I've learnt one very important fact in my life as a doctor yesterday.
MY FINGERS ARE TOO SHORT!
And I thought my fingers are quite long for my size because of my piano playing background. In fact, I recalled measuring my fingers with my classmates last time, and they were surely longer than theirs!
So I was quite surprised to find that my fingers are too short for a simple manual evacuation yesterday.
For those naive to medicine, let me tell you the satisfaction of a manual evacuation. (no not really...not so much satisfaction....more of a disgusted feeling!)
Right. The situation was this elderly lady was in the post-operative period. She has been constipated for a good few days. She has tried various laxatives to help with it, but unfortunately, none was working. I suggested a trial of a phosphate enema (you know, those things that you stick up your bum to activate a bowel motion).
To my horror, the nurse returned to tell me that she was so impacted (ie, her anus was so stuffed with faeces), to the extent that she could not even use the phosphate enema!
The nurse asked me, "So what are we going to do?"
I dreaded the thought I had in my mind.....and I reluctantly said, "Guess, the next step would be manual evacuation."
A manual evacuation of faeces is when a person inserts his/her fingers in a rectum to digitally remove faeces inside it. It is helpful in people who are rather constipated....and just need to unblock the hard faeces that is blocking the rectum. Once evacuated, it makes it alot easier for the person to open the bowels again.
I couldn't have found a better time to perform this procedure......which was after my lunch! Perfect! (I was crossing my fingers that I will keep my food down).
I explained to the patient what I was going to do....and she told me that she did not care how uncomfortable the procedure was going to be, as long as she could get rid of the discomfort she was having as a result of the constipation. She was more concerned that it would be unpleasant for me! How thoughtful!
I said, "Don't you worry about me, my dear....that's my job...to make you more comfortable!"
Prepped with double layered gloves and lots of lubricating jelly, I started the manual evacuation by inserting 2 fingers into the rectum. And............my fingers could not really reach the hard faeces stuck inside. I could feel it with my fingertips. So I just thrusted my fingers deeper into her rectum, and at the same time, wishing if only I had longer fingers. The poor patient was looking quite uncomfortable. She told me not to worry about it. *Bless her! And eventually after a few minutes, I managed to dig out at least 4-5 blobs of really hard stools.
I have to admit that this was probably the most disgusting thing I have ever done! I really wanted to vomit...due to the smell of the faeces...and just the thought of me, digging out faeces from a rectum. (I salute you fellow nurses/HCAs/cleaners)
The lovely patient was feeling so much more comfortable after all of that. She was able to sit comfortably on a chair as she didnt feel too impacted. All the nurses in the ward was laughing at me for having to do this manual evacuation...and the wise registrar said, "Well done. The only time you won't do a manual evacuation, is when you're a consultant! This is probably one of the MUST-DO when you're a junior doctor."
It was quite an experience....and I am glad that I've helped to make someone's life better!