Nose Mints

By , May 3, 2010 12:46 pm

I walk into the cubicle.  There I find a mother, her face drawn and worried.  Next to her stands a man, his head shaven and glistening, his arms folded tightly, his biceps threatening to tear through the sleeves of his T-shirt.  In front of both of them, stands their three-year-old son, Carl, his finger buried up to the joint, deep in his right nostril.

“Hi there,” I say.

“Hi,” say the parents in unison.  She’s all breathy like an air sign, he’s very definitely of the earth.  And yet they speak as one, like they share everything.  It’s kind of weird and creepy.

Meantime, Carl’s finger stays firmly up his nose.

“You’ve found something up there, have you?” I ask, bending down to his level.

“Yeah,” he says, swinging his free arm back and forth, delighted at the attention.

“A breath mint,” his parents say, again in unison.

“Really?” I ask. Carl squeals with delight.

Carl’s mother motions to speak, and her husband nods.  If they are to speak as individuals, it seems there needs to be consensus.

“Carl was sitting in the back of the car with the mints,” she breathes.  “At one moment he had them in his hands, and then he had one in his mouth, and then,” she stops to compose herself, “it was up his nose.”  Tears come to the edge of her eyes.  Her husband holds her arm, helping her through the painful memory.

“And then what happened?”

“Well, I went back, and he was crying and, and…”  she stops, and holds her mouth, like she’s going to vomit.  “And I saw the mint, and his finger was up there, and then it was too far gone.  It was lost.”  Tears begin to stream.

“Lost where?”

“Up his nose.”

“So then what happened?” I ask inquisitively, quite enjoying the story.

“Well, that’s when I rang Tony,” she gushes.

I look across at Tony, who has remained amazingly quiet throughout this time.  He sees this as his cue, but checks with his wife for permission.  She gives a little nod.  Carl keeps his finger up his nose.

“Well, I came straight home,” he says in an oddly squeaky voice.  “And so I held him down, and I could see it.  Or I thought I could, anyway.  So I grabbed some tweezers, and tried to grab it out…”

He stops, and looks at his wife again.  She looks at me.  It’s like it’s my turn to give permission.

“So there was a lots of grabbing going on,” I say, motioning for him to continue, “so…”

“…So I grabbed at the white stuff, which came out.  But not enough.  So I went back for more.  But then his nose started bleeding, so I stopped at that point.”

An image flashes through my head of Tony at home, his biceps as wide as my thighs, holding own a screaming child, stuffing tweezers up his nostril until it bleeds.  My eyes start watering at the thought.

“Fair enough to have stopped,” I say, “I think that was wise.”

I look down at Carl, to see how he’s faring.  He’s humming brightly, his finger going from nose to mouth, to nose, to mouth, in time with his tune.  He does this about every second, like he’s dipping it in chocolate.  Or mint, at least.

The kid’s got rhythm.

“So what happened then?” I ask, my foot beginning to tap to the beat.

“Well, we grabbed him…”

“…Sounds about right…”

“…and we took him to the GP.”  He looks at me again for permission.  His wife has been dismissed – I’m the sole permission giver now.

“And what did he do?”

“He sent us straight here.  Said he didn’t have the equipment for mints.”

* * * * *

I look up Carl’s nose.  For consistency, Tony grabs his arms while I do this.  Carl is upset, but it’s hard to tell whether this is because we’re holding him, because I’m looking up his nose, or because we’ve stopped him from eating his mint-flavoured snot.  All I can see is a white chalky residue at the edge of the first turbinate.  It’s been shovelled up far beyond that.

“What did you see?” his mother asks anxiously.

“Not a lot.  Whatever is in there, it’s beyond where I can see.”  I look down at Carl, his finger back in place.  “And beyond where he can touch.”

I pause for a moment, thinking.

“What type of mint was it again?”

“Umm,” says his mum, “I can’t remember.”

“Do you still have them?”  She nods fervently.  “Can I have a look?”

With that she runs from the cubicle, without warning.  I look at Carl and then at Tony.  After a moment, we begin to exchange small talk, as if that was what we’d expected.  Two minutes later she returns.

“They were in the car.”

She hands me the metal box.

“I want to do a science experiment,” I say, flipping the lid, taking one of the mints out.  I walk out of the cubicle, grab a Styrofoam cup, and fill it with water.  And then I return, dropping the mint in the water.

“This happened three hours ago?” I ask.  They nod in time.  “You say he’d been eating it for a bit before he put it up his nose, so it would already be a little smaller than this,” I say, holding up a fresh dry mint.  “I want to see what happens if we leave this in water for fifteen minutes.

“Cool,” says Tony.

His wife slaps him on the arm.

* * * * *

I walk back in, the clock having just ticked over the quarter hour.  I take the cup, empty the water, and return to the cubicle, taking out the mint.  It’s edges dissolve in my hands, some chalky residue coming away.

“This is what I saw when I looked,” I say, showing his parents.  They nod together.

“That’s what I saw with the tweezers too,” says Tony excitedly.

“Mixed with all the blood,” his wife breathes.

I take the wet mint, and place next to it a dry one.  It’s about half its size.  “So, if this has happened in fifteen minutes, I’m guessing that in the last three hours, the one up his nose has become pretty small.”

“And if it’s still there?”

“His body will have produced a lot of snot, particularly with an irritant like this.  It’s probably dissolved, or he may have even swallowed it by now – it may have gone through the back of his nose and into his throat.

“Gross,” says his mum, seemingly fine with his nose picking, but thrown by this concept.  “Like you said,” I continue, “he was rubbing his nose, and it was streaming to start with.  He was crying and really, really upset, and look at him now.”

We all look down at Carl.  There he stands, with the metal box in his hand, a mint between forefingers, trying to push a brand new mint up the other nostril.

His father grabs at the box, his mother at the mint, both gone from him in a moment.  He doesn’t seem the slightest bit fazed.

“He can’t have been too scarred by all of this,” I say.

They both look away, then at each other, shaking their heads, slightly embarrassed.

“I think it’s probably not a bad idea to get rid of the mints,” I add.

“Absolutely,” Mum says.  She pauses for a moment.  “Is there likely to be any lasting effects from all of this?”

“Well if he keeps this up,” pipes in Tony, “he’ll probably end up with very fresh smelling nose breath.”

His wife looks at me for a serious response to this, but realises soon enough that there isn’t one.

Pumpkin Time

By , April 27, 2010 3:05 pm

I check my watch.  It is 2.23pm.  Just as I am getting up from my desk, I hear the sound of thumping steps down the passage.  Through unconfidential walls, I can hear Glynnis, one of the General Practitioners, bustling past my door, talking urgently as she goes.

“Do you want to call a Code Blue?” a voice asks with urgency.

“Ah, no, not yet, we should be right,” she replies, her tone stating otherwise.

I stop for a moment, my hand reaching for the doorknob.  I pause.  And then the announcement comes:

“Code Blue, front foyer.  Code Blue, front foyer.”

I pull at the door and turn left, walking the hall, following the scent of blood.  As I open the door to the waiting room there is an unusual sight – not a single head facing my way.  Instead, everyone is craning towards the exit.  I follow their eyes through the sliding doors, walking as I do.  And there I see Glynnis and another doctor crouched over a prostrate body.  There are four others standing around in a ring.  As I approach, I see Glynnis stab a barrel through a pair of jeans and into a left quadricep.

Overdose.

Working in Medical Rooms at the base of inner city Commission Flats has been an education.  Based in Paediatrics, I have not been direct witness to the effects of drugs;  more so the indirect emotional and behavioural butterfly effect they can have on kids and their families in the area.

That is, until now.

“Mark, wake up, Mark.”

As if the scene isn’t surreal enough, Glynnis is trying to bring me round.

“Yes, Glynnis?”

“That’s his name,” they chorus together, like they’ve been practising all afternoon.

“Right.”

I reach down for a pair of blue gloves.  As I move around, I see Mark’s face is a darker hue than the plastic on my hands, his eyes ajar, his pupils pinpoint, his mouth slack.  There he lies, in Jesus Christ pose.

Mark’s having a great time.  But he’s stopped breathing.  Party time is over.

Like I said, working near the Commission Flats has been an eye-opener.  The vicious circle of underprivilege hangs like a pall over the area.  Living in government housing, the near-association with gambling and crime, the tap-on effect of alcohol and drugs, and from there, to mental illness.  I’ve the seen the kids of these parents, and the results of this dangerous cocktail.

I’ve written letters to the Department of Housing about cockroach infestations, I’ve spoken to school teachers of kids that don’t get lunch in the second week of the dole, and I’ve liaised closely with the Department of Human Services after seeing forms of abuse that are better not written about.

It’s heartwrenching, and it’s definitely not pretty, but it’s a totally different type of not-pretty to this.  Had Mark not shot up in the toilets of a Medical Centre, in six minutes time, he’d be dead.

“Hey, Mark,” Glynnis yells.  I try not to startle.  She positions his flaccid neck, applying the oxygen mask to his face.  The other GP moves his legs around, stimulating him, trying to check for any signs of life.

A short and measured debate ensues about whether he needs bagging and masking, or whether the Narcan is starting to have effect.  The jab in the thigh will save his life, but cut well-short Mark’s high.  The reality of this situation is that when Mark comes round, he’ll be more pissed about losing his high than he is grateful for being alive.

Ah, beautiful medicine.

“What the fuck is going on?” Mark asks, stirring intermittently, swiping at the facemask, before settling back into his coma.

“You were using in the toilets, mate.”

I feel for a pulse.  Strong and regular.  In about ten minutes, he’ll be tearing strips of the ambos.

“Nah, I wasn’t,” he dribbles about 30 seconds later.  He falls back down the rabbit hole.

Mark is well known to clinic, and through months of trust that had developed, he was granted two minutes alone in the toilet.  This was just long enough for him to grab a spoon from the kitchen, and cook up his next meal.

When, three minutes later, Mark was discovered on the floor with his gear and his spoon, he was dragged to this current plot of concrete.  The spoon was left in the loo, waiting to be retrieved by cleaning staff and returned to it’s rightful home.

Just in time for someone’s pasta lunch.

Glynnis performs a quick neurological examination of Mark, in response to a story about a limp and difficulties standing – the reason for the toilet in the first place.  A bad case of leg-paralysing-constipation.

Surprisingly, he’s perfect now.

Within moments, on this beautiful, warm summer’s afternoon, we see the flashing lights of the ambulance.  It’s Mark’s approaching coach, just waiting to turn into a pumpkin.  Seven minutes and counting.

We stand and chat, the moment passed for medical intervention, as Mark continues to bat weakly at his plastic oxygen mask, in the final throes of his high.  Inside his veins, a powerful drug blocks receptors by the million, closing in like a relentless crusador.  It’ll be over in no time.  Last chance to play the astronaut, Mark.  Fly, buddy, fly.

Two doors open, and from them emerge a pubescent girl and a silverhaired gent.  They walk slowly towards us, all blue uniforms and tilted gaits, their lean balanced by heavy bags and heavy moods.

“Hey guys,” we say.  They look at Mark.

“We got here early.”

“Just in time,” Glynnis says, an unspoken truth understood by all.  We all look at Mark, like something worth pondering.  “We’ll leave it to you guys, then?”

They know that just as they make it to their dispatch hospital in five minutes time, Mark will wake in rage, asking for his money back.

I call it pumpkin time.

Sack Taps

By , April 20, 2010 5:22 pm

The phone goes, and I pick it up on the first ring.

“Mark speaking.”

“Are you the AO?”

“Yep.”

“We’ve got a thirteen year old torted testis that’s just come in.  Where do you want it?”

“Ummm…”  I look at the computer screen, trying to resist the temptation for a joke.  “Cubicle 19.”

“Thanks, love.”

“No worries.  Either that, or just put it straight in the bin.  It’ll be no good to anyone.”

“Sorry?”

“No, I’m sorry.  I couldn’t resist.”

“I don’t understand.”

“A dead testicle?”  I wait for a response.

“He’s a Category 2,” the voice continues tersely, “I’ll send him through.”

I watch through the window of the fishbowl, waiting for action.  In walks a thirteen year old boy, John-Wayne-swaggering as he goes, wincing with each step.  He is followed by a woman, jeans spray-painted in place, her face showing as much concern as the botox will allow.  His younger sister, a lump of a girl, all slumped shoulders and frumpiness, lopes in behind.  Our primped mother, the swaggering boy and his kyphotic sister make quite the scene.

“Hey Joel,” I say, enter the cubicle, having given barely enough time for him to have got on the bed.

“Hey,” he says back.  He kneels, his bum in the air, trying to turn over without putting any pressure on his scrotum.  At this point, I realise that this is not an easy task.

“How’s it going?”

Mum launches straight into the story.  She tells me about Joel’s two weeks of testicular pain, and that it has worsened over the last twelve hours.  The entire time she stands there, like a window mannequin, her arm an outstretched  chicken wing, as if she is arm-in-arm with an invisible man.  Over her wing hangs a bag, a black patent leather thing, brandishing an insignia, the two interlocking C’s of Chanel.  Her jacket looks like the lovechild of a fox and a plastic bag, and crinkles like a chip wrapper when she moves.  Her jeans provide some of the explanation for her posture, that and stilettos that threaten to crack the vinyl floor.

I watch in fascination, writing as the story is told to me, trying to understand how it is that she is still able to move her lips without mumbling.  It’s like watching a ventriloquist that is so good that even the sound seems to come out of the doll.

Meantime, Joel has finally positioned himself.  He lies there, still in school uniform, with a strange look on his face.  It is a mix of bemusement, sheer terror at having to show his bits to another male, and the look of hope that, in this much pain, I can do something about it.  His sister has already buried into a magazine, earphones in place, having almost melted into herself.  She’s like a wax doll that’s been left out in the sun with an iPod.

“Doctor, you just have to see it.  It’s all red and swollen and looks really unwell,” his mother finishes.

“So is the pain still there now?” I ask.

“Yeah,” he says, in that scoffing teenage way.

“Well, let’s have a look then.”

Joel looks at the roof, at the wall, anywhere but at me.

“And it’s the right one?” I ask, looking at two perfectly normal testicles.

“Yeah,” he says, scoffing again.

I complete the examination, checking the lie of the testis, the cremasteric reflex, checking for hernias, and other explanations for the pain.  It all draws a blank.

“Well, it all looks pretty normal,” I say finally, “but the reason you were rushed in here is because of something called a torted testis.”  They all look at me in unison, even the sister.  The two kids manage to furrow their brow.  Mum only manages to look dead.

“It’s a very serious situation when the testicle twists on itself, because it cuts off the blood supply.  The reason you were hurried through here, is that if this is what it is, we need to untwist it quickly, which would be done in surgery.  Consequently, we’re going to get the surgical people to look at it.  But, I will stress, that on examination everything looks okay.  It doesn’t look like it’s twisted.  Everything looks completely normal,” I repeat.

“Oh, thank God,” says his mum, through flaccid lips.  I pause for a moment, looking at Joel.  He looks away again.

“You haven’t had any trauma to the area have you?”

“No,” he says, quickly.

“Nothing else that could explain it?  No martial arts, no fights?”  I pause.  “Nothing else?” I ask, leaving it open.

“He does Muay Thai,” he mother says.

“What’s that?”

“It a Martial art, but it’s non contact.”

“Yeah.  Non-contact,” says Joel.

“Anything else?”  The silence lays thick.

“Tellhimaboutsacktaps,” the sister finally blurts, without lifting her head.

“Shut up,” he mumbles.

“Sorry,” I say.  I turn to her, sensing a clue.  She chews a couple more times.

“Sacktaps,” she repeats, then blows a small bubble.

I turn back to Joel, “What is she saying Joel?”  He looks away, that bemused look coming onto his face again.

“This is your testicles we’re talking about here, Joel.  And I’m having trouble understanding your sister.”  She looks at me like she wants me dead.  “I get the feeling that there’s something pretty important we’re missing here, Joel.”

“Theydosacktaps,” she mumbles again.  The mother stares blankly, only her neck moving.  I can’t help but laugh.

“Help me out here Joel.  Sack taps?”

He rolls his eyes, and then sighs.  “It’s what the others do.  Sack taps.”

“Is that an explanation?”

His eyes roll again, like he’s dealing with an annoyance.  And then he shoos at me with a flick of his hand.

“What’s that?  You want me to piss off do you?”  The sister looks up, suddenly engaged.  Mum tries to focus on something and not fall over.

“Nah nah nah, man.  That’s it.”  He flicks his hand again.  “That’s a sack tap.”

I feel the pieces clunk into place.

“That’s a sack tap?  That’s something that other guys do?  They flick you in the balls?”  I hear the surprise in my own voice.

“Yeah,” he says, “every one does it.”

“Everyone flicks each other in the balls?”

“Yeah,” he repeats.

“How often?”

“Every day.”

“Where?”  My voice continues to betray disbelief, but I just can’t help it.

“Everywhere.”

“Everywhere.  Really?  In class?”

“Nah, in break.  In the hall.”

“You all flick each other in the balls in the hall.”  His sister laughs, but his mother doesn’t.

“Yeah.  Everyone does it.”

“Not in my day they didn’t.”

Hey.  I like a good testicle joke.  But respect the equipment, bro.

The equipment

* * * * *

I call the surgical registrar and tell him the story, letting him know the examination is normal.

“But there is a story of some trauma,” I say.

“Oh yeah?” he asks, marginally interested.

“The boys do something called a sack tap.”

“A what?”

“A sack tap.  It’s where they flick each other in the balls.”

“What?  Where?”

“In the balls.”

“Where though?”

“At school.”

“In class?”

“No, mainly in the hall.”

“They flick each other in the balls in the hall?”

“Yes.”

I hear the phone move away from his face, and in the distance I hear a deep laugh that goes on for about fifteen seconds.

“I’ll be down in a minute,” he eventually says.

I put the phone down and smile.  After a moment, I notice the male doctor sitting next to me.  He has a looks of disbelief, his mouth open wide.

“Who flicks who in the balls?” he asks eventually.

* * * * *

I walk back into the cubicle to find the surgical registrar, in his scrubs, his back facing me.  Now there is a crowd around him, all facing my way.  This time, the sister is paying attention, as is Mum.  An older man, presumably the father, looks on, glowering.  The surgical registrar stands there, his hand flicking back and forth.

“And you hit each other like this, yeah?”

“Yeah,” says Joel, by now bored with the story.  His Dad shakes his head, pinching the bridge of his nose.

“What!” Joel moans, “every body does it!”

“Not in my day,” says the father, warningly.  Joel lies there, fuming, staring at the roof.

“Ultrasound is clear,” I say, breaking the silence.

“So it was the sack taps,” says the surgical registrar, barely concealing a grin.  “Very good.”

He leaves, and I introduce myself to dad.

“The ultrasound is clear, which means there’s normal blood supply to the testicle.  We can’t see anything wrong with the testis, but there may be bruising, or even a little bleed.  But nothing that is really worrying.”

“Oh, thank God,” says Dad.

“But I need to impress upon you the importance of this, Joel.  Sack taps are out.”

“I get it,” he says, putting his hands to his eyes.

“No, Joel, I don’t know that you do.  I know you mightn’t care at the moment, but one day you might want kids.  And you will want to be able to have that choice.  You can choose not to, but you want to be able to choose to as well.  Get it?”

He looks at me and nods, like he’s suddenly got it.

“So I’ve written a letter, and I’ll read it out.”  I check to see everyone is watching.  They are.  “Blah, blah, blah, ‘and this pain is likely to be secondary to an adolescent behaviour called sack tapping, where Joel and his friends flick each other in the genitals with their hands.  Although this has not caused a problem this time, in future it may, and I would strongly suggest that this behaviour not continue anymore, in order to avoid any further requirement for medical attention.’ ”

I look at Joel, then at his frustrated father, and then across at his plastic mother.

“You guys do what you want with this letter.  Give it to the parents of the other kids.  Whatever.  I don’t really care, as long as it stops.”

“It’d be good if it stopped,” Joel mumbles.

I pause for a second.

“Are they picking on you?”

“Who?”

“The other kids.  Are they picking on you when they do this?”

“Nah, everyone does it to everyone.  But it’s just kind of stupid, isn’t it?”

I look around the room.  Everyone’s face matches the static stunned look of Mum.

“Excellent.  Then let’s do whatever we can to stop the sack taps, eh?”  Dad nods vigorously.

Joel slides gingerly off the bed, giving a small smile out of the corner of his mouth.

“Just one more thing,” says Mum, holding herself to my arm with one of her chicken wings.  “What can we do for the pain, doctor?” she asks, as a final question.

“Stop the fucking sack taps,” says Dad, already half way down the hall.

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