Recently The Hospitalist asked readers to share their reminiscences of patients who had left their mark in some special way on the docs’ lives. Here are those stories.
Patient al Dente
Sandi Verbin, MD, pediatric hospitalist at Temple University Children’s Hospital, Philadelphia, and part-time pediatric hospitalist at Holy Redeemer Hospital, Meadowbrook, Pa.
It was midnight in the ER. My shift was ending, and I had to be up early in the morning to drive to my niece’s third birthday party about two hours away. The ER showed no signs of slowing, however, and one of the nurses approached me, asking if I could see the “quick” patient in Room 4: a child with a piece of macaroni stuck up his nose.
In over 10 years of pediatric practice, the allure of placing foreign objects in body orifices has eluded me. Why is this fun? Nevertheless, a parade of toddlers have presented themselves to me with such varied objects as crayons, tissue paper, beads, coffee beans, Play-Doh, M&Ms, rocks, and magnets in their ears and nostrils. (This doesn’t count the unfortunate innocent bystanders who presented with insects having claimed “squatter’s rights” to the patients’ auditory canals.)
Invariably, when asked, the children deny knowing how the object came to be there—at best, a lame “it just fell in” is offered. When questioned as to how the offending object came so close to the involved area, I am met with silence or a shrug. One memorable child told me he did not believe I was the doctor because I was a girl. I let it pass, considering he had put a rabbit food pellet in his ear after being dared to do so by his older brother. I felt his overall judgment was somewhat questionable.
I entered Room 4, prepared to see the usual anxious—or, as in some cases, oblivious—toddler. Instead, to my surprise, a sheepish-looking eight-year-old boy sat on the table, accompanied by his exasperated mother. The pair had been waiting for several hours for the anticipated pasta-ectomy.
Unable to stop myself, I blurted out, “What is a big boy like you doing putting macaroni up his nose? I expect to see this in little kids, but not eight-year-old boys!” The child answered that he had put the macaroni up his nose “when I was in preschool.”
“You mean five or six years ago?” I asked incredulously. When he reluctantly said yes, I explained that I would look up his nose, but that that piece of macaroni was long gone—dissolved or swallowed lo these many years ago. Sure enough, an exam revealed turbinates and mucus but no complex carbohydrates.
I explained to the mother again that there was no way the food item could have survived in the child’s nose for five years, that he would have presented with sinusitis years ago had the macaroni not been swallowed, dissolved, or sneezed out, and that there was no place else to which it could have migrated.
My best diagnosis was that the child had an unusually dry, sharp-feeling piece of mucus in his nose. The discomfort of this had caused him to admit his transgression, committed in the reckless days of toddlerhood, one which had clearly been a source of guilt for him ever since. After some saline nose drops, and no doubt due in no small part to the soul-cleansing effects of confession, the boy felt better. He and mom went home.
I left the ER to contemplate what antics the next day’s group of three-year-olds would cook up. I vowed to keep a close eye on the Jelly Beans.