The new resident, Brian, backed through the breakroom doors with his arms held out in front of him, bent up at the elbows like a surgeon. Like all of us, now. He didn’t notice me as he went straight to the sink, tapped the footplate for hot water, collected some soap, and began scrubbing.
I waited until he was done before speaking. “Take a load off, Brian.”
He put on fresh gloves, made some coffee in the Keurig, snagged a chair with his foot, then lowered his mask to sip the bitter brew.
“How long you been on?” I asked.
He squinted at the wall clock. “Comin’ up on forty hours. You?”
“Almost the same, but I just had a four-hour nap in my car, so it’s all good.”
Brian shook his head. “I didn’t sign up for this.”
I could have gotten on my high horse about the oath and all that, but in truth I was just as exasperated as he was. This was utterly unfair, and just as preventable. There was no way I was going to shut down some very deserved venting. “No one did,” I said finally.
“How long you think we can keep this up?”
“Don’t ask me, it’s my first pandemic.” That was too flippant by half. We’re all strung out. “You got time for a story?”
Brian perked up and nodded.
“I was only a couple of months out of residency here. Of course I was working graveyard. Half the time we went home on time, if you can believe it. This lady came in, late 20s, obese—”
“Morbidly?” interjected Brian.
“No, just fat. 210, 220, thereabouts. Complained of constipation, said she hadn’t had a BM for four days.”
“That’s nothing.”
“I know, but she said it never happened before. Anyway, I took her history, she said her diet was healthy, sedentary—”
“Diabetes?”
“Nope. She denied it, and afterwards her blood test was negative.”
“Celiac?”
“Also negative. No other risk factors. I started talking about how regular exercise might move things along, but she insisted she had ‘tried everything’ and she just knew she had an obstruction. Someday all this will be over, and if you stay in the ER you’ll see your share of this kind of thing.
“Radiology was almost as backed up then as it is now, but I knew the tech in Ob/Gyn ultrasound, and I got her a pelvic scan. I knew what it was as soon as I saw it and so did my friend, but neither of us had ever dealt with it before.
“I roped in the PA and moved the patient to an outpatient room—they were occasionally free back then. There was another patient sleeping in the other bed, but we still drew the curtain around our patient’s bed. Then we had her kneel on the bed, lay her arms down and rest her head on her arms, legs spread and her ass in the air. It was quite round for someone of her girth.”
“Must have been quite a sight,” said Brian.
“I suppose, but you’re always in clinical mode, even back then. I rolled up my chair and leaned in with my lamp, pulling one cheek to the side with my gloved hand. She didn’t shave much down there, so there was no razor burn or other lesions, just some short fine hairs spreading across her perineum. I had the PA hold the lamp while I digitally probed her anus, and the patient flinched.
“‘Pain?’ I asked, but she denied it. I kept going, and I couldn’t have been more than an inch inside when I felt the obstruction. The near extremity was less than a centimeter across, so I thought I could get it out with a polypectomy snare.”
“Local?”
“Yup, topical lidocaine. While I waited for her to get numb, I sent the PA to get some wheat germ oil.”
“What?”
“I’ll get there. In the meantime I’m staring at this woman’s clenching brown pucker and trying to visualize how I’m going to do this extraction. I wasn’t too worried about perforating the rectum, but she was extremely tensed and if she jumped she might give herself an anal fissure. Putting her out would have been a several-hour delay plus recovery, and it simply wasn’t warranted.
“The PA came back with the wheat germ oil, and I applied it to her anus and perineum, slowly massaging them and educating the patient about what I was doing. Wheat germ oil has long been used as a muscle-relaxant and tissue-softener, and I was also trying to put the patient at ease, because she was quite understandably embarrassed. I thought I also might be able to manipulate the obstruction supracutaneously, but there was too much intervening tissue.
“So we brought in the colonoscopy cart with the snare. I gently worked the scope into her anus, trying to reach the far end of the obstruction without impacting it, as I guessed it was rather fragile. It looked to be about two-inches-long. Despite everything, she kept clenching, as if she were caressing the obstruction with her rectum.
“I was probably more delicate than I needed to be, but it took almost fifteen minutes before I was able to get the snare wholly around the obstruction. Then I had to tighten it enough to constrict but not so much as to sever as you would on a normal polyp. There’s no protocol for that kind of procedure, so I had to eyeball it. Once it was as tight as I dared, I started pulling the snare out.
“Her anus was distended about an inch and tried to cling to the tiny man as his slick head emerged into the light. His eyes were closed and because he didn’t immediately gasp for air I thought he was dead. I kept withdrawing the snare and his tiny limbs flopped as they were freed from her anal grasp. The PA brought a sponge underneath him as I released the snare and he dropped through it. Only then did I seem him take a breath.
“The PA took the sponge holding the tiny man and raced to the NICU to put him under a heat lamp so he didn’t go further into shock. I put the scope down on the cart in the dirty field, then rolled my chair around near the patient’s head. ‘Feel better?’ I asked.
“’Are they okay?’ she asked worriedly.”
“No way!” said Brian.
“Oh yeah,” I continued. “I just blinked and asked, ‘How many are in there?’
“’Two,’ she says. ‘Travis and Joni.’
“’I got Travis out, he’s being looked at,’ I said. ‘Hold still while I get, uh, Joni.’
“I didn’t think I needed a clean scope for the same field, and because I hadn’t seen the other tiny the first time she must have been deep inside this woman’s huge ass. I knew they don’t need much oxygen, but I couldn’t imagine the heat, humidity, and pressure they must have been enduring. What had been just a patient’s distended rectum became in my imagination a torrid ravenous gullet, convulsing my new patient ever deeper.”
Brian paled and said nothing.
“I steadied myself by focusing on my instruments, then returned to those massive spread buttocks and gaping anus. I was probably less gentle when I inserted the scope the second time, transferring some of my concern to Joni. Once inside, however, I went slow again, primarily because I was afraid I’d pass her unseen and possibly distend the sigmoid colon.
“The first thing I saw was her foot, her tiny leg extending around the rectum wall and into the darkness. She was oriented with her head furthest from the anus, which meant she was getting the least possible air. I could have grabbed her ankle with the snare, but I didn’t know the orientation of her other extremities, and I had no confidence that I wouldn’t just cut her foot off. So I kept going.
“The PA came back to tell me the NICU was monitoring Travis, and I said, ‘There’s another one.’ The rest of the tiny woman came into view, and her arms were oriented over her head like she was diving into a pool. It took longer than I would have liked, but I was able to slide the snare around both her legs and over her hips, which weren’t nearly as wide as the big patient’s.
“I had to extract her slow because she was leading with her feet and I didn’t want to snag them on anything. Fortunately, the rectum walls had relaxed and it was a smooth slide. I actually had a pretty good view of her face through the scope, but just like Travis I couldn’t see her breathing. When her feet reached the anus, I told the PA to put a fingertip in there and grab her feet. I turned away from the monitor and looked at Joni being pulled from the big woman’s butthole. Both me and the PA had our faces right in her ass, which was trembling, probably from the attention.
“As soon as Joni’s tiny hands slipped free from the anus, the PA whisked her off to the NICU. I wheeled around again to the first patient and looked her in the eye. ‘Is that it?’ I asked.
“‘Yes,’ she said with evident relief.”
“How did you know you could believe her?” asked Brian.
“It was obvious she cared about them. Lotta times with these cases, the patients don’t even know who they shoved up there. I had her lie all the way down and cover up, but she kept asking me if the tinies were okay. I didn’t tell her where they were, but I said I would check on them.
“They both were conscious and alert after about twenty minutes. In the NICU they do the tiny equivalent of an APGAR test, and they both scored fine. They were taking dextrose solution—orally, thank God. You don’t want to do a tiny IV if you don’t have to.
“You know we’re mandatory reporters, right? Once they were released from the NICU, I had to have a private counseling with each of them separately. I asked them the big patient’s name, how they knew her, did they consent to being placed inside her rectum, had she abused either of them before, did they feel safe, should we call anyone else to come get them, etc.
“Turns out it was the tinies’ idea. They both wanted to have sex inside their big friend, who they said loved them and would do anything for them. Apparently, she was reluctant because she thought she might hurt them, but then they all watched some ‘tutorial’ on the Internet and decided it was safe.”
“Did you ask them why they didn’t crawl into her vagina instead?” asked Brian.
“No, because that’s not our business, Brian. And no, I didn’t ask what website was hosting the ‘tutorial.’ Besides, I can tell you the vagina isn’t necessarily any safer, but that’s another story.”
Brian looked up at the wall clock, longer than necessary to note the time.
“What was the point of telling me that?” he said finally.
“I don’t know, exactly. I think I remember that story because every time I tell it to someone, they get all lascivious or prudish or judgy, and they forget that three people were suffering. Yes, they brought it on themselves, but that didn’t matter. This job is entirely about alleviating human suffering, regardless of what caused it or how their behavior might have contributed to it. I need to be reminded of that as much as anyone else.”
Brian nodded. “Thanks,” he said, and finished his coffee and returned to the ward.
I stood up and went to the sink. As I washed my hands, I felt a tiny hand press through the fabric of my shirt and stroke my chest.