Tuesday, December 9, 2008
Medical student (rounding at a nauseatingly early hour some time before sunrise): Mrs. McGillicuddy? Hi, sorry to wake you-
Patient (opening her eyes with a start): Huh? What?
Medical student: Sorry - I just wanted to check and see -
Patient: Speak up, dear, I can't hear you.
Medical student: How are you doing after your surgery, Mrs. McGillicuddy?
Patient: Oh, fine I guess -
Medical student: Are you having any pain? Nausea? Are you passing gas?
Patient: I beg your pardon?
Medical student: Gas. GAS. Are you passing gas?
Patient: Why? Do you smell something?
Medical student: No, no, we just have to ask-
Patient: What's that?
Medical student: We have to ask-
Patient: Ass? They did surgery on my belly, kid. Are you trying to be impertinent?
Medical student: Not at all, Mrs. McGillicuddy, we ask everybody...about...
Patient: About farting? You go around at the crack of dawn to ask about people's farts?
Medical student: Do you mind if I check your surgical site?
Patient: My what?
Disclaimer: I debated and debated with myself about whether to post about this rather sensitive subject. I decided to go ahead because there's so much in medicine that people are reluctant to discuss but do have thoughts on, and sometimes if we share those thoughts, we can learn something from one another. Or, we can totally embarrass ourselves...but I'm willing to risk it. Maybe I'll start a series of posts on "Sensitive Subjects" - death, sex, moral quandaries, competency measures, and the like. For now, though, inspired by a recent interaction at St. Boonie's, my topic isn't quite so lofty; what's on my mind is...gas.
Here's the truth of the matter: everyone passes gas, sometimes in the hospital, and not only do clinicians sometimes hear it and smell it, but also, very often, doctors, nurses, and students have to ask about it.
I haven't been a patient many times, but from my few experiences as a patient I can completely understand anxiety over the lack of privacy one has in the hospital when it comes to bodily functions. I certainly didn't want anyone to know, by sight, sound, or, heaven forbid, smell, if and when I had expelled waste of any kind.
Here's another truth, though: health care workers deal with body fluids and gases for a living, and very little comes as a surprise or as an unusual event. And, deep down, we feel, or should feel, that if people need help dealing with private bodily functions, it's part of our calling to provide that help with sympathy and respect, even if it's not our favorite part of the job.
As an anesthesiologist I have opened mouths that didn't seem to have known the presence of a toothbrush for years. I have suctioned copious amounts of mucus from the throats of smokers or people with colds. I have had a sedated patient pass gas directly into my face while I was placing a spinal. I have been in a room full of people in which an expectant mother in whom I had just placed an epidural let out a particularly loud gas cloud. I finally broke the momentary stunned silence by turning to her husband and saying, "Gordon, my word! I told you the three-bean salad in the cafeteria was a killer." Thankfully everyone took it in the spirit in which it was intended and had a good chuckle.
"A fart can sometimes be musical." -Graham Greene, in the novel Monsignor Quixote.
I guess the point is, it's not so bad. If a patient pees or poops or passes gas or burps or barfs, we offer help if needed, without so much as batting an eyelash, then move on, business as usual. It's okay. Really. Next time I'm the one on the hospital bed, I'll try to remember that. But it's not easy. It takes trust, some real faith in the good intentions of others.
There's a good chance we'll all need help at one time or another with private bodily things. I hope when my turn comes around again that there will be an understanding word and a gentle touch from the person offering that help - that I see in my caregivers the same kindness my colleagues and I, for the most part, try to extend to our patients.
I found out some interesting things about flatus when I looked it up online. Here's a little CME quiz I concocted just for fun (answers below):
1. Flatus is composed mainly of
a) carbon dioxide
d) hydrogen sulphide
2. The ability to "break wind" at will is mentioned in the Catholic classic
a) City of God by St. Augustine
b) Canticle of the Sun by St. Francis of Assisi
c) Summa Theologica by St. Thomas Aquinas
d) The Story of a Soul by St. Therese of Lisieux
3. The particular characteristics of a sample of flatus are influenced by
a) the velocity of the gas being expelled
b) the types of microorganisms living in the digestive tract
c) the tightness of the anal embouchure
d) all the above
4. Which of the following statements is false?
a) Dairy products, legumes, cashews, cabbages, sweet potatoes, leeks, and Jerusalem artichokes can produce flatus.
b) Odor from flatulence isn't treatable.
c) Cumin, coriander, and caraway may reduce intestinal gas production
d) Rice is the only starch that does not cause gas.
5. High-altitude flatus is attributable to this gas law:
a) Charles's Law
b) Boyle's Law
c) Poiseuille's Law
d) Gay-Lussac's Law
(If you're wondering if this is what anesthesiologists do on their vacations to relax, I think the answer's definitely NO - I just had to...get it out, so to speak...)
I leave you with the following august quotations:
"It is universally well-known, That in digesting our common Food, there is created or produced in the Bowels of human Creatures, a great Quantity of Wind. That the permitting this Air to escape and mix with the Atmosphere, is usually offensive to the Company, from the fetid Smell that accompanies it. That all well-bred People therefore, to avoid giving such Offence, forcibly restrain the Efforts of Nature to discharge that Wind."
-Benjamin Franklin, "A Letter to the Academy," collected in Fart Proudly: Writings of Benjamin Franklin You Never Read in School (1990)
"Never was bestowed such an art
Upon the tuning of a fart...
Thanke God quoth Sir Edward Hungerford
That this Fart proved not a Turdd."
-from The Censure of the Parliament Fart, 1607
Thus endeth my reflections on "the gas we pass."
Addendum 12/16/08: just catching up on my blog rounds and saw this delightful recipe from Elaine Fine featuring the musical fruit ("Beans, beans, the musical fruit: the more you eat, the more you toot.")
Answers to flatus quiz:
1)c 2)a 3)d 4)b 5)b