...and no, for once I'm not being facetious. Today I got to do the following:
1) Remove two liters (that's 2,000 ccs) of pus from a nice man's bladder. He felt muuuuuch better after I was done. (The people in the next curtain, however, had to deal with the putrid smell while I was doing it. I felt bad for them.) He came in from a nursing home for "r/o UTI." He had a fever of 101.3. He also had a suprapubic catheter. His bladder was distended and painful. No urine was in his leg bag. I tried to irrigate his suprapubic catheter to no avail. So (per urology) I inserted a very thin catheter up his penis (a 14 French, if you're counting) and got a little spurt of thick, yellow goo. So I aspirated with a 60 cc syringe. And frank yellow pus came out. I kept at it, and after about a liter, I started getting pus mixed with blood clots mixed with amber, dark, foul urine. It was completely gross and yet totally satisfying, especially since the man went from moaning in pain to almost asleep and comfortable by the time I was done.
2) Get to have the following conversation with a cute, young, male, clueless resident about the next step with the above patient:
Me: So, should we set up some bladder irrigation to get that pus out?
Cute Male Resident: Yes, definitely. Let’s have a three-way.
Me: (snicker) Ah, a three-way. Sounds good! But how could we do it? Through the suprapubic? Through the penis? Both?
Cute Male Resident: Hmmm...Maybe a modified three-way?
Interested ED Attending in a Group That Is Laughing While Eavesdropping: What’s a modified three-way?
Me: A man, a woman, and...a transsexual?
(Note for the un-medical: the resident was referring to a three-way catheter used for continuous bladder irrigation--it’s a tube with three lumens: one lumen for irrigation fluid, one to carry the fluid out to a collection bag, and one that is used to inflate the balloon that keeps the catheter in the bladder. Note for the medical: We ended up setting up a “one way”: I inserted a new suprapubic catheter and a Foley cath. We ran the irrigation fluid through the suprapubic catheter and drained it out of the Foley. It was fun.)