Manual evacuation

"Every doctor has to do at least 2 manual evacuations in their entire career. I'm really sorry to do this to you now but the only thing that will help his faecal impaction is really to manually disimpact it."

It was half an hour to the end of my night shift. And those were the parting words of the morning consultant. The other doctors at the handover listening in, smiled to themselves. A registrar couldn't stop himself and let out a booming laugh.

Great. I knew it was heading down this way. The guy hadn't been for more than a week. Had tried every laxative under the sky. I could feel hard impacted faeces on PR. And the xray showed impacted stool and faeces all the way up to the ascending colon. The hard, impacted stool was so stuck in the rectum that the softer, more liquid stool above was leaking out the bottom end, completely out of his control. It wasn't a pretty picture for him or me.

I felt sorry for the guy, having someone to stick a finger up his bottom and literally dig out the hard stools. As a student I had easily gotten over doing digital rectal examinations. Now I could even do it efficiently without hesitation.

Faecal disimpaction was entirely a different matter. So it had to be that this would be my first time.

I rolled up my sleeves, put on a white gown and a surgical mask with the shield up to my forehead. This, in case if there was explosive action. Double-gloved.

As I dug around for the first hard pellet of a stool, I gagged. I clenched my teeth and turned my head to my shoulder, desperate for the scent of my clothes. I knew I had to keep it together long enough to evacuate all the impacted stool. Also, I didn't want my patient to know that this was a hard thing for me to do as it would only embarrass him further and make him feel bad.

I continued to gag throughout the whole ordeal, my clenched teeth barely smothering the sounds coming out of my mouth. Dig. Plonk. Dig. Plonk. Dig. Plonk. The whole time I was praying that my nails were short and were not tearing a hole in the glove.

About 15 hard pellets of stools went into the pan. My glove was smothered in liquid stool. Suddenly the pan which sat on the blanket over the patients legs went teetering over the edge. The prospect of stool spilling all over me startled a shriek from me. The nurse helping me caught it in time.

The patient to his credit suffered the discomfort in silence. Even apologising to me that I had to do it. I knew he was feeling terrible. I reassured him telling him that he was here for a reason and someone had to do it.

I left the cubicle, walking straight to the furthest sink and took deep gulps of fresh air.

The registar who had laughed earlier called out to me, "Well done! Only one more to go!" And he sauntered away laughing to himself.