Two Up


Heavy casualties from active duty only occurred on one shift a year in the Admission Ward of a Repatriation Hospital. It was the evening shift on ANZAC Day in 1976 and I was rostered on duty.


Diggers suffering from lacerations, broken limbs, head injuries resulting from falls, acute epigastric pain, diabetic instability, cardiac arrhythmias, and intoxication were ushered to our hospital by droves of ambulances that had been waiting near ANZAC formalities and “après” informalities in the city.  In our hospital, this day was dedicated to the festivities of surviving the war, and being kept alive after the commemorative merriment!


One particular man had been brought into hospital after spending the day celebrating with his war cronies.  He complained of severe abdominal pain and his belly looked as though someone had inserted tubing into his umbilicus and inflated him to the size a balloon would stretch to before exploding.  It was my job to take his vital signs to investigate his gaseous state.  He was lying on his side like a sick whale, staring straight ahead and he had a look of deep concentration as he directed his energies into pumping his lungs with air around his distended protuberance.


“Burrrrrrrppp ……………. Oo, excuse me Nursey, I can’t help meself” my rotund acquaintance said as I approached him to take his temperature.  “Oh, that’s perfectly ok, probably makes you feel much better” I said as I noticed his breath.  Its odour warned me to take great care when handling the bottom half of his trunk, lest the explosion let loose from the southern end of the equator.  I took his observations and reported back to Sister, who duly instructed me to insert a naso gastric tube into his stomach and attempt to withdraw any gastric content.


I was a very good nurse as far as technique and procedure went but I was swiftly realizing that my reactions to certain procedures were often unheralded and very unpredictable.  In short, I quite often did not like the physical things I had to do to people.


I assisted Michelin Man to reposition himself with the greatest manual handling precision I could muster.  It was impossible to sit him upright as there was no slack left in his torso to bend in the middle.  We negotiated a sort of upwards and sideways banana position, where his spine cradled the mass of soft tissue and organs under his taut skin.


As was my habit, I began explaining the procedure to the patient before commencing the task.  This gave me a sneak preview of my own reactions and gained me a little time in preparing myself to stay poised throughout the coming ordeal.


“…tube is soft and yielding, won’t be uncomfortable if we both relax (yeah right!!) …….  moistened with a film of cool water to assist it sliding up the nose and down the throat……… we will swallow together (I want to gag thinking about this!) ……  I am going to start the procedure now.”


The tube slid easily up the patient’s nose, over the nasal arch and a short way down his throat, till it came to the back chamber of his mouth.  He started to gag.  “Swallow, here, watch me, gulp …….. , see how I swallowed?  Together now, gulp ……… (Wanting to gag, my stomach heaves.  Breathe, talk, give instructions.  Oh no, involuntary heaving from the pit of my stomach.  Focus externally, help this patient, fight heaving sensation.)  “Yes, that’s very good, swallowwwwww, swallowwwwww, ah, I think it’s  in place.  (Relief)  I’ll just test it.  I need to draw some fluid up the tube and if the litmus paper changes colour, it’s in the right place.  Once we’re sure of where it is, we can ease your discomfort by emptying your stomach.”


“Thank goodness that part’s over, I can relax now” I think to myself.  I draw fluid from what I hope is his stomach up the tube but I’m puzzled by the murky brown colour as it flows into the syringe.  I squirt it into a little dish, but before I can test it, the odour takes over the immediate space like a toxic gas.


The patient smells it and begins to heave violently.  I know I should have helped by placing a dish in front of him to vomit into but I can’t move, I’ve been stunned by this gas.  I can feel my skin go clammy.  The heaving I feared now comes upon me so quickly I have no time to think.  All I know now is that this poor man is vomiting up fluid with a pungent faecal odour and it’s making me as sick as it’s making him.


I finished my shift early that day, splashing my face with cold water thinking “this has to be a first in the history of nursing.”  I just threw up in one end of the kidney dish at the same time the patient was throwing up in the other end!


 Posted by at 9:24 pm

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