22 February 2011

That Feeling Deep Inside (originally 14 February 2011)

I recently sent an email to some colleagues at the hospitals where I work promising one lucky winner an advance copy of my book, Between Expectations, available now on Amazon and soon in bookstores everywhere in exchange for their thoughts on love. Now this was a shameless self-promotional plug, the equivalent of screaming on a street corner, "I wrote a book! Please, please notice me!". But it was not as shameless or self-promotional as Valentine's Day is for companies like Hallmark. So I did not ask their thoughts on love of the existential, Dawson's Creekvariety. Rather I asked what were those presenting complaints that bring a patient into the hospital or Emergency Room that make them scramble to claim that patient as their own.

I expected disagreement on the subject.  Surely there would be some inherent personalilty traits that would make particular doctors or nurses excited by the broken femur but repulsed by the vomiting and vice versa. I never expected an overwhelming consensus, but I got one.
What is that one thing, that tantalizing mystery, that compells more medical personnel to elbow interns and residents out of their way in order to be the first person into a patient's room than any other? Simply put, Foreign Body.

Remember, I do not take care of adults. When children stick something where it does not belong it is not gross. It is adorable.

A few examples may help me make my case. A six-year-old walks into an ER. She woke to find she must have swallowed one of her teeth, which the day prior had been loose. It was not in her bedding. It was not on the floor. She was distraught, in a frenzy, convinced that it was stuck in her throat. It was not. She still would not stop crying.

"What's wrong, sweetie," her treating physician asked, kneeling before her.

"Will the Tooth Fairy still come?"

My own patient, years ago, an eight-year-old with a bead in each ear. She had misunderstood a magic trick in which she was supposed to hide the beads behind her ears, not in them, and now she could not get them out. I looked (one was pink, one was blue) and determined I could easily retrieve them. But first I left her room to present to my attending, like the good little resident I was then, and told him the story. He went in to look for himself and confirm my assessment. When he came out he had the beads with him.

Now this particular attending is actually a very good teacher. On other occasions he had helped me to perform a sundry of other procedures. So I have often wondered what possessed him to pilfer an intervention of so little acuity, something he had likely done countless times while I myself had had the opportunity to do only a few. Now I understand that he just couldn't help himself. It was beyond his control. Love makes you powerless. I get that now.

This is not only a recent phenomenon. Last weekend in Chicago my husband noticed that one of the balls in a clear plastic box his parents had on a living room shelf - a game that you tilt and shake in attempts to coax the balls into the shallow depressions on the bottom of their enclosure - was black instead of silver.

"Does this open?" he asked. "One of these is different from the others."

"It's not supposed to open," my father-in-law told him, "but one of your cousins got into it anyway and then swallowed a ball."

There was a pause. My husband took a deep breath.

"And you replaced the ball with this black one?"

"No," his father told him, "it had turned black by the time it came out."

My husband pursed his lips and put the game back on the shelf.

Then, earlier this week, our local news had a story on a puppy who had swallowed a foot long drumstick (the musical sort, not from poultry) that needed to be surgically removed. Scout slept angelically on the daybed next to me.

"Wake up," I said, shaking her. "Pay attention. This is why you don't chew on things that are not yours."

But it was no use. By the end of the night we had lost yet another stuffed creature, this time a cow, to her ferocious puppy jaws. There were tiny dollops of silicone and gossamer trails of stuffing all over the dining room floor. Then, the following morning, there were two piles of steaming dog poo behind the kitchen and right at eye level since we have had so much snow. These too were decorated as if with sugary sprinkles and it took me some time to realize that they were the same silicone pearls I had swept up so many of the night before.

"Better out than in," I said rather cavalierly.

In reality, though, I had been more than a little crazy when the cow went missing since it had magnets in each of its four little legs. If Scout swallowed more than one of them, or if they were left on the floor and Emmaline ingested them, then that was an emergency. Click they might go, across the wall of the dog's bowel.Click they might say, ripping a hole in my baby's ileum. So, yes, I spent more than a few minutes sifting through the carnage underneath the dining room table, ensuring that I had found every last one.

Still this brush with disaster did not make me any less gleeful when I was called the following day about a young patient who had swallowed part of a necklace.

"Send her over," I told the referring physician. "We'll see where it is."

We did. It had passed safely out of her chest and into her stomach, obviating the need for any intervention. I showed her the films. Then I sent her home with x-rays in tow so she could show each and every one of her friends the things she had deep inside.

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