Saturday, May 28, 2011

Revisiting Breakfast

I owe the Saab dealership $1400 to fix my car, and in order to facilitate collection they sent a driver to fetch me from the Orlando airport. (They call it Customer Service, though I suspect it’s actually a way to make sure I come back to pick up and pay for the vehicle.) I’m talking with the driver, and when he finds out I’m an ER doc he mentions that once upon a time he wanted to be a paramedic. He bailed out on that career because he didn’t think he could stand the sight of blood, and didn’t believe a friend who said he’d get used to it. Personally, I’ve never had a problem with blood, especially when it belongs to someone else. But as I’ve previously noted in these pages, I have a real problem with gastrointestinal fluids (vomitus and feces, or barf and poop.) So I explained to him that he was right, that you never really get used to it. Which is why I’m the guy flying out of the room when the retching starts, ostensibly to find a nurse with a plastic pan or to write some orders for medication to help, but really just to get out of there faster than spit. Granted, there’s probably some therapeutic value in standing by the patent’s side offering words of comfort and a reassuring hand on the shoulder, but I try not to stick around long enough to find out.

That’s why I’m so very grateful that my son is not a barfer. Some kids barf at the slightest provocation, mine has a stomach like iron. He comes by it naturally. I myself have done so maybe eight times in my whole life, and with only two exceptions they’ve all been from the excessive use of alcoholic beverages and therefore eminently preventable. (By way of contrast, The Bride is a barfer, but she does so with such charm and grace that I’ve actually thought about holding her hair back if she needed me to. But because she is wonderful, she knows not to ask.)

So it was quite a surprise last weekend when I was sitting happily at the kitchen table and heard an “urping” sound coming from his room. The fact that he was in his room at 9 AM was curious enough…he’s usually well engrossed in the computer by then… but he had told me he felt tired and wanted to rest, and I just figured it was some of his father finally coming through (weekends are sleep-ins for the ol’ man). I didn’t know what to make of it at first, as the only urping noises I’m used to hearing around the house come from the cat having a personal moment with a hairball. So I didn’t think much of it until I heard the sound of liquid on solid, which sounded suspiciously like…well, like what it was.

I have to hand it to the young man; he really kept his cool. No screaming, no crying. It was Spartan barfing. I waited a few seconds or so to give him his dignity, and then heard this small, embarrassed voice say, “Dad?”

I walked in to his room to find a slide full of blueberries. His bed is up on posts about five feet high, with a military d├ęcor. On the foot end of the bed is a ladder to climb up; just on the right side, next to the head, is a slide which allows for a fun exit in the morning. It’s also an excellent surface for the collection of vomitus, and to direct it away from the bed toward the carpet, where the blueberries currently resided in an intense pool where the slide met the floor.

Here is what I’ve learned by having my son barf a pint of blueberries:

1) Revisited blueberries are a lovely deep blue, and don’t smell bad at all. Therefore, while I would always encourage you not to engage in vomiting, if you must do so I highly recommend that blueberries be involved.

2) Blueberry hulls don’t deteriorate in the stomach. Although the juicy contents have been extracted, the hulls themselves stay relatively intact. (See “corn.”)

3) When you mop up the mess, the blueberry hulls stick to the towels.

4) When you wash the towels, soggy blueberry hulls stick to the fabric during the spin cycle. In the dryer, they will separate from the linens and lodge in the lint trap.

Here’s what my son has learned:

1) Don’t eat a pint of blueberries all by yourself during a single two-minute block of commercials.
2) Be sure to wash the blueberries before you eat them.

3) Don’t wash them down with a warm Coke.

Barfing in the ER is pretty easy to deal with, and it’s actually kind of fun to manage. It’s an instant gratification sort of thing. You can make the barfing go away, the patient feels better, the horrible retching noise stops, and everyone is happy. The process usually involves tossing the patients a few bags of IV fluids to aid in rehydration and to dilute out the ketones that have built up, chemicals which themselves can induce the Technicolor yawn; and giving some antiemetics, medications that work to suppress the Vomiting Center in the brain. (I’ve always wondered how they figure this stuff out…keep poking a rat in the brain until it ralphs, figure out where it landed, and call it the Vomiting Center? And yet science marches on.) The disposition process is pretty easy as well. If the patient keeps vomiting, they get admitted. If they get better and can keep down some Gatorade or juice, they can go home. There are lots of pills for vomiting out there, but I’ll usually prescribe a suppository on the theory that while you can barf up a pill before it has a chance to get absorbed, it’ll take a very special effort to bring up a suppository.

Barfing at home is different. The usual solutions include ginger ale, Seven-Up, and soothing noises uttered to the afflicted while cleaning up, all the while silently praying they never never NEVER make you do this again. And you can also…

(I was going to write more, but even thinking about this makes me feel a bit unwell…I’m breaking into a sweat, and starting to salivate. No, really I’ll be fine. Just leave open the door to the bathroom, and please be sure not to block my way. Can you hand me that Sprite?)

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