OR nurse here. This is kind of a long one...
I was taking call one night, and woke up at two in the morning for a "general surgery" call. Pretty vague, but at the time, I lived in a town that had large populations of young military guys and avid meth users, so late-night emergencies were common.
Got to the hospital, where a few more details awaited me -- "Perirectal abscess." For the uninitiated, this means that somewhere in the immediate vicinity of the asshole, there was a pocket of pus that needed draining. Needless to say our entire crew was less than thrilled.
I went down to the Emergency Room to transport the patient, and the only thing the ER nurse said as she handed me the chart was "Have fun with this one." Amongst healthcare professionals, vague statements like that are a bad sign.
My patient was a 314lb Native American woman who barely fit on the stretcher I was transporting her on. She was rolling frantically side to side and moaning in pain, pulling at her clothes and muttering Hail Mary's. I could barely get her name out of her after a few minutes of questioning, so after I confirmed her identity and what we were working on, I figured it was best just to get her to the anesthesiologist so we could knock her out and get this circus started.
She continued her theatrics the entire ten-minute ride to the O.R., nearly falling off the surgical table as we were trying to put her under anesthetic. We see patients like this a lot, though, chronic drug abusers who don't handle pain well and who have used so many drugs that even increased levels of pain medication don't touch simply because of high tolerance levels.
It should be noted, tonight's surgical team was not exactly wet behind the ears. I'd been working in healthcare for several years already, mostly psych and medical settings. I've watched an 88-year-old man tear a 1"-diameter catheter balloon out of his penis while screaming "You'll never make me talk!". I've been attacked by an HIV-positive neo-Nazi. I've seen some shit. The other nurse had been in the OR as a trauma specialist for over ten years; the anesthesiologist had done residency at a Level 1 trauma center, or as we call them, "Knife and Gun Clubs". The surgeon was ex-Army, and averaged about eight words and two facial expressions a week. None of us expected what was about to happen next.
We got the lady off to sleep, put her into the stirrups, and I began washing off the rectal area. It was red and inflamed, a little bit of pus was seeping through, but it was all pretty standard. Her chart had noted that she'd been injecting IV drugs through her perineum, so this was obviously an infection from dirty needles or bad drugs, but overall, it didn't seem to warrant her repeated cries of "Oh Jesus, kill me now."
The surgeon steps up with a scalpel, sinks just the tip in, and at the exact same moment, the patient had a muscle twitch in her diaphragm, and just like that, all hell broke loose.
Unbeknownst to us, the infection had actually tunneled nearly a foot into her abdomen, creating a vast cavern full of pus, rotten tissue, and fecal matter that had seeped outside of her colon. This godforsaken mixture came rocketing out of that little incision like we were recreating the funeral scene from Jane Austen's "Mafia!".
We all wear waterproof gowns, face masks, gloves, hats, the works -- all of which were as helpful was rainboots against a firehose. The bed was in the middle of the room, an easy seven feet from the nearest wall, but by the time we were done, I was still finding bits of rotten flesh pasted against the back wall. As the surgeon continued to advance his blade, the torrent just continued. The patient kept seizing against the ventilator (not uncommon in surgery), and with every muscle contraction, she shot more of this brackish gray-brown fluid out onto the floor until, within minutes, it was seeping into the other nurse's shoes.
