labor nurse has been reborn and shares her experiences as a new nurse-midwife, woman, and blogger

Tuesday, March 4, 2008

Holding My Breath

One of the appeals of obstetric/maternity nursing is that very rarely are you dealing with nasty feces and vomit. Newborn poop and spit up doesn’t count as it is fairly benign. On occasion I have to clean up a woman’s poop when she pushes, but it’s only small amounts that can be quickly whisked away with the chux pads.

So much to my dismay, my most recent shift was immersed with adult poop and vomit. I was assigned to work the triage room, so I take whatever comes walking through the door. I get report that a 32 week pregnant woman is coming in with severe nausea, vomiting, and diarrhea. And severe doesn’t even come close to describing what she was going through. This was a viral thing, and so on top of dealing with excrement of all kinds, I was also acutely paranoid that I was going to catch the virus despite my obsessive-compulsive hand washing and hand sanitizing (and pen, stethoscope, clipboard, etc etc sanitizing). If I could be offered a Haz-Mat suit when dealing with anyone with a stomach viral infection, I’d be suiting up like yesterday. This includes with my family.

After several bags of IV fluids and some zofran, she was a little better and took a nap. In the meantime, an unexpected admission came in by way of ambulance. She was an 18 year old multip who called 911 because she was having severe pressure in her pelvis like something was “trying to escape”. 911 Dispatcher instructed her not to push or sit on the toilet and sent out the paramedics.

She was writhing on the stretcher and I wondered if she was truly in labor. She was also 32 weeks, and so I prepared as quickly as I could for a delivery. A 32 week baby can just shoot out like a rocket in a multip, so you never know. Quick glance at her perineum reassured me that at least a head wasn’t sticking out or at the very least crowning.

As I am settling her in the triage room, asking her questions about what was going on, she asks for an enema.

Yes, an enema.

So I start thinking that perhaps she isn’t in labor but just severely constipated. The more we talk, the more she focuses on her bowels. The conversation goes something like this:

“Are you having any contractions?”

“No, but my belly hurts real bad when I was trying to take a shit.”

“Are you having any vaginal bleeding?”

“No. But I had a brown stain in my underwear.”

“Are you leaking any fluid out of your vagina?"

“No, nothing will come out.”

She hasn’t pooped in one day, and normally she goes 4 times a day. She was trying to go when she called 911. Somewhere there was a lack of understanding between the young girl and the 911 people, because she was really calling about her pain and difficulty with trying to move her bowels.

The physician evaluates her and finds that her rectum is full of poop. First I give a dulcolax suppository, which barely went in and crumbled in my hands. Next was an enema. This was even more difficult as the applicator tip couldn’t get past all the poop. Some how I managed to work it in there and asked her to hold in the fluid for as long as possible. I was afraid she’d spray down the bed so I had piled chux pads over the entire bed. Ten minutes later she went to the bathroom and she didn’t call for 20 minutes.

She was crying and doing a dance over the toilet; she was in so much pain but couldn’t go. When I looked, you could see her anus was dilated about 3 centimeters with a large rock of feces sitting behind it. Ouch.

She asked me to go in and pull it out.

Needless to say I could barely stand the odor in the bathroom as it was, and I knew that I’d be gagging if I had to disimpact her. But that is what I had to do. And she wanted it done in bed, so I didn’t even have the luxury of her on a toilet where it could fall into the water and somewhat mask the stench.

I put a mint in my mouth, some peppermint spirits under my nose, and did what I could do while trying to avert my eyes from what I was doing. There was easily 3 pounds of poop that came out, and that wasn’t all of it. The rest would have to come down into the rectum.

So I ask my fellow med-surg nurses…. How do you do this? How in the world do you deal with all this feces?

13 comments:

Amy said...

Sweet screaming Jesus, this has to be the grossest thing I have ever read in my life. It has totally reconfirmed the fact that no matter how fascinating I find medicine, there ain't no way I could've handled being a nurse.

Hats off to you for being able to handle it.

By the way, what do you mean "occasional poop" when a woman pushes - when I pooped with my first daughter they assured me that they see that with almost every labor. Were they shitting me? (pun intended) Just trying to make me feel better? I'll bet they were just being nice because I was embarrassed... Jeez, now I have to live with that. Thanks a lot.

Amy @ http://prettybabies.blogspot.com

Jaime said...

I know you didn't ask a question to those who have been on the opposite side of this but...I can't believe I'm going to comment without being on anon.

During my the 8th month of my last pregnancy I suffered from extreme constipation. I didn't tell anyone (including my OB) because of the embarrassment and in the end almost did some severe damage to myself because of it.

I'm sure smelling it is beyond terrible but I can assure you, the mortification of being the one stuck with poo in her rear is equally terrible. =)

Labor Nurse said...

Jaime, I totally agree! I would not want to be in that girl's position. It was so painful, so much so that she could care less that she ended up with someone's hand in her rear to make things better.

I guess "occasional" doesn't adequately describe what I meant. It is very common that women pass poop while pushing, but it's typically just small amounts; it's not anything near what came out of this girl. I can handle the small poop nugget that comes out with pushing...piles of it turn my stomach.

Andrea said...

Poop is simply a day-to-day treat in the ICU. Being pregnant, however, has made my previously gag reflex-of-steel turn into the weakest thing that has me wretching at the slightest whiff of *anything*. So, I carry a tub of Vicks Vapo Rub in my work bag, and smear it on the outside of a surgical mask whenever I have to respond to a code brown or worse. Usually does the trick.

Julia said...

Since I just had to disimpact a patient today, I find the timing of this post hilarious. Something in the air? Fortunately I don't have to do it very often, and when I do there is a lot shallow breathing and silent gagging. Prefer it to the incontinent patients feeling the bed with liquid nastiness.

Myra said...

I can empathize. With just 8 more clincal weeks left (in med/surg) in my nursing school before I graduate and work full time as an Obstetric RN, I'm finding my main goal each week is to get through it without having to deal with BM. Funny what bugs some people... For me it is BM and Mucus (especially when one is bringing it up as a result of a bowel obstruction)...just gross!

Patricia said...

Am I the only one who is amazed that she became that impacted after one day? Or that she goes 4 times a day? I'm not saying that is not just as normal as my once every couple of days (my husband is on the multiple-times-a-day train), but it just amazes me.

That poor girl! Poor labor nurse!

GuitarGirlRN said...

In the ED we disimpact people all the time. Never gets easier, either!

the one thing that bothers me is not poop. Or blood, or vomit. It's phlegm. I HATE suctioning people, and I hate trachs.

Prisca said...

i was also amazed she goes 4x/day!!! what is up w/ that? IBS?

tz said...

wow...I just finished my first med-surg clinical and there was more poop then I ever wanted to see...

RehabNurse said...

I'm in rehab and we dig stim patients all the time. Do not breath through your nose if you can help it.

I try to make sure I know where the air freshener is when someone relieves their bowels with or without my index finger's assistance.

I do not leave my people in smelly rooms. This can get challenging if they have lung problems, though. A fan can help.

Hilary said...

Oh, you poor thing, and poor woman!

I have dealt with the birth stool (get it? get it?) when I trained as a midwife. One of my fellow midwifery students had to deal with a situation similar to yours, and the story ended with the poop spraying all over the walls of the bathroom.

I am pretty sure when I have to face this on rotations, I will handle it like I handled gross anatomy and cutting onions. No breathing through the nose.

Anonymous said...

I've heard so many people complain about constipation. I've never had it. Just diarhea. It never occured to me that it impacted. You learn something new everyday.

During my 1st labour, I was horrified when I kept projectile vomiting. I can't stand vomit. I didn't know how to react when the nurse commented that my vomit was weird. She could barely smell it. That makes it better?! It's still projectile vomit hitting the wall like the exorcist!