Surgery Clerkship Part Two

Patient (Pt) is coming in for colonoscopy and hemorrhoidectomy under general anesthesia. After lying down and going to sleep, the patient is rolled onto his stomach. The bed contorts with the whirring of engines to drop his legs down and lift his ass proudly to the Heavens. We pull his legs apart and place them into the anal stirrups. Two physicians (HPS and Brian) are sitting on stools between Pt’s legs for the show. Tape is applied to each ass cheek and then pulled around the bed for even “better” exposure.

The hemorrhoids are enormous and angry looking. They are each cut from the anus and the incisions sewed together. Brian, under the supervision of HPS, grabs the colonoscope. The c’scope is then fed into his rectum and maneuvered past the sigmoid colon, snaked around the splenic flexure, pushed along the transverse colon, and then descends down the ascending colon for a a good look at the cecum. No polyps or other masses. Everyone is happy. Brian pulls the colonoscope out of the colon, HPS leaves the room to dictate the operative note, and I begin taking down the drapes. Brian takes off his sterile gloves, gown, and plastic face shield. I lean over the patients back to release a clip holding the drapes in place and my weight compresses the patient.

PHBLLEEBBTHURUUUURP!

During a colonoscopy, air is pushed into the colon to inflate it for “exposure”. As the colonoscopy is finished, this air is typically sucked out so as to leave the Pt as comfortable as possible when they leave. Brian forgot to do this.

The shit sprays everywhere. On his cheeks, his eyelids, his forehead, arms, and neck. It turns his blue scrubs brown. The anesthesiologist screams. Brian is on the other end of the room, having kicked himself reflexively from the patient on his sliding stool. In fact, he’s still coasting towards the far wall as we watch him panic, trying to find a poopless place on his body to wipe away the poop on his body. He can’t find anything. The panic sinks in its teeth.

“Somebody HELP ME!” But we’re the ones that need help. We’re twisted in knots, fighting for gulps of air as we struggle against the laughter. We’re not even human right now: the laughter owns us. The patient begins to wake up. Hearing the commotion, HPS reenters the room.

“Oh GOD!” And HPS leaves the room to dry heave in the hall. It’s been 40 seconds since my last breath and my chest is starting to spasm. I can’t tell if we’re even making noises anymore or if we’re all quietly dying of laughter.

The scrub nurse walks over to Brian and, afraid of the hand-off, throws a towel at him. He begins to wipe himself clean. The patient is awake now with the embarrassment that only a person with his asshole winking at a room full of laughter can ever truly know. Brian has wiped his face and is now storming to the wash room to clean himself. He walks by the head of the bed and the patient pieces it together.

“Oh, I’m so sorry if I pooped on you.”
Brian manages an “It’s okay” before walking out.

From the halls, we can hear the heavings of HPS start up again.