The man was having a heart attack, and I was putting a breathing tube down his throat so a respirator could breathe for him. He was already unconscious. "Here, put this on, sweetie," the nurse said. I sighed but lifted my head anyway so she could hook the elastic straps of the plastic shield face mask over my ears. No sooner had I put the laryngoscope into his mouth than the man wretched and his vomit covered my face shield. Keeping my hands where they were, I turned my head back to the nurse, who took off that mask and replaced it with another, and then I finished the intubation.
I am as disgusted by vomit as you are. But in settings such as this one, I am not allowed to act on that disgust. If I didn't shut down some aspect of my sensory and emotional input, I would be wholly ineffective. I don't believe there is some type of person who is born able to handle revolting situations. I will grant that I may be toward one end of the spectrum—I enjoy popping zits (not mine, of course), and the only movie I ever closed my eyes in was Species II, which incidentally also happened to be the worst movie I ever saw. And, it's true, being in a medical setting has changed me somewhat in this regard: The words "diarrhea" and "penis" no longer make me giggle. Also, come to think of it, last night, Beth and I kept on eating French fries with mayonnaise as the admitting resident graphically explained to us why she thought a patient's bed sore was infected.
But, bottom line: What's gross to you is gross to me. I think we all just step up to the plate when we need to, like those mothers who they say can lift a car to get it off their kid.
[Please note—the following story is graphic and may be disturbing.]
Maria Alvarez came into the E.R. one rainy Monday evening complaining that she felt something in her vagina. Her last period had been "a while back," she guessed four months, and she thought she might be pregnant. A quick urine test confirmed it, and I brought her into the examining room. She said she had the sensation of "something there," but had trouble describing it further. I asked her if there had been any discharge or bleeding, and she said no. She also said she wasn't in any pain.
I set up for the exam and positioned myself on the stool at the foot of her bed. Her heels rested in the stirrups and a sheet lay draped over her thighs, a thin barrier between us. I'd inserted the speculum about an inch when I saw something I couldn't identify. It was dark green and marble-patterned, almost like a thick leaf. It was wet, slippery wet, and when I poked it with the probe, it smushed in. What was it? What was inside? I tried to pinch it with gauze-covered fingers but couldn't get any purchase. Finally, I used a clamp and grabbed the middle of it with the blunt teeth.
Whatever it was, it popped.
As I sat there between Maria's feet, a water balloon's worth of hot thick yellow fluid came jetting out of her. My stool was just high enough that the fluid didn't hit my face but instead coated me from the neck down. When it popped, Maria made a noise, an "Oh!" and then said, "What was that?"
God bless the sheet. Maria couldn't see me sitting there soaking wet, mouth agape, eyes wide, lungs full, about to … about to …
I couldn't. I couldn't say "Holy shit," or tell her what had happened, or throw up. "Um," I cleared my throat to stifle the quaking in my voice, "Everything's OK, there's something … uh, I think there's something here, just a minute and I'll take a look."
I opened the drawer behind me and pulled out a pile of maxi pads, mopping my neck with them before pushing them down the front of my shirt. I grabbed another handful and tucked them in my wet scrub pants. All the while limbo-ing so as to stay below the sheet wall.
"OK," I said, taking a deep breath and moving on, "Let's see. You're going to feel the speculum again, OK?"
I readjusted the snake-y light to direct its beam into her vagina. I opened the speculum further. There, stuck partway through her cervix was a tiny pair of legs and a little butt, surrounded by the folds of the burst sac. I completely froze.
She was miscarrying. I think. All of a sudden I didn't know. Maybe she was giving birth. Last period, about four months ago. Four months … 16 weeks. Is a 16-week-old fetus viable?—No. No way. Definitely not.
I didn't know.
I wanted to cry, to throw up, to scream. At the very least, I wanted someone else there, someone to reassure me I wasn't going crazy, to tell me what to do because I had forgotten everything I knew.
I feel sick remembering this story. It was terrible. The little baby with its tiny little feet. The mother, losing her baby after 4 months of feeling it inside her. I wanted to bury my head in my hands and cry.
The patient cried out at that point. "Ow!" she said, "Something hurts."
"Ms. Alvarez, I think you may be miscarrying. Don't worry, I'll take care of you."
Her pain snapped me into action. Thankfully, thankfully, there was a phone right next to me on the wall, and I picked it up and paged the gynecology resident.
When he called back, I explained the situation quietly, and asked him what I should do. This was apparently a somewhat routine occurrence, and he immediately and clearly explained how I should get the baby's body all the way out. Before hanging up, I muttered quietly, "Bill, is there any way this fetus is alive?"
"Oh, no, no way," he answered, laughing slightly. "You just take it out, and I'll be down there in a while."
I couldn't do what he told me to do. I did try to gently pull on the legs with the blunted clamp, but stopped when Maria cried out again.
The story ends with the gyn resident coming down faster than I expected and easing the fetus the rest of the way out. A boy. He was tiny and translucent, but fully formed. My heart broke at the thought that this little boy would never grow up to play ball or kiss a girl.
What the resident did next surprised me. He wrapped the baby up in a towel and asked Maria if she wanted to hold him. He explained to both of us that it would help her to grasp the reality of the situation. Maria was as shocked as I, but nodded a small nod and reached out her arms. When I walked out of the room to change my scrubs, she was holding the little body in her arms and smiling down at him.