On a busy medical ward in Scotland, a fierce battle was emerging between the smell of antiseptic and the noxious odours emitted by Mrs. Jones, a ninety year old whose reeking side room was strategically positioned opposite the doctor’s office. Beyond Mrs. Jones’ window lay lush Scottish hills, rising and falling seamlessly into one another – where the air was moist, invigorating and saturated with the more pleasant natural fragrance of peat – pure peace.
Multicoloured blood bottles in hand, I scurried to my office to finish discharge letters, when I was halted midstride:
“Doctor, Mr. Smith hasn’t moved his bowels for four days and is uncomfortable, can you review him?”
Wonderful. Just what every newly qualified doctor wants to hear – an old guy not moving his bowels – probably constipation. After all, eating delightfully underwhelming hospital meals, drinking a token amount of stale, plastic flavoured water, and lazing around in those rigid ‘beds’ would probably make anyone constipated. No big deal – laxatives will sort that out. What the concerned nurse implicitly queries, however, is “could Mr. Smith have bowel obstruction?”
What is involved in assessing bowel obstruction?
Oh yes – the good old rectal exam.
Now, I didn’t undergo seven years of university to put my finger up a bum – if that was my goal, I would have become a politician. (Joking, I love politics – the hospital is full of it – really, I’m not even being sarcastic…not…one… bit).
This poses a dilemma. With a scroll of afternoon jobs, inevitably taking you hours past five, a doctor will re-prioritize. A finger up the bum, or finish that discharge? Possible bowel obstruction trumps most paperwork, which, to your index finger’s surprise, means that Mr. Smith will be seen promptly.
Decision made, it’s time to locate that wonderfully slippery KY Jelly. Lube. Next, ensure you’ve got gloves – two pairs – so if the first pair fails, you’ll save your friendly right index finger from a vigorous scrub down afterwards. Better to be safe than sorry. After you’re gloved up and have the lube, make sure you have something to shove under the bottom of Mr. Smith… in case there’s an accident. Paper towels will do.
Where is Mr. Smith anyway? After analyzing the ward layout at the nurse’s station, the simplicity of the name SMITH quickly distinguishes itself from the assortment of Eastern European names.
Off we go, down the hall, last bay on the left.
Even in a four-bedded bay, it is possible to lose your patient, even though there are only, well, four beds. Luckily for your exhausted mind, patient surnames are written above the beds.
With gloves on tight (two pairs, remember), lube and a nice wad of paper towels (just in case, you know), it’s time to chat with Mr. Smith:
“Hi Mr. Smith, how are you? I hear you’ve not had a bowel movement for a while?”
Next, pull the one-millimeter thick, ultra soundproof curtain around the patient’s bed, ensuring maximum ‘privacy’.
“Sorry doctor? I didn’t quite catch that”.
“You’re bowel motions. I hear you’ve not moved your bowels recently, and you’re in pain?”
I move into position.
The bemused gentleman quickly sits up at guard. You question whether the nurse informed you of the right patient.
“I’ve just been to the toilet, Doctor, it was fine, never been better”.
OK. You definitely start questioning the nurse who gave you this spurious advice.
Bailing out from a tactical position, your right index, double-gloved finger, seemingly retreats independently:
“Right, well, guess I don’t need to examine your rectum then!”
More silence. But this time, Mr. Smith exhibits a perfectly executed smile, as though it had been rehearsed a thousand times, a piece of art, which read like a Dickens novel:
“Don’t point your finger at me, Son”.
Sheepishly, you pull the curtain round again, exposing Mr. Smith to his three wrinkled roommates, each of them hosting a unique smirk on their respective faces, suggesting that the curtain wasn’t at all soundproof.
Following the action of the index finger, quietly retreat out of the four-bedded bay. Head down the hall whilst brewing up a pleasantly harsh concoction of words from the deepest dark corners of your brain – for the nurse who misdirected you. The nurse, who you’re surprised hasn’t sprung two little horns from her occiput, sneaks into her office. Before proceeding to catch your prey, you hesitantly double-check the ward layout.
You are correct – SMITH is indeed in the bay at the bottom of the hall, on the left. Your eyes continue to review the ward layout, trying to solve the conundrum, though you, being a doctor, figure the nurse must have got the name wrong.
This time it appears at the bottom of the hall, on the right.
With your double-gloved hands, lube and wad of paper towels, you head down the hall again. On the way, you catch a glimpse of the nurse in her office, who seems to have got rid of those two little things poking out of her occiput.
There it is, written above the patient immediately as you enter the bay at the end of the hall…. on the right.
Doubtingly, you consult the patient:
“Ummm…Mr. Smith? Have you been having trouble with your bowels?”
As you grasp the lube tight and commence the curtain ceremony, Mr. Smith responds in his thick Glaswegian accent:
“Aye! Aye doctor! Aye!”
Now, Mr. Smith wasn’t actually looking for an ‘eye doctor’…I don’t think so anyway…if he was looking for an eye doctor, then I’m sure to this day he’s wondering what the heck happened subsequently.
Lacking faith in those curtains, I informed Mr. Smith of the inevitable, as I tried to find an optimal decibel such that only his two mature ears could hear what the other six were hoping to capture.
End of bed inspection revealed a rather well looking gentleman. Jolly. Curvaceous. Nervous.
Palpation of Mr. Smith’s abdomen with my cold hand induced an abdominal jerk – which relaxed exponentially as my palm stole warmth from his tummy, allowing me to examine his very own Scottish hills. Unfortunately, the essence of peat was lacking in this environment, as the skinfolds formed fetid fungal fleshy valleys. Ignoring the odour, I conquered my own gut reaction – for professionalism, but more importantly, for the human being – Mr. Smith.
As I withdrew my hand, I could see the fear in Mr. Smith’s eyes of what was to come. He was wishing my healing palm was still examining him – the placebo effect. In his best interest, I moved south.
It was time…
“Just bring the knees a bit closer to the chest, Mr. Smith, makes it easier”.
Mr. Smith awkwardly adopted a fetal position, and though a large man, emoted the vulnerability of a small child. I then carefully stuffed the paper towels down between the pristine white hospital bed sheets and his…well…not so pristine bottom.
It was then necessary to pry the hanging buttock upwards with the back of my left hand – the weight of tissue being sufficient to strain my left forearm. The previously obscured anus was now in view. Once Parkinsonian, my now steady right index finger moved closer and closer to the target – with Mr. Smith’s permission of course. A wink was exhibited – a puckering, like when you stick your finger into a sea anemone when you’re a kid – except with the anemone, your finger comes out cleaner. Unable to see his face, the circumferential force distributed equally along the entirety of my right index finger suggested a certain degree of anxiety.
Despite this, we mutually proceeded.
Withdrawing the finger from the rectum, an examination of the most primitive of medical tools confirmed a blood red absence. Whew. The anal action observed just moments before was then reciprocated by my nostrils due to the overwhelming stench of feces in the air. A once white double-gloved finger now resembled finger fondue…or, simply, a finger covered in poo.
“All done, Mr. Smith…”
After wiping his bottom clean with those handy paper towels, I helped the truly gentle man pull his PJs up over his bottom, restoring his dignity. A faint smile indicated appreciation for my work whilst revealing an understandable embarrassment. I mirrored him.
A real moment, we realized.
Our odd, intimate, mutual journey had been completed.
Constipation. Usually is. Never want to get caught out though.
As I had done with the first Mr. Smith, I pulled the curtains round the bed, and, once again, noticed smirks on the roommates of the second Mr. Smith. Passing the nursing office, I noticed the nurse I had spoken to earlier, who seemed to have grown a small pair of wings on her back.
Life is funny.
Life is also perpetual.
So if you get seen by a doctor wearing a suspiciously thick pair of gloves, holding a tube of lube and wad of paper towels, just lay back, relax, bring those knees to the chest, and then….
*Names have been altered for patient confidentiality purposes