Robert Myers - The Woman Who Swallowed a Toothbrush: And Other Bizarre Medical Cases

THE WOMAN WHO SWALLOWED A TOOTHBRUSH

and Other Bizarre Medical Cases

Copyright Rob Myers, 2003

Published by ECW PRESS
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Toronto, Ontario, Canada M4E 1E2
416.694.3348 / info@ecwpress.com

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form by any process electronic, mechanical, photocopying, recording, or otherwise without the prior written permission of the copyright owners and ECW PRESS.

NATIONAL LIBRARY OF CANADA CATALOGUING IN PUBLICATION DATA

Myers, Rob
The woman who swallowed a toothbrush and other bizarre medical cases/ Rob Myers.
ISBN 978-1-55022-569-3

1. Medicine Miscellanea. 2. Medicine Anecdotes. i. Title
RM706.M84 2002 610 c2002-905416-8

Editor: Tracey Millen
Cover and Text Design: Tania Craan
Typesetting: Wiesia Kolasinska
Production: Mary Bowness
Third printing: Transcontinental
Cover images: Toothbrush2003 Comstock Images,
X-rayTony Stone Imaging / Getty Images

This book is set in Minion and Trajan
and is printed on paper that is 100% post-consumer waste content

The publication of The Woman Who Swallowed a Toothbrush has been generously supported by the Canada Council, the Ontario Arts Council, and the Government of Canada through the Book Publishing Industry Development Program.

PRINTED AND BOUND IN CANADA

To my wife Randi and my children Seth, Rachel, and Aaron

Most medicine is mundane. Clinical presentations fall into predictable patterns, which are rapidly recognized by the seasoned doctor. Some medical specialties are more interesting than others, but ultimately, when youve seen one youve usually seen them all. The adolescent belief that a gynecologists job must be rewarding every moment of every day is not shared by most gynecologists. Those few who agree should probably be placed under surveillance.

This book documents some of the exceptional problems for which patients seek help. Every doctor has been involved in memorable medical cases. These stories are rare, at times profoundly tragic, even bordering on the unbelievable. Whereas 99.9% of medicine is predictable, this book is a sample of the other 0.1%.

I have always been interested in the world of the strange but true. Well-worn paperbacks from the Ripleys Believe It or Not series held an esteemed place in the drawer beside the toilet in the upstairs bathroom of the house in which I grew up. A full decade before graduating to Playboy magazine, I sat until my buttocks were numb reading Ripley.

Medical journals are similarly fascinating. I came across the story of a woman with a toothbrush lodged in her esophagus. After reading the conclusion to this bizarre tale, I decided to catalogue strange, documented tales of medical intrigue.

Though the names have been changed, the stories are real. One might question why any modification of these one-of-a-kind vignettes is necessary. The identifying data, even in its most skeletal form, is like DNA. The likelihood of these events affecting anyone else in the world should be one in a few billion.

And yet, after completing my research for the Toothbrush book, as my publisher and I call it, I found an account in the lay press of the same toothbrush scenario. I e-mailed the writer to suggest that an alternative explanation for the seemingly innocent act of toothbrush swallowing should be pursued with the young lady. Read on and you will soon discover why not all is as it seems in medicine.

Emergency room doctors and nurses are in a constant state of languid preparedness. Periods of boredom are quickly replaced by life-threatening heart attacks, traumas, and other terrible conditions. Shards of broken bones poking through bloodied skin, slippery intestines protruding through bullet holes, severe head injuries anything that can go wrong with the human body may result in an emergency room visit at any time, day or night.

On a quiet Wednesday evening approaching midnight, sirens wailed and lights flashed as a 56-year-old man arrived at the emergency department via ambulance. He had awoken from a restless sleep 30 minutes earlier with sudden severe abdominal pain. He quickly called 911. Though he lived close by, it took the two slender paramedics longer than expected to load his obese 56 450-pound frame into the ambulance.

His folds spilled over the sides of a narrow hospital gurney in the triage room, as the skeletonized version of his story was elicited by the triage nurse. A quick check of his vital signs indicated that beyond his girth, there was a serious problem afoot.

He was tachycardic (had a rapid heart rate) with a pulse of 120 beats per minute. His blood pressure was low at 90/60, he was feverish and breathing rapidly. Oxygen, an intravenous line, and a cardiac monitor all the basics were in place as the emergency room physician appeared. The curtain rattled as he entered the tiny cubicle.

What brings you to hospital Mr. Canderas? he inquired.

I dont feel so good was the unhelpful reply.

Could you be more specific? the doctor continued.

Well, I couldnt get to sleep so I got out of bed around 10 p.m. and fixed myself a snack and watched some TV. It seemed to take a huge effort to speak.

The doctor couldnt imagine that the large man before him could walk or fix a snack. Must sleep in the kitchen, he thought.

I must have dozed off in the chair, the patient continued. I carried myself over to bed and lay down but I didnt feel right, sort of like I ate too much.

Go on, go on, said the doctor.

I suddenly got this horrible stomach pain. I puked all over the bed and called an ambulance.

The doctor moved over to the middle of the bed and worked on Mr. Canderass abdomen. His hands were lost, enveloped by moist pockets and crevasses, surrounded by smooth waves of rubbery tissue. He watched Mr. Canderass face as he poked and prodded his abdomen. Then it came. Not a subtle grimace of displeasure, but a yelp so painful and piteous that were he 300 pounds lighter, parts of him surely would have jumped off the bed.

Diving through fat, the doctors hands had landed on a rigid board-like abdomen. Irritation within the peritoneal cavity, as with appendicitis or liver injury, causes severe pain with rigidity of the abdominal muscles. This man had an acute abdomen. With the associated fever, fast heart rate (tachycardia), and relatively low blood pressure (hypotension), an emergency surgical exploration (laparotomy) was necessary.

The wheeled gurney squeaked and strained under the weight as Mr. Canderas was transported to the operating room, where the centerpiece is the surgical table (although surgeons may disagree). Surgical tables are standard issue and, consequently, narrow. This presented a problem for Mr. Canderas, as the table could accommodate perhaps one of his fleshy limbs. A fleet of four tables and half a dozen of the O.R. night staff was required to finally secure nearly a quarter ton of limp tissue and ready it for the knife.

He was anesthetized and intubated. The surgeon sliced and sliced and sliced. Yellow flecks of fat melted and dripped into the surgical field, lit by a blazing overhead light. Pools of blood formed and were quickly drained by a suction catheter. The peritoneal lining appeared like a thick piece of Saran wrap, embedded with a criss-cross of minute blood vessels. The scalpel rose and fell, and there was silence, punctuated by the staccato beep of the heart rate monitor.