Night Shift: O Tannenbaum

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I’m not working Christmas Eve this year. I don’t think I can take any more holly, jolly. It gives me indigestion. I saw a Christmas tree shaped light bulb recently in Home Depot. You’ve probably seen something like it. It’s normal sized, but has a triangular shape and form of a Christmas tree. I don’t know where you would use it. But the last time I saw one I was pulling it out of an 85-year-old’s rectum. It almost gave me PTSD seeing it again on the shelf accompanied by a big poster advertisement.

I still remember the chart. “Foreign body in rectum” was the complaint.


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“Seriously?” I thought to myself. “What is it this time?”  Entering the room I gave my warmest professional hello and greeting before launching into the sensitive topic. “I understand you have something lodged in your rectum,” I said without flinching. “It’s Christmas Eve, for crying out loud,” I shouted in my head. “I should be home stuffing stockings. Not unstopping your stocking.”

“Yes,” he said without a hint of care. “It’s a Christmas tree light bulb.”

That one stopped me in my tracks. A light bulb?  This was decades ago and the Christmas tree lights then were these small bulbs about the size of a grape. “You could probably poop that out if you really tried,” I thought.


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“I’ve tried passing it out by straining,” he said taking the thought out of my head. “But I can’t get it to move down.”

“Move down?” I said with barely concealed incredulity. “How far UP is it?”

“I can barely touch it any more. I think as I was trying to get it down, I inadvertently pushed it up further,” he said.

“Wait a second,” I blurted out. “Did you put this bulb in your rectum or did you swallow it?”


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“It’s a light bulb,” he said. Now it was his turn for incredulity. “I can’t swallow a light bulb.”

Actually I had seen a fraternity brother eat a light bulb back in the day as a party joke. But he chewed it up first. “How big is this light bulb?” I said with growing clinical interest.

“It’s a light bulb,” he said with some exasperation demonstrating four- to six-inches between his thumb and index finger.

“Whoa,” I said with reflexive awe. “That’s a big light bulb. Weren’t you afraid it would break in your rectum and cut you?”

“Naw,” he said with a shrug. “It’s one of those with thick glass because it’s shaped like a Christmas tree. It goes on a lamp that I get out of storage at this time each year.”

My thoughts were racing. “You get this lamp out once a year to celebrate the holidays and it ends up in your butt,” I thought.

night-shift-light-bulb

“I know it sounds strange,” he said reading my mind. “I know, I get out the Christmas lamp and the bulb ends up in my rectum. But really it’s not so strange.”

I really had no business asking any further questions about this, but he has me hooked on his Christmas story. “Did you slip and fall on the lamp?” I asked slowly trying to come up with some rational story that would end up with this result.

“No,” he said with a look as if he was about to launch into a bedtime story for his grandchildren. “This time of year I eat too much and it causes me to get constipated.”

“Ok?”  I said waiting for the punch line.

“Well,” he continued, “…the constipation makes my hemorrhoids flare up.”  He stopped to dangle me over the precipice of that thought.

“Yes, and…?” I bit.

“I remembered that my old family doc told me that when my hemorrhoids got bad I could treat them by pushing them back in.”

“That’s right,” I exhaled. “But he didn’t tell you to push them back in using a Christmas tree shaped light bulb did he?”

“Yeah,” he said, as if that was obvious.

I just stood there slack jawed.

Even now as I look back on that encounter I laugh at my gullibility. I actually thought for one brief moment that this guy was telling me the truth. I’d heard some pretty unorthodox treatments before. I’d never heard of telling your patient to put a light bulb up their butt to treat hemorrhoids.

“Did it work?” I remember actually asking him.

“Yeah,” he said with a chuckle. He knew that this smart doctor had swallowed his yarn and was enjoying the moment.

“Well I guess we need to get it out,” I said feeling like an idiot.

I left the room to collect all the needed equipment and briefly told the story to breathless nurses at the station. After returning I got the guy into a knee chest position with my trusty head light and anoscope in hand. And true to his description the bulb was visible, but clearly out of manual reach. Calling for a ring force I found that I could grasp the base of the bulb as it extended toward the anal opening. But each time I tried to pull on it, the suction from above caused it to slip out of my grip rebounding even higher. I felt that if I attempted this method many more times, it would result in either sling shooting the bulb up to his sigmoid or prolapsing his colon. “I need to relieve the suction from above,” I thought.

“Get me a nasogastric tube and 200 cc syringe,” I told the tech that followed me back into the room with naked curiosity. He looked at me quizzically. “You’ll understand in a minute.”

Returning with the tube and syringe the size of a shock absorber, I explained, “I’m going to push this around the bulb and put some pressure behind it to allow it to move down when I pull on it.”  After lubricating the tube I was able to easily push it along the rectal wall to a position well above the bulb.

“Now as I pull down on the bulb, I want to you to gently increase the pressure behind it by pushing in the syringe.”  He nodded as he seemed to understand his role appearing to be honored to be a part of this medical procedure.

“Sir,” I said to the patient peering around his massive hips. “If you feel the urge to push, feel free to help us out a bit. I’m sure we will have this thing out of you in a jiffy.”

I inserted and spread the anoscope as far as I dared. After identifying the brass base of the bulb I grasped it firmly and instructed the tech to put a little pressure behind the bulb. Without really seeing how much pressure he was applying I could see that the basic physics of the maneuver was beginning to work. The bulb began to slip gently down the rectum. I felt like an OB using Simpson forceps to deliver a lazy baby. “A little more pressure please,” I instructed the aid as he looked over my shoulder

Just then I heard the man give out a loud groan and saw the effects of his massive Valsalva. Instead of slipping out the rectum, the bulb was roaring out like a midnight freight train. I was able to grab the bulb and dodge left. My technician was not so lucky and ended up wearing all of the Christmas dinner that was held back by the dam. His expletive was perfectly descriptive.

“Sorry,” the old man said to the young man as the tech stomped out of the room swearing. The man turned to me and said he felt great.

“I can imagine you do,” I said looking at the mess we had created.

“Can I have the bulb back?” he said catching me off guard again. I thought for a moment.

“Sorry, but I have to send all removed foreign bodies to the pathology lab for identification,” I lied. The truth was that I had to work New Year’s Eve as well and I didn’t want this guy anywhere near this light bulb again.

ABOUT THE AUTHOR

FOUNDER / EXECUTIVE EDITOR Dr. Plaster has been an emergency physician for more than thirty years, working exclusively night shifts for the past twenty years in emergency departments across the country. During that period he joined the U.S. Navy and served two tours in Iraq. Dr. Plaster is the founder and executive editor of Emergency Physicians Monthly and the founder of Plaster Publishing.

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