“Here is a phenergan suppository for your nausea. If you puke that up, we have a serious problem…”
It always gets a laugh, even out of the sickest patients.
But the vomiting of poop… it does happen.
Cue the pager.
(Beep, beep, beep!!!!)
It was late at night. Of course. I was still groggy from sleep.
“Yeah, doc. I have an admit for you. She is 27. Nausea and vomiting for two weeks. Dehydrated.” Then a pause for dramatic effect. “And I’ll be damned if she isn’t vomiting stool.”
I sigh. Can’t turn away someone puking poop.
I check my hair and make sure mascara has not melded with drool and smeared across my face, then head to the ER.
Sure enough, the poor woman is hunkered over an emesis basin and bilious vomit mixed with poop is pouring from her mouth.
I get her a wet towel to wipe her face and put a nasogastric tube down to her stomach. Then I write admit orders, complete with three or four nausea meds and IV fluids, then head back to the call room feeling satisfied with myself that I have saved the day.
The next morning, she is still puking poop.
The next day she is still puking poop.
And the next day.
And the next day.
For a whole dang week.
We imaged her from head to toe and found nothing. Blood work was all perfect. The GI specialist was scratching his head.
Then one morning, while wearing silent tennis shoes, I burst into her room to find her hunkered over the emesis basin again. This time, however, she was eating the poop.
That’s right. Eating poop.
As it turns out, she would eat her poop and then force herself to vomit when she was sure a healthcare worker was watching.
This sort of thing, yeah… She was suffering, just not in the way we had thought. You are probably grossed out. You are probably writing her off as a looney. Before you do that, though, think about what kind of life stressors you would have to have in order to reach this point.
We ALL have that capability. We do what we think we have to do in order to survive. If faced with having to eat poop or death, I would absolutely eat poop. In a heartbeat. There are probably a lot more things I would rather eat poop to avoid if I sat down and thought about it for a while.
Food for thought, so to speak.