June 6, 2008, 9:08 am

Stuck in the Middle With You

Just what annoying troubles do you get from harsh toilet tissue?

A sore rear end?

Unless this prim and proper patient is wiping with bark, she should probably spend her money on a more gentle tissue.

She certainly looks like she can afford it.

The nurse is thinking, “What a loony toon!”


One of the nice things about my job is the flexibility of scheduling. Each shift does their own schedules, and the nurse responsible for my shift is a freaking miracle worker.

I need one night off for a Jeff Scott Soto concert (okay, two nights) and she arranges an entire week off around the dates!

No request is too big, no length of time is too long…you ask, you get!

I love it.

And that is why I am now in the middle of a six night stretch, including a 12 hour shift tonight.

It’s hard to say “no” to someone who never says “no” to you!

Can’t say I’ll be very pleasant to work with by Monday night, but I will be there!


As an emergency department nurse, I am many things to many people.

I am a counselor, a pain-reliever, a consultant, a giver of advice, a dispenser of reassurance.

But there is one thing I am tired of being.

A rectal roto-rooter.


I’m sorry, but constipation is NOT, never HAS been and never WILL be a freakin’ emergency.

A soap-suds enema is not a life sustaining procedure and is most certainly not part of any Advanced Cardiac Life Support class I’ve ever taken (yet).

My vast experience tells me that if you can take a soap suds enema, you don’t NEED a soap-suds enema.


There are two types of constipatees in the ER. One type will present with abdominal pain or cramping, not knowing what the problem is. They will receive labs, fluids and really good pain medications while they get their abdominal cat scans that will confirm the now very expensive diagnosis of…


The second type comes in with the complaint of “I’m constipated.” Usually they haven’t had a bowel movement in 36 hours. Oh boy, call the code team!

And do you know why they show up at the ER with that complaint? Because their internist/general practitioner/family medicine physician or the advice nurse on duty TELLS them to come in! At 3:00 am.

A pox on all your houses!


I could go into a detailed explanation of what a soap-suds enema entails, of how it exhausts the patient, of how the soapy water shoots out faster than you can instill it, of how the entire procedure is useless, messy, smelly and time consuming.

But I won’t.

Let me go on record as saying IF you are truly diagnosed as being “FOS” (use your imagination) and there is nothing else seriously wrong, then a good bottle of nice, tasty Mag Citrate is what you need.

Yummy. Tastes just like 7-UP. And you won’t have to worry about NOT having a bowel movement for 36 hours as you will proceed to have a bowel movement that LASTS 36 hours.

MIssion accomplished.


I’d also like to point out that the next doctor who orders this ridiculous treatment in the ER while I am on duty may just wind up being the recipient of the same.

Think I’m joking?

Try me.


  • TC

    June 6, 2008 at 10:08 am

    It’s true, ER nurses HATE giving enemas. Well, I’m sure all nurses hate it, but I can vouch that it is pretty annoying in the ER. If the patient could walk, talk and reach their backside, I’d try and talk the doc into letting them do a fleets. We used to have one older guy come in once a month-we think he liked having people stick things up his butt, because he was never really constipated. Ewww.

    BTW-who’s old enough to know what a Triple H enema is?

  • Blondefabulous

    June 6, 2008 at 11:07 am

    Giving someone an enema is an actual procedure that Dr’s make you guys do??? OMG!What a waste of time and people power! I can see if someone has been blocked for weeks….. but 36 hours? Not a real bell ringer there.

    And we wonder why the ER’s are all backed up all the time…….

    (ha ha…. backed up…. get it?)

  • Stacie Mc

    June 6, 2008 at 12:26 pm

    Yummy. Tastes just like 7-UP

    How can you lie like that????

  • marachne

    June 6, 2008 at 12:40 pm

    Kim, I get your point, but just a little quibble with you here — constipation — or more appropriately bowel obstruction CAN and IS a serious situation. (And I won’t even get into autonomic dysreflexia…

    I’m not saying your guy who strolls in saying they haven’t taken a dump in 36 hours isn’t just a PITA (sorry for the bad joke), but you get some of my patients — the people with cancer, or end-stage COPD, or the like who are high doses of opioids w/o appropriate bowel regimens who haven’t gone in 8-10 days and you’re talking major problems (esp if it’s colon or pancreatic cancer. There is a new drug out there that looks pretty promising – check out this piece: http://www.pallimed.org/2008/05/making-sht-happen-methylnaltrexone.html

    But you know what makes me crazy? Docs ordering opiates w/o appropriate bowel meds — I’m sorry, docusate is next to useless in this situation: you need SCHEDULED senna and really good education on the need to keep things moving.

    Oh, and a final word — just because someone isn’t eating doesn’t mean their colon isn’t still shedding dead cells and stuff. I don’t care, unless it looks like you’re going to die in the next few days, I wanna see your bowels moving.

  • grumpyrn

    June 6, 2008 at 5:06 pm

    Quite right, enemas have no place in A&E(ER) medicine, took us a few years but we finally managed to stop our docs prescribing them. Eventually reached the stage where they were told if you want it, YOU give it. Marachne – I understand your concerns but this is not A&E medicine. TC I am well old enough to understand that, in UK = high, hot and hellofalot, ah the good old days.

  • marachne

    June 6, 2008 at 5:47 pm

    grumpy RN. I understand what you’re saying about what is and isn’t appropriate tx for an ED. All I’m saying is that ignoring someone who is “full of s*hit” could lead to devastating results.

  • Wanderer

    June 6, 2008 at 11:30 pm

    I was wandering down the “stomach ailments” aisle of the local Target and saw, to my surprise that they carry Mag Citrate, MOM, Fleets, Miralax and a further wide variety of stuff to help with constipation. Found it amusing…the wife said that was because of my obsession with poop.

    And for someone who is a “walkie-talkie” who hasn’t pooped for 36 hours, with no other symptoms, it is definitely not an emergency. Uncomfortable yes, emergency, no. +4 days, yes, it is an issue.

    Worse though is digital disimpaction…

  • Jen

    June 7, 2008 at 9:37 am

    My mum, who is visiting for my grad (BScN UOttawa ’08) and is a grad of St. Mary’s Montreal ’54 says triple H is “High Hot and a helluv alot”

  • Black Cloud ER Tech

    June 7, 2008 at 1:30 pm

    Enough with the enemas… Here’s a simple, yet effective solution that is available in ANY ER across America (if not the world)…

    1 8oz cup STRONG coffee.

    Yall know the kind… The stuff we make at 2am to keep us going ’til 7a when the night shift is over?

    Give the PT the coffee… and by the time they are D/C’ed from the ER and home, they are ready to go.

    WAHLAH! Problem solved.

  • Angel

    June 7, 2008 at 4:46 pm

    I think only a nurse can appreciate this. Laugh, I did, heartily. Years ago(not saying how many), I was orientated by 2 “older” nurses. They used to get all the young nurses to administer what they called “the 3 H” enema (high, hot and a helluv alot). It was such a regular occurance that us younger ones started a tally and awarded the nurse with the most enemas “The Brown Crown”. Thank goodness I’m in community nursing now……no more “3 H’s” from me!

  • Rae

    June 9, 2008 at 8:01 pm

    When it comes to constipation like this, patients seem to procrastinate terribly! I have worked with many patients over the phone–do this, this, and this….if none of THAT is accomplished by this, call me! and whaddya know…they call days later with the same problem, sometimes even ignoring my initial advice.

    let’s face it, nobody (that really needs one) likes enemas.

  • mojitogirl

    June 14, 2008 at 5:17 pm

    A solution to ER enemas? 3 little words: KAYEXELATE TO GO.

    We GUARANTEE you’ll poop until you say uncle…..

About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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