Flags For Our Troops
Israel
Corpulent
I often get well meaning e-mails from the gravitationally challenged asking if I hate fat people. Like, why do you pick on them?
No, I don’t hate fat people. It just so happens that a large (no pun intended) portion of the patients I see are corpulent (see, nice PC word for FAT). No really, in the ER you see a disproportionate number of smokers, diabetics, nut jobs, elderly (PC for old folks), and the synaptically challenged.
During the 14 years I have worked ER, I have seen only one patient with an active MI who was not a smoker. So, keep puffing it up out there because I want to stay employed. Smokers come in all sizes and shapes. The diabetics I see are usually corpulent. There is just no way to get around it. Diabetics that end up in the ER are usually morbidly obese. That’s not my fault, it just happens, and when it happens, it gives me ammo for more stories, sometimes funny, but more often tragic.
So if you’re diabetic, obese, and a smoker, keep it up and I’ll see you soon.
So why do I sometimes pick on fat people. I don’t really mind the patient’s size, as long as they can move their own pile of lard without me having to strain myself to help. You got that fat by yourself, why should I hurt my back and jeopardize my entire income and lifestyle because of your inability to control your appetite.
One of the nurses I work with has a permanent back injury caused by an insensitive lard-assed pile of goo. This fat, lazy, shit encrusted pustule wanted to sit up in bed. At slightly over the gross tonnage of the titanic, and just as wrecked, he reached out and grabbed my friend without notice. She couldn’t get out of his grip and when he tried to use her for leverage, he caused two herniated discs in her back.
So, if you’re fat and want me to help you move, you better contribute to the process with a mighty effort.
The spousal unit (a paramedic at the time) once went on a call for a woman down. One of those, I’ve fallen and I can’t get up calls. Now you all know that the weight and the severity of the patients illness is inversely proportional to the height of the building, the absence of, or size of the elevator, the amount of trash in the room, the size of the room, the odor, and the lack of any sort of ventilation in the room. Plus there is always the amount of cat feces bombs, vomit, and the patient has usually soiled themselves.
School can prepare you for the medical emergencies; it will never prepare you for the SMELLS.
This particular call was for an enormous black mama, 500 plus pounds. Who had fallen between the bed and the wall, and was wedged so tightly they couldn’t budge her. Keep in mind this was at the back of a large projects building in a unit with no elevator. They hauled the gurney up four flights of stairs, and picked their way through the cat bombs to the bedroom. There she was, wedged tightly between the bed and the wall.
The woman was so large, the daughter told them, she literally had to go through the bedroom door sideways to get into the room. I’ll leave the telling of this story for another time. It turns into the run from hell, but I’ll move along.
I was working at the local ER on a Saturday afternoon when we received a call from the medics that they were bringing a rather large patient to the ER for treatment. Her complaint was respiratory distress. They had found her in a trailer park in the synaptically challenged area of the county. Anyone who works
Bingo!
The ambulance arrived and the medic opened the back of the modular rig and stepped out, taking a deep breath in the process. He had been entombed in the back of the rig with an immovable mountain of greasy, sweating flesh. Fetid flesh would have run crying into the wilderness had it sniffed a whiff of this lovely patient.
The woman was slightly under 800 pounds. I never did find out the exact tonnage. The medic stood up-wind of the ambulance trying to get a breath and clear his head. He told me we needed to wait for the engines to arrive before we tried to move her. She was in severe respirator distress and was close to needing a tube. I went back inside and called RT to have them come and assist with SVNS outside in the ambulance.
I then checked on the weight limit for our hospital beds. As I suspected they were only rated to a maximum of 500 pounds. I called risk management and maintenence to see if we had a bed rated high enough to support her weight. It turned out we didn’t have a bed and had to call medical supply to have one delivered later.
The charge nurse wheeled a regular bed into the ER and lowered it as far down as it would go. Finally the other engines arrived and 13 firemen and paramedics began the task of getting her into the ER bed. She was lying on a large tarp and was squeegeed from the modular unit and onto the ground.
Sweating and straining they brought her into the ER, and positioned her on the bed. After we propped her up with lots of pillows, one of the firemen pointed to the tarp and told me, we need our tarp back.
Immediately after he said it, he knew it was stupid thing to say. I turned and told him, if you can figure out how to get it out from under her, go for it. We then both went outside and had a good laugh together. I thanked him for the tarp actually, because we would later use it to move her to the Big Boy Bed (that’s a brand name).
The fireman related to me how they had to use a saw, and cut a section of the trailer out, to get this lady outside and into the modular unit.
The medics left and we began to care for the patient. She needed all the routine care a respiratory distress patient needs. Cardiac monitor, IV line, SpO2 monitor, ABG, EKG, oxygen, labs, breathing treatments, x-rays, medications, and a foley catheter. Several of the nurses attempted to start an IV line while others attempted to prop this patient up so she could breathe easier.
X-ray came and you could see the look of terror in the techs eyes. The, how am I ever going to get the plate positioned correctly for this patient, look. Followed by the quizzical, can we roll a nuclear power plant in here with enough power to penetrate this mound of flesh and burn a readable image on the plate?
The x-ray techs did a great job and provided us an image that revealed congestive heart failure. Nice puffy white lung fields surrounding an enlarged heart. Lasix was given IV, knowing the full effect would be rapid and produce a flood of urine.
When attempting to insert a foley in an extremely obese patient, you need to set up before-hand and gather the necessary staff. In this situation, five staff members were required to complete this procedure. A sheet was wrapped around each upper thigh, and inched up the thigh as close to the target as possible. A third sheet (two already wrapped around each thigh) was passed under the pendulous abdomen that hung down between her legs. After all the pillows were pulled from beneath her, she was reclined on the bed. The abdominal sheet was pulled taught and the two nurses struggled to force the pendulous abdomen up and off the perineal area, exposing the outward vestiges of our intended target.
When the abdomen was pulled back, the vaginal folds were displayed to the air for the first time in who knows how long. I was busy trying to swallow my tongue and nose so as to cover the smell. When the smell hit the nurses pulling on the sheet, they relaxed their grip and we regrouped for a second attack.
The second assault began after we were properly masked, and had smeared peppermint oil on the masks and anointed the bed in strategic locations. Two nurses once again strained at the ends of the sheet and managed to expose the patient’s vaginal area, a site I hope I never have to witness again in my life. The labia majora were the size of walrus cheeks and about the same consistency, curly thick whiskers and all. God, I’m going to suffer flashbacks, I thought. Followed by, I’m never going to have sex again, ever.
I was manning the left thigh sheet and was just beginning to perform my task. I pulled with all my might to separate the thigh flesh from the labia so the tech could insert the foley. The tech really should have had a Racal suit for this job, but as it was she only had the maroon and white pajamas (scrubs) most of us used. A vet glove would have also been of use, as the vaginal lips were so big she could not spread them without risking contamination of her own flesh. I transferred the ends of the sheet to one hand, reached down with the other, and pulled a walrus cheek out of the way. The nurse on the contralateral side did the same. This exposed the target area. I have often wanted to design a shoulder mounted foley inserter, because this would have been the perfect patient to use it on. Ready, steady, go, I can imagine saying, as you pull the trigger and propel the subsonic foley to its destination. Who cares if you miss, urethral or suprapubic, it’s a foley either way.
The male model could be an electric drill that has metal clamps clasp the end of the penis, while a router is forced along the urethra, and a foley follows and is inserted into the bladder. I could call it the TURP-OH-MATIC.
The tech finally got the foley catheter inserted on about the fifth try and we readied the patient for transport to the ICU. The transfer was uneventful and the ICU staff was less than excited by our arrival. It was about
Have a nice shift I smirked as I left the ICU.
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