Sweet as Sugar
First day of surgery clerkship. I was feeling very authentic in my new cerulean scrubs but less so in my abbreviated version of a white coat with pockets abounding bilaterally with what resembles 20 pound dumbbells to an outsider. Most of the day was spent in a haze of confusion; wasn’t there a manual for this adventure? Side note: There was, I just have problems reading directions. It wasn’t until the next week I cracked open the packet labeled “Surgery Clerkship Manual” I received during orientation that I finally got more of a handle on things.
The resident’s pagers goes off followed by an eye-roll. “We have a consult in the ED, prolapsed ostomy, med students go.” Prolapsed ostomy, I had to see this. Of course this wasn’t important enough for the actual surgery doctors to investigate so they sent the three medical students to clean up the mess. I quickly learned that a “surgery consult” actually translates into “bullshit consult.” They hardly ever climaxed in us performing surgery or even needing us to see the patient.
We arrive in the ED. Better check the chart so I know the proper leading questions to set up a seamless H&P. The patient’s PMH looked like he had gone to the Axis 1-5 buffet. History includes schizoaffective disorder, substance abuse and he’s homeless. This is a perfect recipe for a shitty ass interview. We approach the patient and examine the situation. We pull back the sheet and unveil approximately 8 inches of colon that has spewed out of this man’s abdominal cavity, uncontained, and openly draining stool. The interview proceeded as smoothly as his colon had popped out of his body. I had never encountered a patient that was not alert and oriented X3 and had always wondered how I could assess that a patient was not. Well I found the answer to that question quickly. It was like trying to get answers out of a toddler with raging ADD and an alcohol problem.
Phone calls to a half-way house, rehab facility and his mother assisted in piecing together something that resembled a medical history. What we had deduced was that in a fit of mania this man pulled off his ostomy bag and tried to attack a fellow boarder at the half way house with his exposed colon. This guy was insane, or maybe he just watched one too many episodes of Game of Thrones and grabbed the closest thing to him. Personally, my first weapon of choice would be something a little less flimsy/mucus laden than my colon but hey, YOLO.
Having a history we still had our initial presenting problem: how do we retract this colon? It’s not like this is a google-able question right? The med students stood there for about 10 minutes just staring at each other, trying to seem as though we were formulating a plan (common med student tactic when you’re clueless). Eventually, a random resident must have smelled our inexperience and mosied over. “Oh, prolapsed ostomy. Just sprinkle some sugar on it.” Haha, very funny dude, do you realize I’m trying to impress my chief on day one? A few minutes later another resident walks by, “Just slather some sugar on that bad boy.” Is this “fuck with the new 3rd years day”? It took about 3 other residents suggesting we turn this guys exposed colon into a pixie stick when I realized they were actually serious. “Haven’t you ever put salt or sugar on a slug when you were a kid?” they asked. Um, well yea…but a slug slightly different from functioning organ right?
I kept thinking I was starring on the surgery clerkship version of Punked as I made my way to the cafeteria. All of a sudden my attending, who I had never actually met, was going to pop out from behind the bagels giggling how I failed 3rd year for entertaining the idea that these nutjobs were serious. I reach the condiments section of the cafeteria. Did his PMH include Diabetes? Sugar or Splenda? Jesus girl, this guy isn’t on a diet, we’re trying to reduce a colon here. I grab about 20 packets of sugar. Is this enough? Like this was a question there was a legitimate answer to. Better grab 10 more for good measure.
I see a fellow 3rd year on the internal medicine service. “What’s up with all the sugar?”
“You wouldn’t believe me if I told you,” I responded.
We arrived back in the ED, colon is still flopping freely like a flaccid male fallice. Next thing I know we’re ripping open packets of yellow Domino sugar and slathering 10 inches of intestine, transforming it into something out of Candy Land. This continued until the point that if heat were applied the entire ED would have had cotton candy. We were a ferris wheal away from being a three-ringed circus. Now we just have to wait, and put an ostomy bag on this thing.
Ten minutes later to our surprise the prolapse had reduced! It wasn’t perfect but it was a start. The Diazepam had begun to kick in and our patient seemed to have calmed down to the point of reason (this is relative in psych patients). At least he wasn’t trying to go Robb Stark on us GI style. Even reduced this was like fitting a square peg into a round hole. We worked on it for another ten minutes until we decided this slug just needed a bit more time.
We went about the rest of our day, changed dressings, drained an abscess. All the glamorous scutwork of a surgery clerk. The time came to check in with the ED resident on our pixie stick I had such high hopes for. Somewhere down the line the diazepam had worn off. Not only did Mr. Skittles continually remove his ostomy bag but he eating the sugar off his colon. How dare he tamper with my glucose-encrusted masterpiece! Besides being disgusting I was quite disappointed, betrayed. I spent a good portion of my first day of rotations turning this man’s intestines into a saccariferous monument and this was how I am repaid. If anything, I came out of day one with a good story and an aversion to adding extra sugar to my coffee. I found Domino sugar packets in my coat pockets for weeks.