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?