My attending storms out of the bathroom and looks over at me, “It’s a fucking turd!”
Let’s back up a few minutes.
My patient has been having (if you are squeamish you might as well stop reading now) copious, purulent, pungent discharge coming out of her vagina for two months. When I say copious, I mean she had to change her pad every two hours. When I say pungent I mean it was rank. Imagine a smell that stings your nostrils and sits like a rotting mouse on top of your gag reflex, now multiply that by twelve. This poor woman has been living with this for 60 days, and so far no one has been able to tell her what’s wrong.
While prepping for the pelvic exam my attending put on his camping head lamp started to tell me a story. When he was a third year medical student a classmate on his rotation was in line to do the next pelvic exam. Well, his classmate got lucky. Half way through the exam the emergency room smells fetid and the student started pulling small body parts from the woman’s vagina. A miscarriage hadn’t completely evulsed. Pieces of the fetus embedded themselves in the walls surrounding the cervix.
Don’t worry, today there were no body parts.
As we were chatting my patient went to use the restroom. Then there was commotion. I need the nurse! I need the doctor! My attending screams from the bathroom, get me a paper towel! Get me a specimen jar! Things quiet down and the nurse, my attending, and the specimen jar emerge from the restroom.
I ask, “Um, what just happened?”
The nurse: “Something was coming out of her vagina.”
My attending: “It was a fucking turd.”
That begs another question, so in my most professional voice I ask, “Uh, how did a fucking turd come out of her vagina?”
My attending: “A g.d. fistula? I don’t know if it really was a fucking turd but holy shit it smelled like one.”
And so we regain our composure, get our patient calmed down and back in the bed, and begin the pelvic exam. We proceed, head-lamp and all, and see something peeking out from the crevices behind the cervix. A tampon. It was fermenting. It had been there for two months, and started abscessing the side of her vaginal wall.
Tampon goes into a new specimen jar. Both specimen jars are sent to path. We tell her to schedule a follow up with her gynecologist and the woman is saved. Hooray!
And no, I still don’t know what came out of her vagina in the bathroom. It might’ve been a piece of the tampon we found later, it might’ve been a sponge, and yes, it might’ve even been a turd.