“Sometimes sh*t just happens.”

Just a few days ago, I finished yet another string of four hectic shifts in the ER of our incredibly busy trauma center. After saying my goodbyes to my coworkers and transferring the care of my remaining patients to my partner, I left the building through our ambulance doors, avoiding the main pedestrian entranceway where the hectic waiting room sat.

It was a safe choice to leave this way, as it was 3 a.m. and both the ER and the waiting room were still swarming with much activity. Had I tried to navigate leaving through all the chaos of the waiting room, I would have been a target of many evil and angry stares from those patients who continued to sit there with non-emergent complaints, watching the lone TV that was looped with repeating segments regarding diet and fitness. Of course, who wouldn’t want to learn the benefits of eating cauliflower and doing fifty daily sit-ups at 3 a.m., right?

As the sliding glass doors of the ambulance entrance opened up, a blast of cold winter air greeted me, daring me to leave the warmth of the ER. Easy decision, of course. I stepped into the waiting night.

The pathway to my car was short, just a brisk walk on the sidewalk that leads to the parking garage. I traveled it quickly, arriving at the door in just minutes. Before grabbing the handle to open it, I glanced around at the illuminated surrounding landscape, appreciating the quiet and calm that accompanies this time of night.

I shouldn’t have.

While sweeping my appreciative eyes, I noticed that just across the street, among a row of small pines, was a lone figure. It appeared to be a man, wearing a ski jacket and cap. He appeared to be squatting down toward the ground. My initial thought was that maybe this was someone in distress who needed my help. Maybe he dropped his keys, even, and was looking for them.

Twisting my torso to get a better look, I was able to better appreciate what I was looking at. Not only was this man squatting toward the ground, but his pants were down around his ankles. His bare ass, side profile, was in plain sight.

“What the heck is he doing?” I wondered to myself, blaming my lack of sleep for my ignorance.

Ugh. It took me a nanosecond to figure out the situation. This man was taking a sh*t. Right there, under the lights, in full view, among our hospital’s lovely landscaping.

Of course, this scene caught me off-guard.

I wasn’t able to turn away. I stood there, my hand ready to pull the door’s handle, just staring. A million questions went through my head. Why there, instead of inside our waiting room bathroom? Do you have diarrhea? Are you sick? Do you have toilet paper? Is this going to leave a mess? Are you skillful enough to miss your pants and shoes? Are you homeless? Are you a CEO of a local company? Did you hope that no one would see you? Do you do this often? Are you afraid your ass is going to get frostbite? Are you going to pick up your mess with a baggie or leave it? 

Finally, after a few seconds, I opened the door, got into my SUV, and drove me and my wild imagination home.

I loved the unexpectedness of this, of being caught off-guard, and couldn’t help but chuckle to myself. After all, those of us who work in the ER, for the most part, have warped senses of humor. If I didn’t laugh about a drunk patient vomiting on me or a patient having an accident during a rectal exam, I would never have survived my job for the past 22 years. And because we encounter body fluids every shift, whether it be blood or urine or pus or spit or vomit or phlegm or stool, nothing about this guy fertilizing those little spruce trees grossed me out.

Let me take a moment here to send a big thank you to the inventors of shoe covers, gloves, face shields, and body gowns.

Of course, I should have predicted something like this scene would have happened after I left my shift. You see, right before leaving, a small group of us had a conversation about how much sh*t we had seen during our recent shifts. Literally, sh*t. So clearly, I had jinxed myself.

You want some recent examples about this dilemma? OK, then …

I had a recent homeless patient, otherwise healthy and capable, who sh*t himself in his bed without any warning to our staff.  “Why did you do this?” the nurse asked him. “Because I didn’t want to get up and go to the bathroom,” he answered. Our wonderful team of aides cleaned him up, got him fresh clothing, fed him, and ultimately we were able to place him into one of our homeless shelters. A taxi was called and picked up this patient to take him. In ten minutes, though, the taxi returned, dropping this patient back off at our entrance. The reason? This patient decided to take another dump and urinate in the backseat of the taxi. “Why did you do this?” he was asked again. “Because I didn’t want to wait.” The upset taxi driver, of course, made it very clear that our hospital would be footing the bill to have his cab cleaned out. Sounds fair.

Also during my past shifts, two younger patients came to our ER to torment us and have their bowel movements in our ER cots. The first, a female college junior, got so drunk that she needed to be brought to us for IV fluids and monitoring. Within an hour of her arrival, an obnoxious but familiar smell began to fill up the corner hallway near her room. Yes, she had sh*t herself. It’s amazing how some alcohol can totally absolve one from such vulgar activities. Then, to add insult to injury, after being cleaned up, she decided to show us who’s the boss and she sh*t herself again.

The second patient, a man in his early thirties, came to us after using methadone. He, like the college student, also was stable but needed monitoring and some treatment. And he, like the college student, also decided to relieve himself during his dream state. Not long after he arrived to us, his nurse was asking for help to roll this patient and change him into some clean clothes. No, she was not wearing a smile while asking.

When patients come to us, a part of our job is to preserve their belongings while they are in gowns and being treated. Usually, these belongings are put in a clear plastic bag, with a drawstring, and kept with the patient until their disposition to either be admitted or discharged. The question was brought up–should we take these messy belongings (i.e., their stained pants and underwear) and keep them safe or do we throw them out? If we keep them safe, should we put their cell phone and wallet and keys at the bottom of the bag and then put their dirty clothes in, so that they have to wade through the muck (just like our team did during clean-up) to get them? Do we leave the drawstring open?

Of course, it goes without saying that there are patients who are completely forgiven for their accidents. We are all human, and each of us will have (if you haven’t already) an accident along our life journey. Especially, elderly patients deserve and receive compassion and understanding when this occurs. Some of these wonderful patients are embarrassed and humbled and regretful when this happens, and my heart melts for them. Patients with a wicked case of food poisoning or stomach flu also deserve a break. The list of forgiving reasons is short, but it does exist.

Case in point. Recently, I treated an ill but gracious female patient who came to our ER with her husband. She had a fever and a wicked case of nausea and vomiting with diarrhea. After multiple bouts of diarrhea at home, they came to us by private vehicle. Along the way, this patient had an accident. Arriving to our facility, she had to walk through our security station (yes, they swept her for weapons with a wand) and our waiting room before being brought back to her room. In her room, she had another accident. We all felt bad for her. Seriously.

Arriving home and pulling into my driveway, my mind went from all these thoughts back to my squatting friend. Catching him in his private moment dominated my thoughts for my twenty-minute ride home and took my mind in the directions above. I wondered if someday I would ever be caught squatting outside, pants down around my ankles, grunting and doing my business with reckless abandon. If so, would I have an extra Kleenex in my pocket? I would hope it wouldn’t come to that. Furthermore, I wondered if I would ever be a patient in the ER having an accident. This would be a more likely scenario. If so, it will probably happen when I am elderly and obsessed with my bowel movements and the amount of daily fiber I am intaking.

I doubt, though, that it will happen due to me being intoxicated or high on methadone.

After all, I don’t have time for that sh*t.

“StorytellERdoc” is an emergency physician who blogs at his self-titled site, StorytellERdoc.

Image credit: Shutterstock.com