Sunday, March 22, 2009

Nasogastric tubes

As a medical student I had to insert a gastric tube to measure my own gastric acidity. I remember it as one of miserable days of my life. On that occasion I had to pass it via the mouth and it was only down for three hours. Following my two pint vomit they decided to insert one transnasaly.

At the age of 16 I played at center half for the school second XI. On one occasion I was about to head the ball over my own crossbar to concede a corner from a high cross, when our goalkeeper, Roger Millward, rushed out and in attempting to punch the football, punched me in the nose. When I came too my nose was broken, and this is why inserting a nasogastric tube was very painful, even though the nurse inserting it was Nurse Nightingale and extremely skillful with it.

I have taught generations of students that the word 'retch' is pronounced 'reach' and not 'wretch', but they will not learn. The presence of a tube at the back of the throat stimulated the gag reflex and causes retching. Many surgeons, Dr Fozard included, are not keen on the use of nasogastric tubes post-operatively, but when gastric stasis leads to vomiting, there is very little choice. The usual practice is to spigot the tube and wait until the stomach is clearly emptying before removing the tube as soon as possible. In my case the stasis was prolonged and the tube was down for several days. Eventually Dr Fozard took the decision to pull it up and immediately I felt better.

When I was about 14 I rapidly expanded my vocabulary and began to use long words instead of short ones. I would say 'commence' instead of 'start' or 'begin' and 'velocity' instead of 'speed'. I discovered the word 'recuperate' which for some reason I believed was a posh word for 'to belch'. I remember writing an essay at school in which I used 'recuperate' several times with this meaning. I couldn't understand why the boys in the class were laughing.

After abdominal surgery the first sign of recovery is the downward passage of wind. The nurses come round every morning and discretely ask, "Any wind?"

I see now that as a teenager I got thinks upside down. 'To recuperate' doesn't mean 'to belch', it means 'to fart'.


Anonymous said...

It's certainly not funny as I've managed to avoid an NG tube to date, but I chuckle when I recall trying to swallow an esophageal manometry catheter (effectively the same thing) during my years of training as a "mercenary" when finances were tight.

In those days the $75 "volunteer" remuneration would have gone a long way to feeding my family, but gagging and retching precluded my completing the task.

Over the years I have passed many NG tubes as I was especially proficient at it in difficult patients.
I also learned during my internship that stimulation of the nasopharynx via gentle insertion of a red rubber tube or Levin tube (never use a large tube for this) into the nasopharynx via the nares is a very effective means of stopping intractable hiccups.

Many patients ended up thanking me for this seemingly cruel maneuver!

Get well quickly,


Deb Light said...

Oh my Dr. Terry,thanks for the laugh!!I needed that!LOL!
Hope you are feeling better!
God Bless,

Marcia said...

Somewhere in the meaning of "recuperate" there must be something about laughing, or causing others to laugh. I'm glad you are up to it!

Pat said...

You have indeed illuminated my afternoon and brightened it with laughter. And thanks for the proper pronunciation: good to know tho' I expect most listeners would stare back blankly when I put forth "retching" with a long 'e'.

Rest well.

We all care so much about you . . . your care and concern for all of us makes it seem as though we know you well.. . .