The poor fellow had already received a thorough rectal exam from me, and now he was going to have to deal with something a little more intrusive and uncomfortable.

The poor fellow had already received a thorough rectal exam from me, and now he was going to have to deal with something a little more intrusive and uncomfortable, a nasogastric tube.

On my last day of surgery, we had been consulted to see a man who had come in with abdominal pain. The man had come in with a recurrent history of small bowel obstructions, so he basically knew the drill. I had obtained his history and did his physical exam. In his case, with a positive family history of colon cancer and a personal history of Crohn's Disease and multiple past and present abdominal issues to consider, I had to include a rectal exam and test for fecal occult blood. Luckily, it was negative. After the imaging showed that he had a partial bowel obstruction and his breath was noted to be "feculent" in nature (essentially meaning that he had been quite backed up and there was nowhere for the contents in his GI tract to progress forward), we decided to decompress his stomach with a nasogastric tube.

I was aware of his past medical history involving anxiety and a strong gag reflex, so I numbed the back of his throat and even the nostril I was going to use. He knew the drill and placed his head forward and grabbed the cup of water that had the straw for him to sip from (it helps to swallow water during the procedure). He was already starting to get nervous and his wife left the room due to previous bad experiences with the procedure. He looked up at me and with a cautious voice said, "you're pretty good at this, right?" I simply responded saying, "you're going to do just fine." I figured it was a better way to answer him than to tell him that this was my 1^st time performing the procedure and that the previous one I had observed (performed by one of the residents) had gone terribly wrong.

I set up the tube, measured it, and lubed it up well. I knew that once I started, I would have to just keep pushing and pushing no matter how the patient reacted. I told him in a calm voice that I wanted him to take a deep breath in, and then a deep breath out, and then I started feeding the tube down his nose while he sipped at his water. Despite the topical anesthetic, his gag reflex was kicking in quite a bit and he was struggling for a few seconds, but I managed to get the tube all the way down and in place in his stomach. Using a stethoscope and a syringe, I checked the line by placing the stethoscope over his stomach and pushing a syringe full of air into the tube to make sure I could hear it well and know that the tube was in place. After taping the tube in, he complimented me on how well it went and said that he was expecting it to be so much worse from all of his past experiences having them put in. Again, I refrained from telling him that it was my 1^st time doing it. Luckily, I got it in on my 1^st attempt and was able to call his wife back into the room.

Afterwards, my surgical resident and I went over to the lobby, turned off the electronically-played piano, and we started jamming on the piano for a little while. It was a nice way to end the day and the rotation.