It All Comes Out in the End

That's funny. I learned the importance of toilet tissue when I was about 2 years old. I don't remember any toilet tissue unit in Maternal/Child Health class, nor do I remember doing a visual inspection of the roll prior to my patient's use. What is she looking for?

Maybe she is counting the squares. That's what my great-grandmother would do. She said you should never use more than three squares. Yeah, right....never mind that my sisters and I are personally responsible for a good portion of the planet's deforestation. I just figured"Three-squares-per-wipe" must have been a Depression-era slogan. Did they ration toilet-paper in the Depression?

It has been my deepest belief from the time I entered the hallowed world of emergency nursing that assistance with elimination of solid waste from the body did not fall into the realm of the emergent assignation. In other words:

ENEMAS ARE NOT A FUNCTION OF THE EMERGENCY DEPARTMENT.

Ever. Period. End of discussion.

Say a patient comes in with abdominal pain. There is no obstruction; no appendicitis. The patient is acutely "FOS" or "full of stool" (feel free to vernacularize). There is no reason the patient cannot be given an oral preparation to initiate the free flow of flatulance. Or given a suppository to use at home. Or an enema preparation to use at home. And don't get me started on soapsuds/tap water enemas. Water in, water out. They aren't worth the H2O they are printed on and are a waste of emergency department time and resources.

Yes, I am passionate about this.

Now, what about the patient who presents with the chief complaint of "Constipation" ? They are literally sitting in triage because their regularity has been disrupted for, oh, what...TWO DAYS? Maybe three? Did they call their doctor. No. Did they try anything at home first? No.
And the ultimate response: I called my doctor and he/she said to come to the emergency room. (!!!!)

A pox upon that doctor's house.

Emergency room doctors feel they must do something so they order enemas. Do they understand that anything other than a Fleets takes up valuable ER nursing time? The patients can do it themselves at home. It can be done at a nursing home. It can be done as an inpatient if that is where they are headed. While the nurse is working in the land where-the-sun-don't-shine, their other patients are not getting EKGs, labs, meds or anything else. Or worse, because enemas are not a priority, the constipated patient waits and waits until all urgent/STAT/god knows what else is taken care of. And then they are miffed and beg to go home and then write to the head of the ER about how long they had to wait with their non-urgent problem. There goes the Patient Satisfaction rating....

I wonder how many enemas would be ordered if they had to be done by the ER doctors?

Of course, the patients never know this. They are "enema-ized" as ordered. I always tell them that I understand it is uncomfortable and not to be embarrassed, we deal with it all the time and they will feel better soon. Then at discharge we discuss how they can keep it from happening again.

But everything I do for them could have been done at home. For a lot less than $1000 plus dollars. For about the price of a Fleets, actually.

Give me a freakin' break.