The View from the Vue (10 page)

Thus, homosexuals were seen frequently in the Bellevue Admitting Office and on the wards, and we came to look upon them with a reasonably casual attitude. When you came right down to it, their habits were no more peculiar than those of the great majority of our patients.

My first encounter with a homosexual and his particularly homosexual problem occurred while I was serving my internship rotation in the Admitting Office. About two o’clock one morning, the nurse handed me a treatment slip on which she had written “FB.” This was the abbreviation for “foreign body,” and when written in such a non-specific manner it usually meant that the complainant had a cinder in his eye. I couldn’t figure out why the nurse was smirking as she handed me the slip.

I walked into the examining room, where I found a young man in his twenties. He was wearing a tight-fitting pair of chinos and a suede jacket over a white T-shirt. His hair was blond and curly, considerably longer than what was fashionable in 1963. His hands were clenched in his lap, his lips were tightly drawn.

“Got a little something in your eye?” I asked.

At that, his face broke up and he started to chortle. His amusement seemed odd and inappropriate to my question, and I involuntarily stepped back a pace. My expression must have transmitted my dismay, because the patient made an effeminate “never mind” gesture with his hand and said, “Please don’t take offense, Doctor. It just sounded like they hadn’t taught you your anatomy very well. You
were
joking, of course, weren’t you?”

I took a quick look at the treatment slip; it certainly did say “FB.” But then the vagueness of the terminology struck me, especially since it was more than apparent what this fellow’s sexual preferences were.

“I…I’m sorry,” I said slowly, holding up the treatment slip for reference. “All this paper says is that your problem is some sort of foreign object, but it doesn’t say where. I assumed it was in your eye.”

The man broke into laughter again. “Oh,
Doctor
,” he said. I’m afraid your nurse was being, shall we say, a little delicate? Actually, to be quite blunt about it, my problem is that I’ve got a Coke bottle stuck up my ass.”

I fought fiercely to keep a straight face, but the battle was lost before it had even begun. My patient, both satisfied that I was not angry, and pleased to have brightened my nocturnal hours, said, “Shall I tell you how it got there?” He smirked, looking very much like the nurse had looked when she handed me the treatment slip.

“No, that won’t be necessary,” I answered. Although I had never before personally encountered such a situation, the Bellevue scuttlebutt had been sufficient in educating me. Homosexuals engage in anal intercourse, and as the sphincter of the anus becomes stretched by repeated dilation, the sex act becomes less and less satisfactory. Therefore, prostheses of greater dimensions are used. Greased bananas are reportedly a favorite, but after a while they too become less than satisfying. At that point, soda bottles come into use, and with their gradually increasing diameters, it becomes sort of a measure of gay macho to see how much of the bottle the recipient can tolerate. Apparently I was dealing with a highly talented individual but, unfortunately, his partner must have developed slippery fingers at a highly inopportune moment.

I told my patient to disrobe for examination. Then I put on a glove and smeared some lubricating jelly over my index finger. In a rectal examination, the anal sphincter usually permits the examining finger to pass only with considerable reluctance, to say nothing of discomfort on the part of the patient. In this case, though, there was no resistance or discomfort whatever. I probably could have put all five fingers through, but there was nowhere for them to go. Directly inside the anal opening was the bottle.

I cursed as I felt its surface and realized that the bottom was facing me; I had been hoping that the bottle just might have been inserted base first so that I would be able to hook a finger inside the neck and pull it out. For approximately fifteen minutes I tried to extract the bottle by inserting both index fingers, one on each side, and pulling outward. All I accomplished, though, was to make the bottle spin around within the rectum.

Finally I decided it was time to call in the reserves, so I took off my gloves, walked across the hall, and told my story to Henry Kaufman, the surgical resident. Henry grinned. “Your first Coke bottle, huh?” he said. “Well, it won’t be your last, you work around here long enough. Come on, I’ll show you how to do it. These guys got assholes like you can’t believe: they really stretch out. You can’t be afraid to pull a little: just pull straight out, not sideways, and you’ll never rupture a rectum.”

We walked back into my patient’s room, Henry put on gloves, and then he went to work. Slowly, gingerly, he slid in the middle three fingers of each hand. Then he braced himself and began to pull. The bottle bulged against the attenuated sphincter, and as it did, Henry’s hands came together in the midline with an audible slap. The bottle squirted upward, and the patient let out a yelp.

Henry stepped back, almost scratched his head, but recovered himself just in time, “Hmm,” he mused. “Bend over and let’s try again.” Henry tried again, but the result was the same.

“This is the god-damndest slipperiest bottle I’ve ever seen,” Henry said to me, a puzzled look on his face.

Suddenly I realized why. All that lubricating jelly I had used on my fingers had been transferred to the bottle, making it as slippery as the proverbial greased pig. My feeling of chagrin was not lessened when the patient slipped me a sly wink.

“I’ll be right back,” Henry said. “I’m going up to OB for a minute.”

“OB?” I asked. I couldn’t imagine why Henry would be going to the obstetrics floor at that point.

“Just don’t go away,” he said, as he walked briskly out the door.

A few minutes later Henry returned carrying a contraption I have since become thoroughly familiar with, but which at the time was utterly foreign to me. “This is called a vacuum extractor,” he said, as he walked in. “It’s used sort of like forceps, to pull a baby out. This little cup here fits on the top of the baby’s head, and the vacuum pump, over here, creates a suction through the hose. Then you just pull on the hose, and out comes the baby. Or in this case, the Coke bottle.”

“Jesus God,” I said. “Did you tell the OB resident what you were going to use his baby-schlepper for?”

“As a matter of fact, I did,” said Henry. “I know the guy who’s on tonight pretty well, and he’s kind of a character. He thought it was a pretty clever idea. Actually he wanted to come down to watch, except he had a lady all ready to deliver.”

Henry checked the assembly of the vacuum extractor, and then set about trying to apply the metal cup to the base of the Coke bottle. But every time he pushed the cup against the bottle, the latter would float deeper into the rectum, and he was never able to achieve a tight enough seal to permit him to pump up the vacuum. Finally, his face bright red and dripping sweat, he put down the instrument and shook his head sadly.

“Do you think we could get a pair of obstetric forceps and use them to pull it out?” I asked hopefully.

Henry shook his head again. “They’re too big,” he said. “I’m afraid we might put the end of one right through the rectum.” His face brightened. “But maybe we could get a high-speed drill from maintenance, make a hole in the bottom, and hook a stick or something through it.”

“That doesn’t sound wise,” I said. “For one thing, the glass slivers up there might not do him too much good. And for another, if the bottle wouldn’t hold still for the vacuum cup, it’s not very likely to hold still for the drill bit.”

“I wish you guys would figure
something
out,” said the patient, a little querulously. “I know it’s my own fault, but I really don’t want to go through the rest of my life with this bottle up my ass.”

Henry jumped up and slapped the man on the shoulder. “Don’t worry, old fellow,” he said. “We’re going to get your bottle out for you all right. But we’ll have to put you to sleep to do it.” Then he turned to me. “Arrange for anesthesia and an operating room,” he said, “and call me when they’re ready to put him to sleep.”

A couple of hours passed before I could take care of all the preliminaries which are necessary before someone can receive general anesthesia, but finally we were all set, and I gave Henry a call. After the patient was rendered unconscious, we strapped him to the operating table in the prone position, with his knees drawn up against his chest. Then the anesthetist, at Henry’s order, lowered the foot of the table so that gravity would be of maximal help in the procedure.

With a bit of a flourish, Henry produced a pair of rubber gloves, two squares of yellow sponge rubber, a roll of cellophane tape, and a pair of bandage scissors. While I watched, entranced, he put on the gloves and then proceeded to cut out finger-sized pieces of the sponge rubber, which he taped to his gloved digits. This done, he inserted the middle three fingers of each hand into the patient’s anus, as he had previously done in the A.O. Squeezing the Coke bottle so tightly that his teeth were clenched, he pulled. This time, with the improved traction provided by the sponge rubber, the bottle slowly emerged through the sphincter. Henry held it aloft in triumph.

The anesthetist whistled appreciatively. “Twelve full ounces, that’s a lot,” he said.

The Great Coke Bottle Extraction was a sweaty affair for a while, but it was a minor venture compared to the matter of Arthur Arisburi’s rectal miseries. Arthur was a slight young man with sandy hair that hung forward into his eyes, and when he staggered into the Admitting Office, he appeared to be about a step and a half in front of the old fellow with the scythe. He made it to the nurse’s desk, moaned, “My stomach…” and collapsed in front of her. She motioned to a guard who was standing in the corner. The guard hurried over, picked Arthur up under the arms, and dragged him into an examining room. Meanwhile, the nurse rushed into the room where I was culturing up a strep throat to tell me my talents were needed elsewhere,
prontissimo
.

An aide was undressing Arthur as I walked in. I stood and watched as they slipped a gown onto him. He lay on his side, legs drawn up to his chest, clutching his belly, and rocking gently back and forth. I put my hand on his shoulder to draw his attention, and asked him what was the matter.

His eyes were glassy as he looked up at me. “My stomach…hurts real bad,” he whispered. The very effort of saying the words seemed to cause him pain.

“When did it start?” I asked.

“Few…hours…ago,” he answered.

“Have you had any nausea? Vomiting?”

Gingerly, he shook his head yes.

I told him to turn over onto his back so I might examine his abdomen. He winced.

“I’m sorry,” I said. “But that’s the only way I can try to find out what’s wrong.”

It hurt me to watch him roll over, but finally he made it, lying on his back, breathing shallowly and rapidly, with knees pointing toward the ceiling. When I placed my hand to the right of his navel, he screamed in agony and then shivered violently.

I was puzzled. This man had all the signs of acute peritonitis, but had a normal blood pressure and temperature. That ruled against an infectious cause for his problem, and I wondered whether he was suffering from a perforated peptic ulcer, with spillage of stomach acid into the peritoneal cavity. Such a catastrophe would also have permitted the entry of free air into the peritoneal cavity through the hole in the stomach, so I had Arthur wheeled over to the X-ray department for films. When he returned, I slid the pictures up onto the view box. I had been right on the ball! Under each diaphragm was a clearly delineated pocket of air.

Clutching my roentgenologic triumph, I went into the hallway and collared Randy Braxton, the surgery resident on A.O. call that evening. “What do you think of this?” I said smugly, as I held the X-rays up to a nearby gooseneck lamp.

Randy pursed his lips as he stared at the films. “Has he got the clinical signs of a perforated viscus?” he asked.

“He sure as hell does,” I answered. “I figure it must be an ulcer. Come on in; I’ll let you look him over for yourself.”

When Randy and I walked into the room where they were keeping Arthur under observation, the nurse stage-whispered: “Dr. Karp.” As we turned in her direction, she pointed at the stretcher that Arthur had been lying on to go to and from X-ray. Right in the middle was a little puddle of blood.

Randy walked quickly over to Arthur and told him to roll off his back and onto his side again. Slowly, Arthur complied. Randy bent over and peered from below as he spread the patient’s buttocks. I watched intently from behind. The entire area around the anus was bloodstained.

“Gimme a glove and some jelly,” Randy called to the nurse. “Let’s do a rectal and see where this blood’s coming from.”

Arthur moaned like a poleaxed cow. “No, no,” he pleaded. “Don’t examine me there. Please.”

“You’re bleeding from there,” Randy said coolly. “I just want to put my finger inside. That may show us what’s going on with you.”

“No, please don’t,” whined Arthur. “It just hurts too much there.”

Suddenly the vision of a giant Coke bottle materialized in my mind.

“Listen, Arthur,” I said, “maybe this sounds a little silly, but you didn’t put anything up there, did you?” Arthur remained very quiet. Randy craned his neck at the X-rays, looking for a foreign object in the region of the rectum.

“Come on,” I said. “Why don’t you tell us what you did. If you don’t know it, you’re a pretty sick guy, and you may save your life. At least you may save yourself a rectal examination.”

Arthur looked up at me, his eyes full of fear. “You wouldn’t kick me out of here, would you?” he whimpered.

“Christ, no one ever gets kicked out of Bellevue,” I said. “Don’t you know that?”

Randy put on his examining glove with a snap.

“All right, all right,” cried Arthur. “I’ll tell you. A few of us were fooling around a little, you know, at a Gulf station up First Avenue a-ways. We were taking turns sticking the air hose up each other’s ass and blowing in a little air. It feels kinda funny, you know? Anyway, one of the guys decided to get wise; I didn’t know it. He turned the meter all the way up before he gave me my kick.” The little man winced in recollection. “Oh, I tell you, Doctor, I never felt such terrible pain in all my life. I thought he had blown me up.”