Friendly Fire
This story is drawn from real experiences. Protecting my patients’ confidentiality is of utmost importance to me; names, details, and timelines have been changed to honor their privacy, and any similarities to actual persons or events are purely coincidental. The emotional truth remains intact.
In pediatrics, you have to be willing to give a lot of yourself to the people you care for. When parents face the fear of the unknown and the stress that comes with that, we want to help. We understand the helplessness they feel when their child is sick. We see their furrowed brows, their silent tears, or hear an edge in their voice; we try our best to help them feel anything other than fear, sometimes with unintended hilarious consequences.
Years ago, I was on service and had completed rounds with the residents when a friend of mine on the surgical team asked if I could give him a hand with a procedure. We chatted about the case as I walked with him to our patient’s room. Baby Elizabeth was around a week old, and she’d been admitted to rule out a condition called Hirschsprung’s Disease. Hirschsprung’s is an abnormality of the nerve cells at the bottom of the intestines. Babies with the condition are missing the nerves that help move poop out of the rectum and through the anus.
In normal humans, when stool enters the bottom part of the rectum, the anus is relaxed by those nerve cells we were hunting for. This allows poop to exit the body. For babies with Hirschsprung’s Disease, the absence of those nerve cells keeps the area right around the anus tight and unable to pass any stool. Over the first few days or weeks of life, these babies retain more and more stool and become increasingly fussy and bloated. It’s a medical emergency and can lead to life-threatening outcomes if left untreated.
My friend needed help with the suction rectal biopsy, a procedure we use to determine whether babies like Elizabeth are missing these essential nerve cells. Suction rectal biopsy is a bedside procedure, but it is often helpful to have an assistant hold the baby, assist with suction control, and serve as a “third hand” for the trickier parts.
We arrived in Baby Elizabeth’s room to find her being held by her mom. Baby Elizabeth had a significantly distended abdomen and was pretty miserably fussy. Mom was similarly distressed. The first week of having a new baby is a tough enough adjustment to life; add an ill baby and sleepless nights, and you’ve got a perfect recipe for high levels of worry. Elizabeth’s mom was wearing all of that stress. You could see it in the tightness of her shoulders as she rocked her baby, and you could hear it in her voice. Between the words, she was pleading for help, for some relief from the burden of it all.
While I moved Elizabeth to the crib, my friend chatted with her mom about the procedure ahead, what the risks and benefits were, and gave her clear expectations for when we’d have the results. He answered all her questions and was kind and reassuring. She was appreciative, but you could tell that she bore the weight of the world on her shoulders and nothing short of a healthy baby would lift it.
Having answered all her questions, we began the procedure. It’s a quick and relatively simple procedure. A small suction tube attached to a gun-like device is inserted through the anus and a few centimeters into the rectum to the area likely to be missing the nerve cells. Once positioned, this special tube uses suction to draw a small amount of rectal lining into its lumen. Then, a small blade integrated into the device can be engaged by the gun’s trigger to slice off a tiny amount of mucosa. With the sample now secured in the device tip, the entire tube is retracted and, voila, you have your specimen—easy peasy.
At one tricky point during our procedure, my friend asked me to move a touch to improve his angle on the device. I shifted around toward the foot of the crib to make room for him.
That’s when it happened.
Remember that tight area of the rectum we talked about? It’s the one causing all of these problems. So here’s the thing: if you insert a device like a suction tube, past the blocked portion, there is no longer a physical barrier to the passage of poo. Nothing is now holding back days’ worth of pressurized, liquid waste.
We knew our mistake even before we felt its consequences. The moment I stepped around the foot of the crib, but before my brain could scream “hit the deck!”, an explosion of poo accompanied by a thunderous slapping fart shot forth from little Elizabeth, and I had no way to escape. Little Elizabeth had become a giant, wet-fart cannon. A jet of liquid baby poo traveling faster than a human can react left her body with such force that it flew six feet in an ever-expanding cone of destruction emanating from innocent little Elizabeth. In pediatrics, it’s called the “Blast Sign,” and on that day, it left nothing but a crime-scene outline of this pediatrician on the wall.
There I stood, covered from head to waist, in, well, waste. It dripped off of me. I slowly removed my poo-covered glasses to see the wide eyes of my friend. They tracked from him over to where Elizabeth’s mom sat. Slowly, her expression shifted from shock and awe toward what can only be described as the beginnings of delight, and then shortly after, pure hysterical laughter. While clumsily apologizing, my buddy started laughing too. All I could do was laugh. I’m not sure, but I think one of the nearby nurses may have said, “Um, doc, you’ve got a little something…” while gesturing her hand in a large circle encompassing pretty much all of me.
Baby Elizabeth did well. She underwent a surgical correction of her abnormal rectal segment. I can only assume she went on with life, perhaps amused by a story her mom still tells about the day she spray-painted her doctor with poo. But can we take a second to recognize my selfless contribution to this family’s well-being? In one moment, I was able to take all the building stress and worry Elizabeth’s mom had been bearing for days and take them away from her. I think her laugh may have been the purest I’ve ever heard.
Not all heroes wear capes, they say. Sometimes they wear poo from head to toe. I set out to help a friend take care of a baby. In the process, I delivered a moment of peace to a mom who deeply deserved a respite. I’m a giver; what can I say?
You’re welcome.