All's well that ends well...

When people hear that I'm an emergency physician, they inevitably ask, "What's the grossest thing you've seen in the ER?" It's a fair question, but what grosses out the average person doesn't bother me at all. I love to open abscesses because of the feeling of satisfaction that comes with each milliliter of pus that pours out. The awful smell just enhances my joy. But now, I have the greatest gross story ever!

Last week, the local police did a raid on a known drug house. Three of the inhabitants thereof surrendered immediately, but the fourth, who later became my patient, barricaded himself into a bedroom. The SWAT team was called in (a little overkill if you ask me) and they broke down the door. Upon entering the room, the police observed future-patient swallowing several packets of cocaine. They brought him to me for "medical clearance" for incarceration.

Let me clarify "medical clearance". A few years ago a local police district had a man die in custody. It was discovered that he had been highly intoxicated and likely choked to death on his own vomit without anyone noticing. Since then, all suspects who are apprehended are brought to the ED for medical clearance. This supposedly takes any responsibility for the patient's welfare off of the police and shifts it squarely on to my shoulders. I even have to see people with no complaints! What am I clearing? I haven't the foggiest.

However, this was a legitimate clearance issue. If the cocaine packets burst inside future-patient-now-current-patient's intestines, he would die very quickly. The patient was also completely crazed on cocaine. He was brought in with his hands cuffed behind his back, screaming obscenities, fighting with everyone, wearing a layer of cocaine powder around his lips (think Dave Chapelle's drug addict sketch). He freely admitted to using "crack, percocet, xanax, and cough syrup with codeine". When I asked about heroin, he got very defensive and told me, "Hell no! I'm a man of god!" We all have our criteria. In any case, it was obvious to me that this man was not going to cooperate with the flushing out of the cocaine packets and wasn't in a mental state to make coherent decisions. His heart rate was 160 and his blood pressure was through the roof. His veins bulged out of his forehead. We gave him some powerful sedatives and he soon conked out. A tube was inserted through his nose into his stomach. We administed what is called "go-lytely", which is an agent that cleans out your intestines really fast. People take it the night before a colonoscopy to give the doctor a squeaky-clean view.

Two hours later, he still hadn't pooped. I listened to his abdomen, which sounded like a volcano getting ready to erupt. The nurse kept checking to see if he had gone. About an hour later, the nurse checked the patient's bottom and saw something sticking out of his rectum. This brave nurse pulled out the object and found himself holding a little baggie with a bunch of money rolled up in it. What a good place to hide your cash! I have always used a wallet but am reconsidering. The nurse had little time to celebrate, though, because he had taken the proverbial finger out of the dyke, and poop flew everywhere! It was all over everything and everyone. And THAT is the grossest thing I've ever seen.