Anatomy 101.

He was already in a cubicle when I arrived for my shift. I was at the end of EMT class and was doing the required clinical time in as many of the local Er's as I could, doing as much as the staff would let me do. So, when the nurse I was assigned to shadow told me that the surgeon was coming down to see him and did I want to come into the room for the exam, I jumped at the chance.

"He's got his home health CNA with him" said Shelly, my nurse. "She's the one who signed him in. She says he's got a stage 3 decubitus ulcer on his buttock that's leaking stool, so it looks like he's going to be going to the OR. Hottie O'Leary - the surgeon - is on his way down to take a look and see what he thinks needs to be done"

"His chart says he's 43...so why does he have a home health CNA?" I looked up from his chart.

"He's a paraplegic. Had a car accident 4 years ago and had a cord injury at T12. He's not a very happy 'plegic, either, he's in here pretty regularly with decub's that are infected. I guess 'sullen' is the best word to describe him when he's having a good day and 'a downright misery to be around' is the politest phrase I can think to use when he's having a bad one....heads up, girl: Hottie O is checking out your bee-hind, hehehe"

Hottie O was very aptly named, by the way. He looked more like an Irishman than some Dubliners I know and he was very good looking in a Celtic kind of way.

"Shelly-belle! My favorite ER nurse.....and who might this be?" he turned to face me, offering me his hand.

"Hey Doc. I'm NinjaMedic, but you can call me NinjaMedic" I took his hand and tried to give him my best ' I may be a girl but don't fuck with me' firm handshake.

"NinjaMedic, huh? I'm not going to ask you how you got that moniker, but I'm sure interested to find out, heheh.....so, Shelly-belle, whatcha got for me this fine evening?"

"Ralphie's back, Doc. With his home health 'nurse', this time. She says he's got a decub on his rear that's leaking stool. I haven't had a chance to look at it yet; you know how he can be." She handed him Ralphie's chart.

"Ralphie Mayor, the grumpiest paraplegic this side of the Mississippi" Hottie O mumbled, scanning the first page. "Alrighty, then. Miss NM - is that the right title, or are you a married lady..?"

"She's married, Hottie. Nice try, though" Shelly interjected.

"I see. So, MRS NM, would you care to join Shelly and I in a physical examination? Not afraid of bedsores, are you?"

"Not at all, Doc, and I'd love to" and we all three approached the cubicle that housed Ralphie Mayor. Doc O pulled the curtain back...

"....Doctor, my name is Juniper Berry and I am Mr Ralphie's private nurse. He has been running a febrile on and off for the past 2 days, he has some blood pressure changes, his air is clean and he isn't having any cathardiac problems. I've oscillated his lungs every 4 hours and I can't hear any rails, but he does have a bed ulcer on his left buttocks that has feckull matter oozing from it. I believe he needs a colponostomy, stat. I have all of his vitals written down in his journal right here if you want to see them." Juniper folded her arms, looking very proud of herself for being so thorough.

"O.....kay. Well, thank you very much, Juniper. I'm sure that Mrs NinjaMedic and Nurse Shelley here will be VERY interested in seeing those and will need you to be very detailed when you tell them how your patient has been the past few days. Now, if you'll excuse me, I need to talk to Raphie. Hey man, what's up?" he said, offering his hand to Ralphie.....who ignored it and continued to stare at the TV.

"I don't know why I'm here. I don't want to be here, I don't need to be here. I don't care to be here either. When can I go home?" Ralphie was, as predicted, sullen.

"well, I need to take a look at this ulcer of yours first, my man. Let me grab some gloves and have Shelley and NM roll yo..."

"They aint rolling him NOwhere. He MY patient, I'm-a do the rollin'."

"....ok then, let me grab some gloves and have JUNIPER and Shelley and NM roll you onto your side so I can check this out. We'll be back in a jiffy". I caught Hottie's eye as we were putting on our gloves.

"Yeah, I know" he said. "Frightening, isn't it?"

"Terrifying".

We stepped back in and found Juniper gloved, gowned AND sporting a surgical mask. "I aways come prepared" she declared " you never know when a doctor is gonna need some help with a operation or something".

Okey doke, I thought.

Shelley and I took a hip and shoulder and gently rolled Ralphie on to his side. Juniper was jockeying for position with Hottie, and for a moment I really thought she was going to elbow him out of the way. Whilst his buttock looked slightly red, I didn't see any sign of an ulcer.

"So, what is your 'pinion, doctor? Am I correct about the colponostomy being needed stat?"

Hottie glanced up and Shelley and I. "Umm....Juniper, can you show me where the area you're concerned about is, please? I want to make sure we're on the same page..."

"Why sure, doctor" Juniper drew herself up to her full height, and whilst I couldn't see under her mask I was certain she was smiling proudly. "That's it, right there. See the feckull coming out of it? It's bad, isn't it?" She pointed, and I heard Shelly snort and then start to cough.

"Ok...just so we're clear, this is the area, yeah?" Hottie pointed to the same spot Juniper did.

"yes, doctor. That's it".

I started to cough.

"Well, Juniper, I don't see any ulceration that requires a colpn...colonostomy"

"What is it, then?! If it aint a ulcer, what is it?!?!! What do you see??" Juniper was starting to get aggrivated.

" Actually, I see a perfectly normal anus with stool coming from it....."