Posts tagged: ridiculous

Spud

By , June 2, 2010 7:05 am

I walk into the cubicle, with Ken in tow.  There I find an eight-year-old boy, hoeing into a packet of chips.

“Hey, Daniel.”

“Call me Spud,” he says, without looking up.

“Hey Spud.”

With that, he raises his head, and smiles from ear to ear.

“This is my Mum,” he says, gesturing across the cubicle.

“Hi Mum.”

Spud lets out a laugh.  “She’s not your Mum!  She’s my Mum!”

I look across at Mum.  She holds her head in her hand.  “He was sick when we brought him in here, I swear.”

“Hey, I believe you.  Kids turn around quickly,” I say.

I look around at the intern, who has been taking down everything I’ve said.  He looks confused.

“Kids turn around quickly?” he parrots.  I nod.  He scribbles some more.  It’s like owning a puppy that can write.

“These are admission notes, Ken.  You don’t have to write everything.  In fact, nothing that we’ve said yet should go in the notes.”  Ken looks deflated.  I look back at Daniel.  “In fact, just put the pen down, Ken.  I don’t even know that Spud is going to need admission.”

Spud lets out another little laugh, a delighted cry.   His Mum rests her head in her hand, shaking it some more.  Ken looks at me like I’ve scolded him.  It’s like the Charades Olympics.

“It’s okay, Ken,” I repeat.  “Let’s…just…listen.”  Reluctantly, he puts the pen on the bench.

I turn back to Daniel, just as he begins to pull the auroscope off the wall.

“So you weren’t crash hot this morning, Spud.”

“Nup.”

“What was going on?”

“Sore eyes.  Stiff neck.”  He fiddles with the expensive equipment, bouncing it up and down by the cord, oily finger marks trailing all over it.

“So I heard.  The emergency doctors were worried that you might have meningitis.”

“That’s what they said, yeah.”  He tires of the auroscope, letting it go by his side.  It springs back up like a bungy, hitting the wall, before bobbing up and down on its coil.  Its tip scratches the wall, making a sound out of a B-grade horror movie.  Ken looks frightened.

“Cool,” Daniel says.

I grab the auroscope, putting it back in its holder.  “Not that cool, mate.  Six hundred bucks cool if it’s broken.”

“I don’t care.”

“Sure you will.  Once mum pawns off your iPod, X-Box, Wii and PS3 to pay for it you will.”  He looks at me and frowns, stopping dead.  “That’s right.  All of them.  So let’s just settle down a bit, okay?”

I glance around the room.  Spud gives me his complete attention, his Mum has lifted her head out of her hand, and Ken now stands motionless.  We’ve gone from Charades to Statues.  Ken gives me one more pleading look.

“You can write if you need to, Ken.”  He smiles, picking up the pen, touching it quickly to the page.

“So Spud,” I continue, “the sore eyes and the stiff neck.  What happened?”

“Gone.”

“Headache?”

“Gone.”

“Problem with light in your eyes?”

“Nup.”

“Nausea?  Vomiting?  Lethargy?  Sore joints?”

“All gone,” says Mum.  Her head returns to its rightful place.

“So they all just kind of disappeared, hey?”

“Yup.”

“And no fever at any stage?”

“No.”

I shine a torch in Daniel’s eyes.  He doesn’t blink.  I stare at the back of his eyeball with the ophthalmoscope, the non-greasy companion-piece on the wall.   His eyes stay open.  I complete a neurological exam, testing his tone, power, reflexes and sensation.  Perfect.  I check his abdominal, respiratory and cardiovascular exam. Everything is completely normal.

Ken takes notes the whole time.

“There’s one more thing I want to do Spud.  I need to raise your leg while you lie still.”

“Yeah?  You really need to do that?”  He looks genuinely excited.

“I do, yes,” I say, a little confused.

“Then watch this.”

With that, Spud takes his leg, holding it at the ankle.  He takes it in a grip that looks odd, initially.  It begins to make more sense when he takes his leg and places it over his head.

“Is that what you wanted me to do?” he asks, a little breathless.

“Well, not exactly, Spud…”

“…What, you need it to go further?”

“No!” I yell, worried about what comes next.  “No, I was not going to take your leg and put it over your head.  I just wanted to lift it up off the bed a little bit.

“Oh,” he says, disappointedly.

“Did you know he could do that?” I ask Mum.  She shakes her head some more.

“Well it’s not meningitis,” I say.

“Are you sure?” asks his Mum.

“That last test is normally called the ‘Straight Leg Raise’, or – in Spud’s case – the ‘Over the Head Raise’.  It puts a stretch on the lining around your spine, the meninges.  With meningitis, raising the leg causes a lot of pain, as it puts pressure on the meninges.   The fact that Spud can stick his leg over his ear gives me a fair indication that he doesn’t have meningitis.  In fact, it gives me a fair indication that you’re somewhat of a freak, Spud.”

The Straight Leg Raise

Spud's Leg Over the Head Raise

Spud slaps his thigh like a good ol’ boy.  I just which he had a piece of wheat between his teeth.

“So I think you’re okay, partner.  You haven’t got meningitis, and you are free to join the circus.”  He laughs again.

“So why the headache?” Mum asks

I look at Ken.  He looks at me with fear, before returning to the safety of his page.

“Don’t know,” I say shaking my head.  “Headaches come and go.  Maybe it was a first-presentation migraine.  Maybe just a bad headache.  I’m not sure.  But what I am sure is that it’s not meningitis.  I’d suggest going home and having a good rest, Spud.  And try to keep your legs in front of your head, at least for today.”

“Sure,” he says, taking my hand in a shake.

“Thank you, Doctor,” says his Mum.

“Pleasure.”  I look down at the cheeky cowboy on the bed, the one who almost tore the equipment apart, until I threatened to confiscate his electronic pacifiers.  After that, he turned into a real character.  A real little lad.

“See you Spud.  It’s been a pleasure.”  He slaps me on the back, and winks at me.

“Pleasure was all mine, doc.”

I frown, looking at his mother.  She laughs.

“Just one more question for you Daniel.  Why do they call you Spud?”

“We live on a bit of property,” Mum says, interjecting, “and Daniel has always been interested in growing things.  So we got an empty wine barrel, cut it in half, and filled it with soil.  And Daniel grows potatoes in it.”

“I love potatoes,” he says shaking the chip wrapper like a talisman.

I pause for a second.

“What were you doing this morning?”

“Tending the spuds.”

“You do it every morning?”

“Most mornings,” he says.

“Do you use fertiliser?”

“Of course, man,” he says, “Dynamic Lifter.”

“And you used that this morning?”

“Yep.”

“How much?”  He looks back at me with confusion.  “How big is the packet?”

“Well, it was pretty big, I guess.”

“It was?” asks his Mum.

“You used the whole packet?”  He looks off to the side.  It’s the first time I’ve seen him look anything but confident.  “How long after you poured the whole pack of Dynamic Lifter over your barrel did you start to get sore eyes and a headache?”  He furrows his brow some more, before grinning sheepishly.   He raises his arms in a shrug.

“At least the spuds will grow though,” he says, finally.

Mum’s head returns to her hand.  Spud laughs.  I leave. Ken continues standing there, writing something.

Medical Records 101

By , May 25, 2010 3:25 pm

Problem:  INJURY – ARM (FOREARM AND WRIST)

Assess:  “Fell off couch & now limited movement, distressed with any attempt tomove (sic) arm.  Has croup like cough & black eye from cat.  PainStop @ triage.”


From this descriptive triage assessment, we can interpret:


1. That the child fell off the couch, and since that time is acting like a teacup.

2. Becomes distressed when no longer allowed to play that game.

3. Also has a cough.

4. And a black eye from the cat.  No need to try to make this funny.  That’s actually what they wrote.

5. Has given their contact details as painstop@triage.com

This triage assessment was initially confusing to me, until I read the doctor’s notes:

* * * * *

* * * * *

Then it all made sense.

Brevity is the key to clarity.

* * * * *

Plaster Master

By , May 20, 2010 6:29 pm

“Zeb?” I yell into the waiting room.

I stand and wait, while fifteen heads look at me, frozen.  This is my favourite part – being stared at.  The patient you call is never within sight, they’re always round a corner, taking years to get their things together.  While everybody else stares at you.  It’s the best bit.

“Zeb?”  I call again.  This time I hear a faint shuffle, and then movement.  And then the rattle of plastic bags.  Promising.  Very promising.

One of the staring people looks away, staring at something else.  Hopefully, staring at Zeb.

And with that, from around the corner, Zeb bounds.  All perky, and…green.  Fluoro green.

“How’s it going?” he asks in an Australian drawl.

“Good mate,” I return, and he giggles delightedly.  His mother rolls her eyes, and grandma tries the same thing.  “Nice colour, Zeb.”

“Yeah.  I like green.”

“This way,” I say.  “First door on the right.”

He walks off down the corridor ahead of us, and into the plaster room.  We follow him, waiting for grandma, who eventually places herself down on a stool.  The plastic bags fall to the ground in a heap.

“Can I get a different colour this time?  Sure, I like green, but this time I want red.  Or yellow.  Or, yeah, pink maybe?  Hang on, maybe not.”  It’s difficult to tell who he’s talking to.  Possibly no one.  “Yeah pink.  Can I, can I, can I?  Huh, huh, huh?”

I look at Mum.  She looks tired, but not as tired as you might expect.  Grandma is the one who looks beat.

“I think you’ll be getting white, mate.  I don’t think we’ll be getting out the fresh colours here.”

“Oh,” he whines, “why not?”

“Because I’m only a doctor.  I only do plaster.  It’s the plaster techs who do fibreglass.  That’s where the colours come into it.”

“Yeah, right, I get it,” he starts.  “Well, there’s a plaster under here.  From the start.  From, like, when this all happened.”  He nods, and his mother and grandma do too.  “And then we went back to the GP, like – I don’t know – like two days later, and it was only up to my elbow, right?  So he, like, sent me to the Children’s Hospital, and there the guy was like, ‘Dude, I don’t think it’s quite right, but I don’t want to re-break it for like a third time…’ ”

“…Third time?” I interject.  I get that interjection is the only way with Zeb.

“When he broke it was once, and when it was straightened made a second time,” Mum manages to say.

“…And so, re-setting it would make a third time,” completes Zeb, “and he was like, ‘That would be no good, man’.  So we were all, like, ‘Yeah, cool,’ and he was like, ‘Do you like fluoro?” and I was like, ‘Uh, duh, who doesn’t like fluoro?’…”

“You like fluoro?”

“Uh, duh!” says Zeb predictably.  We, the adults, laugh.   “And then he was all, ‘You can have any fluoro you want, and we can, like, cover up the whole white mess, if you want, dude.’  And so I went all, ‘Sure.  Do you have green?’  So he’s like, ‘Yeah, we got green’, so we, like, totally got it.”

He stops.  We all take a breath.

“That is a really amazing story, Zeb.”  He nods his head vigorously.  “But why are you here?”

“Yeah right,” he says, taking a breath.  I sit down, readying myself for a story.  “I got a pen lid stuck down there.”

He stops dead.  I do a double take.

“Is that it?  No story to go with it?”

“Nah, it’s, like, pretty boring.”

“So there’s a pen lid down your cast?”

“Yep.”

“Where exactly?”  He taps at his elbow.   “So pretty much half way down.  The furthest distance from either end.”  He nods again, like it’s a bore.  “And how did it get there?”

“I was, like, scratching myself.”

“With a pen lid.”

“Well, yeah.”

“You do realise, that you’re a goose?”

“Yup.”  He looks at his mum, raising his eyes.  “I’m a goose.”  We all laugh.

“This is a good story, Zeb.  Tell me, how did it get down there?”

“What do you mean?”

“Like, dude, like, tell me how it, like, got down there?”

“Is he making fun of me?” Zeb asks mother.

“Yes, he is.”  Grandma laughs some more.

“Well,” he says, cocking his head, “I was scratching, and, it, like, came off.”

“Oh, so it was on the end of a pen?”

“Dude!  I wouldn’t just stick a pen lid down there.  It might get lost.”  We all look at him raising our eyebrows in unison.  He ignores it.

“So, anyway, it came off the end of a pen?”

“Yup.”

“So then what happened?”

“I got some chopsticks out.”  We all laugh some more.

“This is great,” I say.

“Nah, nah, nah, I was really close.  I had it up to here!”  He points to the top of the cast.  “But I didn’t have enough hands left to grab it.”

“Why didn’t you ask for help?” asks grandma.

“Because I was embarrassed,” he says quietly.  It’s the first time I’ve seen him contrite.

“Lucky you managed to avoid embarrassment, eh?”

He raises his eyebrows, knowingly.

“So what now?  Do I get a different colour?”

“Not so fast, buddy.  Firstly, we need to get the lid out, right?”  He nods.  “So we’ll have to cut it down to here, so that we can split the cast and grab it.  You think you know where it is?”

“Yeah, it’s right here,” he says, pointing.  “I can feel it.  Right here.”

“Are you ready then?”

“Yup.”

I turn and open a drawer, one dirtied by years of plaster, revealing a treasure chest of torture devices.  Splitters, cutters, shears, giant bolt cutters – a whole stack of big metal things, with smooth handles at one end, and sharp bits at the other.

“Cool!” says Zeb.

* * * * *

We start with the shears.  It chews the fibreglass ineffectively.  I get about five centimetres in, before I give up.

“This is more like a crusher than a cutter,” I say.  I feel sweat on my forehead.

“You’ve got a long way to go,” says Zeb.

“Thanks for the reminder.”

“I’m just saying’s all.”

I look him in the eye, and then put down the shears.

“I’ll be back.”

I walk next door and return, wheeling in a machine on a cart.  I plug it into the wall, and the machine revs up.  From its end emerges a snaking neck, a buzz cutter on its tip.  A circle of teeth sits on the end of a rotor, a dangerous circular saw.  Zeb’s eyes pop.

“It’s okay,” I say, “it can’t cut you.”  I turn it on, the circular blades vibrating.  I place it against my skin.  I feel its vibration.  Zeb’s mouth drops wide.  “See?  The blade zigs back and forth – it doesn’t spin right around.  So it won’t cut skin, because skin’s not fixed.  Your skin just wiggles against it.  See?”  I put it against my arm once more.

“Cool,” he says.

We start.  I work my way down, the satisfying squeal of an electric saw with each stroke.  Each time it makes it through, I check Zeb’s face.  He’s freaked out, in a boy kind of way.  He doesn’t know if he’s thrilled, or filling his pants.  Or both.

We get to near his elbow, when I ask for guidance.

“Where is it again?”

“Right here.”

“I don’t want to cut the pen lid in half, do I?”  I pause.  “In fact, why didn’t I just cut out a window at the start?”

“That’s what I thought,” says grandma.

“Me too,” says Mum.

“I wouldn’t have minded suggestions, guys,” I say.  “I guess I’m so used to taking plaster off from the top, that I didn’t even think of that.  It’s not like I go fishing for pen lids in casts every day.”  They all laugh again.  “Where is it, Zeb?”

“Right there.”

I cut a hole, 4cm by 3cm.  I peel back the plate of fibreglass, it’s final fibres cracking.  I feel like an archaeologist.  I stick my hand in and fish around, finally feeling my finger against something round.  My eyes widen.  Everyone else’s do too.  I pull, trying to free it.  And finally, out comes the lid.

“There you go,” I say.  Grandma claps.  “I didn’t know that I’d find it that easily.”

“Why not?”

“The story is just such I good one, Zeb, I guess I didn’t know what I’d find in there.”  I hand the lid to Mum.

“Can I have it?” he asks.

“I think Mum should keep it,” I say.  He rolls his eyes once more.  All this family does is laugh, raise their eyebrows and roll their eyes.  It’s like they’re all having seizures.

“So what about fixing it up?”

“This will do for now,” I say, wrapping a crepe bandage, and taping it up, “just for overnight.  “But come back to tomorrow morning when the plaster techs are in.  Then you’ll get to choose a colour.  If I did it now, you’d only get white.”

“White, like, sucks man.”

“Like, I know.”

He rolls his eyes at my poor attempt at teen speak.

“Later,” he says.

“Hopefully not,” I say.

“Right.”  He jumps off the bed.  “You’re all right, man, you know that?”

He walks out the door.

“He never says that to anyone,” whispers grandma as she passes, shuffling her plastic bags between shaky hands.  “Especially not to men.”

I nod, watching Zeb walk off ahead, his mother and grandma in tow.  I catch him, looking back occasionally, making sure he doesn’t get too far ahead of his mother or grandma.

* * * * *

Hospital Charts

By , May 14, 2010 12:41 pm

The following quotes are taken from actual patient hospital charts, mainly in the United States.  They have been reproduced before, but they never get old.  Enjoy.

“The patient has been depressed ever since she began seeing me in 1993.”

“Rectal exam revealed a normal size thyroid.”

“Bleeding started in the rectal area and continued all the way to Los Angeles.”

“She has no rigors or chills but her husband says she was very hot in bed last night.”

“Patient has two teenage children but no other abnormalities.”

“Patient had waffles for breakfast and anorexia for lunch.”

“The patient has no past history of suicides.”

“She can’t get pregnant with her husband, so I will work her up.”

“Healthy appearing decrepit 69 year-old male, mentally alert but forgetful.”

“A midsystolic ejaculation murmur heard over the mitral area.”

“Both breasts are equal and reactive to light and accommodation.”

“Occasional, constant, infrequent headaches.”

“The baby was delivered, the cord clamped and cut, and handed to the pediatrician, who breathed and cried immediately.”

“Between you and me, we ought to be able to get this woman pregnant.”


* * * * *

“The patient refused autopsy.”

“The lab test indicated abnormal lover function.”

“The pelvic exam will be done later on the floor.”

“Skin: somewhat pale but present.”

“Large brown stool ambulating in the hall.”

“Exam of genitalia was completely negative except for the right foot.”

“Examination reveals a well-developed male lying in bed with his family in no distress.”

“Patient’s past medical history has been remarkably insignificant with only a 40 pound weight gain in the past three days.”

“She stated that she had been constipated for most of her life, until she got a divorce.”

“While in the ER, she was examined, X-rated and sent home.”

“When she fainted, her eyes rolled around the room.”

“Patient has chest pain if she lies on her left side for over a year.”

“Exam of genitalia reveals that he is circus sized.”

“Discharge status: Alive but without permission.”

* * * * *

Growth Charts 101

By , May 4, 2010 5:29 pm

A 12-month old boy presented to a Paediatric Clinic with concerns regarding his growth.  Prior to arrival, the chart below was faxed through.

The following pattern is pathognomonic of a single disease process.  It is a spot diagnosis, but often missed by inexperienced clinicians:


The disease phenomenon is known as Shrinkingheaditis, eponymously named after Alfred Shrinkinghead, the great 19th Century English physician, who never owned a computer, most likely because they were yet to be invented.  All the same, he found buttons of any description very confusing.

To the untrained eye, the changes above may be missed.  Yet, if you examine the growth chart closely, you will find that the last three dots are below the two prior to that – an unusual finding for a skull, as it is made of bone.

Don’t despair if you miss it at first;  these changes are very subtle.  If you are having difficulty, you may need to squint, or even stare through it, like you would with one of those 3D drawings everyone loved in the 1990s.  Several readers have suggested swapping between internet browsers to appreciate the changes, which are often missed if only viewed through Internet Explorer.

This is a very serious condition.  Thankfully, this disease is reversible, and was discovered just in time.  Had Shrinkingheaditis continued for another few weeks, then the case would have become fulminant, the curve represented a parabola, and the child imploded and become a black hole.

Which would have been very embarrassing indeed.

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.

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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