The Circumference of a Grapefruit

At the beginning of this year I had a patient with multiple medical challenges.

She was suffering through a poorly healed chronically painful tibia/fibula fracture, Chronic Obstructive Pulmonary Disorder, Congestive Heart Failure, Diabetes, many pressure ulcers, blindness, etc. She was in her early 60's.

You know what bothered her most?

She hadn't crapped in a week, and this caused her severe physical discomfort. She couldn't eat, was vomiting, and had belly pain of 9/10. Enemas and suppositories brought no relief.

Huh? Never had I thought that something as "small" as constipation could compete with the "big" stuff like fractures, heart and lung problems.

The trick was to assist her in defecating without having her stoke out or drop her heart rate dangerously low from the effort of pushing.

I put on a plastic gown, two pairs of gloves, mask and eyewear, then rolled her on her side.

We began "coached pushing." Someone standing outside the door must have thought I was delivering a baby:

"OK, Three Big Pushes! One! Two! Three! Nicely done, now rest, take a big breath. You're doing fine, it's coming out nicely. Good job. Now I want two more strong pushes! Ready...

Holly Hanna, this thing coming out had the circumference of a grapefruit! Her perennial skin was stretched so thin it was taunt and blanched white. I prayed she wouldn't tear.

Finally a single gargantuan, petrified lump of poop emerged.

She was pale and exhausted from 45 minutes of pushing. With sweat beading on her brow, closed eyes and a cracking voice, she whispered, "Just clean me up and let me rest."