How to Keep a Straight Face When Your Patient is Buzzing

I was a radiographer still in my first year so technically a probationer. I had just really started doing out of hours, had the odd drunk making lurid suggestions and coped well maintaining a professional face throughout. It’s amazing how sensitive a nose can be when placed up against the x-ray plate for a skull x-ray but that is another story.

I’d done my normal 9-5 day and had taken the usual three hour break before the start of the night shift. Night shift started at 8pm with 2 colleagues, one working 2-10pm the other on the same shift as me, 8pm-8am. The evening had been steady, a normal influx of patients with injuries, usual ward rounds and theatre. Midnight approached and my remaining colleague and I split the rest of the night between us, I was taking the first half of the night and my colleague would cover the 4am – 8 am portion unless we were snowed under in which case we would both be on until the workload eased. Midnight and my colleague went off to bed leaving me alone in the X-ray department. Now we had a strict protocol for out of hours use of the x-ray department. We did nothing that could wait until morning, we literally covered just emergencies.

There was a new intake of interns in accident & emergency so I expected to be vetting requests quite heavily all through the night and as it turned out I was right. X-ray examinations are done if a radiographer and/or radiologist deem it appropriate and as such all requests are vetted but I expected to be bending the ears of most of the new interns for silly requests.

It got to 2 am and I was just getting ready to head to the staff room to get an energy drink to get me through as I could tell A&E was still quite busy. My pager went off and it was one of the interns, I asked the porters to bring the request around and it arrived on the reception desk as I came back with my drink. The request card had very little information on it regarding what the examination was for. I looked the card over for clues as to how urgent this might be. The clinical information given was FB? Abdomen. Not a lot to go on even for a qualified practitioner. Basically it meant the doctor was querying if a foreign body was present in the abdomen, foreign body being an object that should not be present in the body under normal circumstance. For example a splinter or a swallowed coin. I looked at the patient information and discovered he was an adult of around 40 years age. Now normally things that require retrieval in an adult are penetrating injuries from for example falling through a tree and ending up with a branch poking through. If that had been the case I would have expected to see more history on the request to tell me I was expecting something traumatic or even to be examining the patient in Resus with a mobile unit. It didn’t even occur to me that it might have been something inserted by the patient from the little info I had, so I called the doctor who had made the request, one of the interns who I had not had much from through the night. I asked what we were looking for and she told me straight out. I was still only in my early twenties and quite inexperienced in certain things so I was embarrassed into silence briefly. I recovered quickly and asked if there were any special views she might need and she replied that they just wanted to see how far in the object was so they could decide if surgery might be needed. I made notes on the back of the request of what the intern had told me and told her I would send the porters for the patient once I was ready.

I looked at my canned energy drink on the desk and decided I no longer needed it and put it back in the staff room for later and poured water instead. I called the porters from the staff room extension and asked them to bring the patient straight away, made my way back to reception and started to focus on the task ahead, which would mainly be maintaining a straight face. About 5 minutes had passed when I was roused from my internal reverie by a noise coming from A&E. It was literally just past one set of fire doors so I could hear pretty much anything above a whisper around the first couple of bays in A&E from the X-ray department side. the noise continued for about a minute and then started to become louder. I realised what it was when I saw the porters face through the window on the door. I beckoned them in as I moved from the reception desk towards the examination room. I’m not entirely sure how I kept a straight face for those first few seconds as the patient came through on a trolley, buzzing quite loudly now the sound dulling effect of the doors was gone, but I did and managing to do so put me at ease and me being at ease put my patient at ease too. The porters kindly pushed the trolley right into the x-ray room for me and then left. My eyes followed them briefly and I was glad that they were also keeping straight faces on their egress from my department. I think the faintest flicker of a smirk would have broken my own façade.

Now in the privacy of the x-ray room I worked to put my patient at complete ease. I asked him his details to check his identity and then moved on to general conversation about what had brought him to the area. He was quite forthright and admitted to being in the area for the gay festival in town but ostensibly here on business. As I prepared the x-ray plate in the shelf under the trolley we continued to talk, I told him I was recently qualified and on my first full night shift and he laughed and joked about what sort of patients you got on a weekend night shift in Manchester, including himself in that group. He asked if the night had been busy and general chat ensued right up to the point of me laying my hand on his stomach to align the x-ray’s LED guidelines to his body and the main landmarks of the abdomen, namely the belly button, the symphysis pubis, the xiphisternum and the iliac crests. I put my hand on his tummy and immediately pulled my hand away as I had felt the strong vibrations of the vibrator stuck in his intestine. At that point he said “Its got fresh batteries in it” and we both burst into laughter. Breaking the ice, that is the key to maintaining a professional appearance, not maintaining a stony silence and a matching stony complexion. Pointing out the elephant in the room makes it much smaller than it appears to be. So he had been naughty away from home, he was certainly not going to be doing it again, at least not exactly the same way. I took the x-ray and my heart fell, the vibrator would definitely need surgery to remove it as it had worked its way from rectum up to the splenic flexure.. no amount of gloved rummaging around would find it. He had mentioned hoping not having to stay overnight as he was due back home the next day. I found it was actually more difficult to maintain the smiles once I knew things would not be going the way he had hoped. I felt so very sorry for him I had to take a few minutes to compose myself.

I suppose there are a couple of morals to this tale. The first, don’t play away from home. The second moral is to not use fresh batteries. And the third is to not put anything in that you can’t get out again easily even if you have to put a rope around it so you can pull it out when you lose sight of the bottom as it runs away to explore the vastness of the large intestines.


About nicessus2012

A quiet woman with a hint of sanity
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6 Responses to How to Keep a Straight Face When Your Patient is Buzzing

  1. tarafromtexas says:

    I am a fresh radiographer (graduated a little over a year ago) and this made me laugh so hard. I work in pediatric radiography and FBs are a daily occurence…still working on my medical poker face

    • nicessus2012 says:

      😀 it comes with time. In this case the interaction with the patient was relaxed because he was relaxed though sheepish. Other times it is just a case of focusing on getting the job done. Judging how to approach your patient will become second nature… And remember the staff room is a good place to share experiences, to indulge in medical humour and to learn new approaches from colleagues young and old 🙂

  2. Anonymous says:

    The reason I left the medical field is that I never wanted to lose sight of my emotions.
    Keeping a straight face, as they did, would have pushed me over the edge.
    I’m curious, though…wouldn’t a huge bowl of oatmeal, followed by a laxative, have averted surgery?

    • nicessus2012 says:

      I didn’t get to follow up the patient other than the er doc saying he would be in surgery the next day. The main problem was the freshness of the batteries which continued to try to drive the object deeper in but could not manage to move past the convolutions. Add into that the shape allowed for easy ingress but the battery compartment was not shaped for easy egress so using a purgative could have led to tearing of the sigmoid which would lread to surgery anyway and possible complications such as air in the abdominal cavity or peritonitis from faeces entering the peritoneum.

  3. fran says:

    hahaha love it :D….its amazing what people do to get enjoyment 😉

  4. Anonymous says:

    LOVE IT 🙂

New writer, would appreciate feedback, thanks :)

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