Tush Trouble and a “Meet Cute”— An Emergency Department Story of Priorities
As Mrs. Tannenbaum said, “I’ve got tsuris in my tuchus,” but…
“Hi Mrs. Tannenbaum.* I’m Michael Burg, one of the Emergency Doctors. How can I help you today?” I said. My standard greeting to ER patients healthy enough to sit and communicate.
“I’m almost embarrassed to say, Doctor. And I hate to waste your time, but I don’t know what else to do,” came the reply in precise, lightly Germanic-accented English.
Then sensing — correctly — she was with a person who would understand, and trying to insert a hint of humor into a difficult, and personal, situation, Mrs. Tannenbaum continued, “I’ve got tsuris in my tuchus.”
I understood her meaning, immediately.
There was trouble (tsuris in Yiddish) in my patient’s buttocks (tuchus, or sometimes, tush).
“What sort of trouble?” I inquired gently.
“Well I haven’t had a bowel movement for a week.”
“Nothing at all?” I asked.
“Well,” Mrs. Tannenbaum went on “just a little liquid stool if I strain hard, but nothing more. It feels like something’s there I can’t pass.”
Her words, precise, polite, and exactly what I’d expect of a elderly woman from the “old country.” Her being, impeccably clothed in expensive woolen blends, and words like “stool,” “bowel movement,” “pass,” and “tsuris,” reminding me of relatives, and of a hundred others I’d cared for in the ER.
I knew, even before an exam, what her problem was, and what needed to be done to fix it.
After asking a few more key questions, I exited Mrs. Tannenbaum’s cubicle and asked that she change into a patient gown, with nothing on below the waist.
I returned moments later.
Taking care to preserve her modesty, by placing a sheet and blanket across her hips and legs and lifting her gown only to her upper abdomen, I examined my patient’s belly. The only finding, a curious fullness in the lower abdomen. Nothing more. No pain, no tenderness, nor any other abnormality.
“OK, Mrs. Tannenbaum,” I said, beckoning a nurse to chaperone, “I need to do a rectal exam.”
“Please roll over onto your side. I’m going to gently insert one gloved and lubricated finger. You’ll feel pressure but no pain. I must do it to diagnose your problem.”
“OK” said Mrs. Tannenbaum, rolling onto her side, facing away from me.
And then I felt it, the cause of my patient’s “tsuris,” and her inability to pass a normal bowel movement.
“You have a fecal impaction,” I explained. “That’s when the stool lodges and hardens in the rectal area, creating a blockage. Yours is about 10 centimeters around, about the size of a newborn’s head.”
Then, with my patient sitting and facing me, I continued, “We must loosen and dislodge the hard stool. Then you’ll be able to have normal bowel movements.”
“I’ll ask your nurse to give you a special type of enema to loosen the stool. Then I’ll return to do a manual disimpaction. That’s where I use my fingers inside your rectum to break up and remove the stool until you can pass the remaining stool yourself. Manual disimpaction is painful and not without some risk, especially in someone of your age, but it usually goes well and produces the desired result.”
“Is it OK with you if we get started?” I asked.
Following a bit more back-and-forth and further explanation Mrs. Tannenbaum consented to the procedure.
After an adequate enema dwell time had elapsed, I asked that a light sedative be administered. I returned for my part — double gloved, double masked, and heavily gowned — with a goodly supply of towels, lube, and a bedpan.
An aside: Not to trade in stereotypes, but I knew my people, particularly my relative-look-a-likes in the Emergency Department. In general, when faced with discomfort or adversity they took comfort by expressing either “oy” (dismay) or “oy vey” (another form of the same). Swearing or lashing out wasn’t part of their profile. Just, “oy” or “oy vey,” often alternated.
As a slightly cynical, but keenly observant, ER doc — and I don’t know one who isn’t — I’d taken to calling the “oy — oy vey” alternating singsong “oy-geminy.” So named for the heart rhythm disturbance, “bigeminy,” a largely non-serious condition, marked by a normal beat followed by an ectopic one, in a repeating pattern. Everyone I knew in medical school, residency training and professional practice used the same shorthand, in private. There was no disrespect implied or intended. “Oy-geminy” was simply quasi-medical parlance for a cultural phenomenon we all knew and appreciated the significance of.
I expected to hear some oy-geminy from Mrs. Tannenbaum as I went about solving her problem.
I did … in volumes.
As I did my duties, digitally disimpacting her and delivering her stool baby, Mrs. Tannenbaum serenaded me and the entire department with piercing oy-geminy choruses, oy! … oy vey!! … oy! … oy vey!! …
Knowing (or perhaps imagining I knew) just how painful a digital disimpaction could be, I was as kind and solicitous as I could be.
When the “oy” and “oy vey” volume peaked, I paused, asking “Are you OK if I go on doing what I’m doing, Mrs. Tannenbaum? I want to make sure you’re all right. Can you tolerate this?”
My patient’s response was steadfastly the same.
Taking an oy-geminy respite and drawing a shuddering breath, Mrs. T. said “Yes it’s OK. Do what you have to do. I know it’s necessary.”
Then, as soon as I recommenced my horrible, but essential, ministrations, the “oy — oy vey” karaoke from Hell recommenced as well.
It was a long, arduous experience for both of us.
Mrs. Tannenbaum, obviously in distress, sweating, squirming and shouting, but toughing it out like the stalwart I knew her to be.
Me, sweating in my near-Hazmat suit, dealing with the stench and the sight of ever-growing mountains of stool appearing in the bedpan. My brain silently flagellating me with bits of the Hippocratic Oath — “First do no harm.”
Then it happened.
Near the procedure’s end, when knuckles-deep in poor Mrs. Tannenbaum’s tush, and about to remove the last stool clump I could reach, her oy-geminy crescendoed.
Fearing I’d gone too far, literally and figuratively, I hesitated.
Mrs. Tannenbaum quieted, and inhaled a long deep breath.
“Dr. Burg,” she said, turning slightly to look over one shoulder at me, “Would you like to meet a nice Jewish girl? My granddaughter brought me to the hospital today and you seem like such a nice man. You’ll probably like one another.”
I struggled to answer in a normal voice.
There we were, Mrs. Tannenbaum and, I locked together in a professional, intimate, therapeutic embrace, surrounded by truly hideous sights, smells and sounds. Mrs. Tannenbaum had just settled from her loudest shriek yet, in an incredible series of loud shrieks, and her fondest desire was to arrange a culturally appropriate date.
I drew my own slightly shuddering breath, paused a beat to still any unseemly note of levity in my voice, and said “Yes, I’d love to.”
Once degloved, unmasked, disgowned, and thoroughly washed — twice — I met Mrs. Tannenbaum’s granddaughter.
She was exactly as I would have predicted, pretty, smart, accomplished and charming. And grateful for the service I had provided her grandmother.
Had I not been seriously committed to another relationship at the time, I’m sure we would have enjoyed one another’s company tremendously.
“Oy” and “oy vey” would not have been part of our background music. I’m one hundred percent certain of that.
The events in this story happened near the start of my career in Emergency Medicine, well over 30 years ago.
I will never forget Mrs. Tannenbaum’s strength and focus, rising above what must have been her worst day, and her oy-geminy aria, to look after her granddaughter and the nice Jewish doctor who’d cared for her.
*Name changed
