How I spent my Friday night

Sometimes I really feel like I don't get paid enough for what I do.

It's Friday night, and I'm at work (problem number one: it's Friday night, and I'm at work and everyone else I know is at a braai/pub/party watching South Africa squash England), and I'm seeing a patient who's been moaning 'help me, help me' for the last three hours, trying to work out what his problem is.

It turns out he has several: he's had three previous strokes, and he's extremely spastic on his left side. He also has bladder outlet obstruction, and therefore can't pee, and his suprapubic catheter has fallen out, so he's been backed up for three days. But his most pressing problem, as he informs me, is his bum.

'What's the matter, sir?' I ask him, 'What do you need help with?'
'My bum, my bum,' he moans.
'What about your bum?'
'It's sore' For some reason he then elects to pull my hair.

I notice in his folder that nobody's ever tried to establish why he has outlet obstruction, so I decide to do a rectal on him, as an enlarged prostate might be blocking the pipes. This is where I discover problem number two: a nappy full of poo. The nursing staff is already overbusy, so I decide to take the nappy off and clean him up myself. I do this sort-of ok, and then try to wipe away the one last piece of stool lurking at his anus so I can do my PR. What comes away is a baseball-sized chunk of faeces, followed by a river of overflow diarrhoea (definitely problem number three). Mr Help-Me breathes an immense sigh of relief, while I desperately fight my gag reflex, and deposit the prize in the bin. My concern for the nursing staff's over-business vanished, I inform a nurse that he's soiled the bed and ask her to clean it up (my respect goes out to all nurses out there: you definitely don't get paid enough to do what you do).

After the nurse has cleaned up, I go back to Mr Help-Me. I notice he's still leaking a bit PR, but feel his prostate anyway (ten points to Karen for thoroughness). I then prepare to put his suprapubic back in: a suprapubic catheter involves boring a hole through the skin, muscle and bladder above the pubic bone. It's pretty painful, but the patients you perform this procedure on can usually be counted on to thank you profusely afterwards, as they've usually got two or three days worth of urine stuck inside.

Mr Help-Me, however, does not thank me at all. He instead smacks me repeatedly over the ear with his good arm (problem number four), yelling 'Eina! Jou moer man! Fok, jou donder! Bliksem!' (I'm sorry, there is no english translation for this kind of cussing) for the duration of the procedure. After the catheter's in, and his urine's streaming out, I ask him if he feels a bit better. He looks at me blankly. 'My bum is sore,' he says. I decide to go check out the next patient.

I hope you all had a good weekend - don't forget to check out Surgexperiences 104, a surgical blog carnival, hosted by Bongi over on Other Things Amanzi this week.