manual disimpaction
one of my patients has been acutely deterioating over the past 1-2 weeks. While he had a MMSE of 25/30 previously, now he's too drowsy and confused to cooperate for a repeat MMSE. in my search to a cause of his delirium, i decided i'd look very silly if i don't do a PR (per rectal exam) in case he's faecally impacted (this means exactly what you think). He was conveninently lying on his side and i didn't have too much trouble locating the orifice. although he wasn't concrete-ly impacted, his rectum was so full of faeces that it looked like it was about to explode any minute. So i had no choice but to get it all out. As the stuff was more on the soft side, i didn't have to much trouble and managed to scoop out about 5 ping-pong sized faecal material. ping-pong sized rather than anything else cos that's what my bent index finger produces.i thought i was stronger than i was and went in to do it mentally unprepared. but mid-way thru it i was full on gagging and turning red in the face. it was a good thing the patient was too drowsy to notice anything.
so why am i blogging about this?? i guess i am more human than i thought. thankfully a whole year's work has not desensitised me to gruesome things as this. but perhaps after a few more disimpactions i'll get used to it.
posted by zhinger @ 9:09 pm
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