Postnatal Checks

Having been on obstetrics and gynaecology, I have had to do a fair few postnatal discharges as a resident.

These postnatal discharges are quite repetitive I must say, in that it’s always the same questions. You find out how they delivered their baby, what blood group they are, whether they are rubella immune or not, what complications arose in labour etc.

With any woman that has had a 3rd or 4th degree tear, they have to had opened their bowels before they are allowed home. In addition, they must be getting regular laxatives (usually lactulose) while as an inpatient.

Around the time of Christmas, I see a woman who had a 3rd degree tear. She hasn’t passed bowel motions for the last 5 days. Reading through her notes, she’s been seen by previous residents, even had a general surgery consult in regards to exclude any anal dysfunction. I panic at the prospect that I have to see her.

I eventually decide that I need to see her everyday, after looking at the anus, and noting normal anal tone. She tells me that she’s starting to get abdominal pains, and I think I can feel the poo in her tummy on palpation. Poor thing.

For the next 3 days, I see her every day, always asking if she has pooed yet, and if she has passed wind yet. Still no. It’s about 2 days out from Christmas. The patient informs me “I really do hope that I pass a bowel motion soon. My wedding anniversary is on Christmas.”

I make light of the situation (it’s too good to pass) “Oh goodness. I sincerely hope that you won’t be in hospital waiting for a poo on Christmas and on your wedding anniversary!”.

Pumping her full of laxatives, the patient questions my medical management. “Is there anything else you can do aside from just giving laxatives? I mean I’m really concerned something bad is happening”. I reassure her that the abdominal x-ray series has excluded a bowel obstruction, and that we are giving optimal medical management.

“There is no other alternative aside from either manual disimpaction or inserting a tube up your anus to flush the poo out. But with your 3rd degree tear, those aren’t really good ideas”. The patient almost faints after I explain manual disimpaction, wriggling my index finger. “How will the index finger get the poo high up out!!!???”

I think I was enjoying myself too much teasing this patient. Not in a mean way, but in a light hearted way so as to make the situation less serious.

After seeing her on the 3rd day, news gets out that she has some incontinence. Only a few mls according to the patient however. An hour later, and she has opened her bowels with a massive amount of faeces. I try to see the patient to congratulate her, but she seemed pre-occupied in the toilet. Unfortunately, I wasn’t able to see the patient as I had to rush off to the clinic. But I’m proud of the laxatives I gave this patient.

I feel happy for the patient. At least she doesn’t need to spend Christmas and her wedding anniversary waiting for a poo.

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The Patient Did What???!!!!

Perhaps one of the most “ewww” inducing factor I had come across happened to one of my patients. And it’s not very frequent where I go “ewww” because of a patient’s actions, but this one patient really did it for me.

So, having arrived at the psychiatry ward right after morning meeting, I go about my business ready to start my task of mundane ward jobs. One of the nurses approaches me, and I know that she wants to talk about the patient she’s looking after.

“Oh yea, I was wondering if you’d be able to write up some laxatives for Mrs A. She states she’s been suffering from constipation the last 2 days. ”

I reply “oh yea, so has she still been unable to open her bowels this morning?”

“She went to the toilet this morning. But she states that she had a lot of difficulty, and used her fingers to manually evacuate.”

“Manually evacuate”

I couldn’t help but let a wide grin form on my face. The patient manually evacuated because of constipation. It just doesn’t seem right when a patient does it.  I mean, I’ve done several rectal examinations (with gloves of course), but a patient doing a manual evacuation was just somehow very gross.

I saw her later that day, and asked about her bowel habits.

“How have your bowels been lately?”

“Doctor, they havn’t been to great. I tried to go this morning, but I’ve been really constipated, so I had to use my fingers.”

I fought back laughter, and tried thinking of lots of sad things to prevent myself bursting out into inappropriate laughter.

“Well, I can put you on some coloxyl and senna and some movicol”.

Whenever I see this patient now, images of two fingers manually evacuating faeces always conjures up. I can’t help it. I don’t know why after having done probably 20+ rectal exams, it’s only been this one patient that brings up such a strong image of fingers up bottoms.

How I Handle Nudity

If you were to handle a nude person, how would you go about doing so?

I never considered this question before, but when circumstances put you in front of a nude person, you try and do your best when it is a wholly unexpected situation.

And so it was, she a female in her 60’s, completely stark naked in front of me. Being in the common area, patients and nursing staff were around.

All I had asked for, was to have a quick look at the rashes on her thighs that were present yesterday. I was warned by nursing staff that “she’s not wearing any underwear”. Bearing that in mind, I thought it would be appropriate to ask her to return to her room where I could examine the rash on her thigh. But bringing up the subject of the rash, she went off.  Asking her about the rash led to one thing after another, then she started hammering her fist down on the table, appearing more and more frustrated.

“If you want me to take my clothes off, I’ll do just that!” And just like that, she removed her top off, to expose her naked body right in front of my very eyes.

“Please put your clothes back on” I said calmly. She refused to do so, and fortunately with female staff around, they eventually helped persuade her back into her clothes.

I felt embarrassed and shocked at the same time. Before retreating to the doctor’s room while she stood naked before me, I made sure to take a good look. That way, I got to see her rashes on the thigh had definitely resolved.

Guess what this patient had? She was bipolar, and manic.

Good heavens, I hope I don’t need to deal with another naked patient in psychiatry. But then again, anything goes in psychiatry…

When My Registrar Irrigated a Urology Patient

There are some things in medicine that just stick with you for the rest of your life. It’s something that you won’t forget. Perhaps something so different to the normal routine of things seen, that it just jumps out at you.

For me, that was yesterday. Doing the urology ward rounds with my registrar, we came across a gentleman who had urinary retention secondary to haematuria and possible clots. This gentleman had a catheter, with bloody urine draining into the catheter bag. Just the thought of blood in urine ….. Gives me the creeps

Anyway, I stayed holding up the bag connector tubing while my registrar vigorously irrigated the catheter with water. Squirting water in and withdrawing water. The first few sucks yielded nothing. She pulled slightly on the syringe, but it was unyielding. “I’m going to go a bit rougher”. And with that, she gave a vigorous squirt of water, and a massive effort withdrawing the plunger, and pop! Clots, lots and lots of clots out into the syringe. Admidst cheers of the gentleman who cheered her on “oh yea, come on, you can do it! You got this Doctor!”

I contemplated how funny the situation was; a female registrar breaking up clots in a mans bladder, while the man cheered her on in an almost orgasmic tone.

With clots and blood dumped in a bucket, it was probably one of the most disgusting things I had seen during medicine, and I’ve seen and done lots of disgusting things (Bloody PR exam anyone?).

Anyway, it’s something that’s going to stick with me for a very very long time. Good dinner conversation too

🙂

Medical Lexicons Thrown Around In Hospital

In medicine, there are essentially new words and terms to learn. It’s like a whole new language you have to learn.

Below are some of the more interesting terms and abbreviations we doctors throw around verbally and write in medical notes all the time:

 

BIBA – Brought In by Ambulance

I have just seen a 90 year old male BIBA, who came off his Harley Davidson doing 160km/h on the highway

DDx – Short for Differential Diagnosis

Med Student 1: Um, the medical notes have a heading DDx, and then just a list of medical conditions. What does DDx stand for?

Med Student 2: That stands for differential diagnosis – it’s essentially a list of the most likely medical diagnoses based on the history taken.

DRE Short for digital rectal examination (same as PR)

ED Consultant: The patient in bed 3 hasn’t passed bowel motions in over 10 days. Let’s get one of our interns to perform the DRE on that patient *high fives the other ED senior doctors*

Drip – Cannula (a piece of plastic tubing inserted into the veins to allow blood access for administration of medications)

Intern (speaking to patient): Ok sir, I’m going to need to give you a stab to put this drip in

Patient: You’re going to stab me? That sounds really painful!

Intern: Oh, terribly sorry if I scared you. I meant I’m going to insert this needle into your vein, and leave behind a plastic tubing so that we can give you fluids.

Perf – Short for perforation

On review of the patient’s X-ray, free gas was seen under the diaphragm. The patient has probably got a perf, probably from his peptic ulcer.

PMHx – Short for Past Medical History

Med Student 1: I don’t get it. The notes have PMHx and just the patient’s current illnesses. What does it stand for man?

Med Student 2: Past Medical History. It’s just a list of the patient’s current illnesses.

PR – Short for per rectal (a rectal examination)

Intern (to another intern): Ugh, just had to do a PR on a patient who hasn’t defecated in 10 days after being co-erced by the consultant.

SOB – Shortness of breath

I saw a 55 year old gentleman that presents with acute onset SOB on a background of a 40 pack year smoking history…

Stat – Instantly

That 55 year old gentleman is severely dehydrated from diarrhoea! Give him a fluid order, STAT!