Then he shook his head and dropped it still attached to the instrument onto the tray with a resounding clang.

“You mind disposing of that for me?” he asked.

“My pleasure!” I said, as I continued to monitor the patient while I cleaned up the mess we had made while trying to get it out.

The young woman’s husband was in the room during the procedure. When I told them both why we were going to give the versed, and how it worked, he had a couple of questions.

I said, “The versed has sort of an amnesic effect. She probably won’t even remember the procedure.”

Dr. K was also in the room and the young man directed his question to him.

“How far back does that amnesia thing go with that medicine?” he asked looking sheepish.

Dr. K. looked at him squarely and with a soft chuckle he said, “Not far enough for you to get out of this mess, Son. If I were you, I would get rid of that book too, and I do mean, Pronto!”

“Yes sir.” He muttered.

After Dr. K left the room, the young man turned to me and said. “The worst part is her parents are visiting. We need to figure out what to tell them when we get back. They were asleep when we left so they may not even know we were gone.”

“Well, you can go stealth. Try to sneak back in without them knowing you left, or you can tell them she had a UTI or something. You had to wait a long time. They’ll believe that. Everyone knows you have to wait forever in the ER.”

The problem was solved but, children. Do not try this at home!

Working nights appear to bring out the best, when it comes to getting things stuck in orifices, where they do not belong.

A young man came in after midnight complaining of severe abdominal pain. He was a tall, slim cowboy looking fella, right down to his wranglers and boots.

His wife was with him and seemed very concerned about him. I overheard her talking on the phone with someone and she said she thought it might be appendicitis.

He was checked in and had an x-ray and labs done.

A few minutes after the patient returned from radiology the doctor called me over to look at the x-ray on the computer.

“Wow! That’s impressive. I have to say that is a first for me,” I said.

After making sure the wife was not in the room and enlisting my help to make sure she stayed out, the Doc wheeled a computer into the room so he could show the xrays.

I stood in the hallway monitoring it for the wife, in case she decided to come back in. I was close enough to the door that I could hear most of the conversation.

The patient’s voice was getting louder, “Listen Doc. I am telling you I am not gay! I have a wife. I have kids. They must have mixed up the x-rays.”“

These are definitely your x-rays. I never said you were gay. I said you have hot wheels in your rectum,” the doctor replied firmly.

The doc stuck his head out the door and whispered to me, “Can you get whoever is on call for colon rectal surgery on the phone? If we don’t have colon/rectal get me general surgery. No way am I going in after those. I am afraid if I try with just a proctoscope and sedation I will do more harm than good.”

"I’m on it.” I said, “but what do you want me to do with the wife?”

“Let her back if she wants. I am not going to be the one to talk to her. That is all on him. Some days I thank God for HIPPA, especially when it gets me out of this kind of conversation. He’s a big boy and he can tell her whatever he wants. Either way he needs to be ready for surgery tonight.”

Yes, this man had used his butt for a parking garage, for not one, or two, but six Hot wheels trucks. I believe the surgeon mentioned in his note later that it was three Chevy, two Fords and a GMC. I was impressed that they were all American made.

A man walks up to triage. I bet you thought I was going to say, “A man walks into a bar.” But this is no joke. It may have started in a bar. Nothing good happens after midnight.

I asked him to take a seat so I could get his vitals. He frowned at the chair.

“I’ll stand if it’s alright with you, Ma’am,” he said politely.

“Well, I won’t be able to get a good blood pressure with you standing.”

I looked up at him. I noticed for the first time that he seemed quite nervous and was shifting back and forth, right foot, left foot. I also noticed, with my super keen assessment skills, that he was wearing very loose pajama pants. They had a significant tent at the groin.

“Alrighty then! Let me take you back to the treatment room. You might be more comfortable on a stretcher. They can triage you back there.

I walked him back to a room and motioned for Jason, one of our experienced nurses, to follow me back.

I returned to triage. About 15 minutes later Jason came out and asked if I knew where the ring cutter was. I told him it was in the cabinet of the Charge Nurse’s office.

Any piece of equipment that we didn’t want lost or stolen was locked in a cabinet in the office for safekeeping.

“What do you need the ring cutter for?”

“That guy you just brought back to room fourteen has a metal ring at the base of his penis and we can’t get it off,” He whispered. " He also has priapism which is compounding the problem.

“No way!” I said.

“Yes way.” He replied.

“Good luck with that.”

He headed back with the box containing the ring cutter. He wasn’t gone for more than thirty minutes when he came back with a strange look on his face.

“What happened? Did you get it off?”

“No way. That thing is like really thick, like a … Well, I don’t know what, but it’s thick and it is solid. NO way to pry it apart, solid all the way around. We tried Joe’s Dremel tool too, but it was getting too hot. We had to quit and regroup.”

“Damn, what’s next?”

“We just sent Alex out to his truck to get his bolt cutters.”

"Seriously? Those things that have like 2-foot-long handles?”

“Yep. One of us is going to stabilize the, uh, appendage while Alex tries to work the bolt cutters to get it off.”

“That is incredibly brave of him. Aren’t those rings supposed to be like, easy open or something? Don’t they come with instructions? Not that I know anything about sex toys, but I’ve read about that somewhere, I think.”

“Yeah, I think your right, not that I know much about these things either.” He said with a grin.

" This guy didn’t buy it from a catalog or a porn shop though. He bought it at Lowes, and it is solid. I mean it is really, solid.””

“He bought it at Lowes. No way! Did he see that on HGTV or something? That is ridiculous.”

About an hour later the patient came to admissions to check out. He smiled and waved his discharge instructions, keeping them up by his face so he could be as incognito as possible as he passed by triage.

I saw Jason a few minutes later and asked, “So, the mission with the bolt cutter was successful? I saw him leaving. By the way, what discharge instructions do you give for that particular injury?”

“The bolt cutter did the trick, but it required excessive force on the handles. Just witnessing it made my gut clench. As for the discharge instructions… I free texted those. Basically, it says stay away from Lowes!”