Friday, November 17, 2006
I remember reading in a surgical journal some years ago about the extraction of a jar of maraschino cherries from a man's rectum. Being a glass jar, and large, there were problems getting purchase (in the grasping, not the monetary sense: presumably it had already been paid for), and there was concern about breaking it. Performing some sort of version maneuver, they unscrewed the cap, emptied out the cherries, and grabbed the lip of the jar for a successful end of the case. The icing on the cake, the cherry on top. But it wasn't the process that impressed me; it was the apparent credulity with which the authors reported the mechanism of entry in the first place. The man, so they explained, had been camping and had, in answering the call of his lower intestine, sat on a branch to perform the evacuation. The branch broke, and, as luck would have it, he'd been unknowingly positioned exactly above an upright jar of cherries, and landed orificially straight upon it.
I suppose were I to sit upon a branch to perform the needed function I'd never think of looking at what was below, and I'm quite certain I'd completely overlook a jar of cherries. Nor would I wonder what the hell it was doing there, perfectly upright under a branch in the middle of the wild, nor move it. Does a bear shit in the woods? Of course he does. And he marks the territory with the fixings for a sundae.
People who people their recti with foreign objects tend to obfuscate. "No idea. Passed out at a party, woke up with the (insert insertion here) up my ass." That's what the man told me when he showed up with a candle in place. No ordinary candle this: probably three inches in diameter, it was over a foot long. How his colon accepted it without tearing, I can't say; I'd guess it had had practice. The upper end of the candle disappeared behind the lower edge of his ribs. Prodigious. A quick rectal exam in the ER clarified that there'd be no way to remove it without anesthesia. More often than not, we do such a thing under spinal anesthesia, both to avoid regurgitation if there's a full stomach, and because it very nicely relaxes the sphincter muscles. In this case, perhaps presciently, the man requested going to sleep. Good choice. It turned into a sort of monumental episode. Wick-ed tough.
Imagine a broad piece of brittle wax, lubricated, obscured at its bottom (as it were) end by tender tissues; slippery by its nature, ungraspable by its geometry. I sat between the man's legs for a goodly amount of time, trying everything of which I could think: big tongs chipped off pieces of wax and the candle squirted headward. I slid a balloon-tipped catheter along side and as high as I could wriggle it, inflated the balloon and withdrew without success. I heated a round-tipped probe thinking I could melt it in, let things cool, and pull it out. Because the north end of the candle was well above the man's ribs, I couldn't apply counter pressure to squeeze it downward. I could stretch his sphincter enough to insert most of my fingers, but the sheer size of a hand grasping a three-inch wide waxy thing and sliding back out was impossible. Even given a certain pre-existing laxity.
There were a couple of other operations going on at that late hour, and as the other surgeons finished up they drifted into my room, suggesting various orthopedic instruments unknown to me, making many and varied and uniformly unsatisfactory recommendations. After a while, it was as if I were in a Greek tragedy, with a murmuring Chorus behind me. I knew I had the ultimate option, but deferred as long as I could, trying everything up with which anyone could come. Finally, I did what I had to do: made an incision in the man's lower belly, grabbed his colon and its content with my left hand, and pushed it downward while guiding anally with my right. Took a minute, slipped it out. I'd not wanted to give the man an incision, admit him to the hospital, subject him to the embarrassment of having to explain himself to a few shifts of nurses. But I'd run out the string. I'd never claim to be great, but that night no other surgeon held a candle to me.
Not every person who packed objects was as demure. As I described in my book, one brave fellow with a vibrator lodged in the sun-free zone had great grace. Awake under a spinal anesthetic, when presented by me with the retrieved vibrator and asked "Here it is Mr Jones. What would you like us to do with it?" Calmly, he said, "Oh, how about you replace the batteries and put it back in?"
It was a rare occasion when we were able to unburden a person in the ER; it almost always required an anesthetic, since those that didn't usually would have been handled by the owner. On the one occasion we were successful, we decided to send the item to the pathology lab. The report remained posted in the ER for some time: "Normal cucumber, with feces."
FFA, before my residency, stood in my mind for "Future Farmers of America." I learned another meaning in San Francisco, after meeting a couple of members and reading their impressively well-produced monthly magazine. The first F stood for "fist." The glossy and professional pictures had at least two people in them, and generally a can of Crisco. One upper extremity was quite hidden, pretty much completely below the elbow. I don't know if their organization required dues, or if they had a secret handshake. If so, it would have been done carefully, I'd think. The one member with whom I became involved professionally required a colostomy. Let's leave it at that.