“Three Fleet enemas?” I ask the nurse. She isn’t much interested in a conversation with me about anything. She is busy. “This man, so far as I understand it, does not have a colon.” It looks to me like they want to reconnect his colon,” she says as if I hadn’t said what I just said. “I am not a doctor,” I remind her, “but I don’t see how that is possible. Too much of his colon is gone.” We had been waiting at the clinic for four hours to get this new plan, which counteracts an earlier plan for surgery to repair John’s colostomy system, which is believed to be breaking down. It might be in danger of clogging, we’re told. “I just don’t understand how a Fleet enema works on a man with a colostomy,” I say next. “I will get a doctor,” she says, exasperated with my persistence. Soon she takes me back to where there is one very fresh-faced intern. He looks at the paperwork and sees that it is signed by the senior resident, Dr. Woolsey. “The Fleet enema could clean up in that area,” the young man tells me. Then this: “Perhaps they can explain it to your satisfaction at digestive health over at the main hospital.” He is getting a bit frosty now. So I go there, through a maze of tunnels in the basement of the hospital and a swinging door to places I am not sure I belong. I reach a desk at digestive health where there is a young nurse sitting at a computer. Another nurse comes up to the desk as I am talking to the first woman, listening to what I am saying. I explain (again) that my client John, is scheduled for a colonoscopy the next week — Tuesday morning. And he doesn’t have a colon. I am confused by the medical order that says he is to have three Fleet enemas before the procedure. I need to understand this better so I can explain it all to John. By this time, the older woman of the two looks over the order. “It is odd,” she says.” I don’t see how Fleet enemas help very much, and if this poor man has the advanced cancer you say he does, you have to wonder why they would be doing this at all. “Still, it is an order from the trauma clinic, and your best bet is to go back to trauma and ask for an explanation. Say the family demands one.” I know that there is no one left at trauma, but I decide to go back just the same because there is this pleasant and often helpful clerk and scheduler named Tara. I explain to Tara my worries for John. She promises to bring the matter to the Trauma doctors’ attention when next they are in, which she believes will be Friday. This is Tuesday, and the following Friday, I receive a call from yet another scheduling person at University Hospital who identifies herself as a nurse. She calls me because I am listed as the contact person to be given the lowdown for a surgery planned for John on Monday, not the Tuesday colonoscopy. I figured somebody higher up has finally reviewed everything, and the original surgery to repair the ostomy system is back on the docket. Not so! She has not yet been notified that the Monday surgery has been canceled in favor of the colonoscopy for Tuesday. She needs to make some calls to verify the changes. Soon she is back and says, “Yes, it is to be a colonoscopy on Tuesday.” I explain the situation again. She needs to make additional calls to digestive health, she tells me next. Good luck, I think. Sooner than I expect, she is back. “All you need to do,” she says, “is put Fleet enemas in the ostomy system.” “Is that done?” I ask. “Oh, yes,” she says with a confidence that makes me pause. “Is that what they want?” I ask her again. “Seems so,” she says (now less confident). “Somebody is going to need to put this in writing for me,” I insist. “Write an order making it clear you are recommending the patient use three Fleet enemas in his ostomy system.” It doesn’t sound right to me, and it could be dangerous to his health, I am thinking. So I make my way back to digestive health, back through the maze, and meet still another nurse, a lady about forty with graying hair. She listens to me carefully. I ask about putting Fleet enemas in an ostomy system. “Is it done?” “Oh yes, all the time,” she answers. “It is common. Well, perhaps not common, but it is done. I wonder about an order for three Fleet enemas. That seems like a lot. You’d better check again with the trauma doctors.” I don’t answer her. I just leave. I decide I will bring John to digestive health with the three Fleet enemas in a paper bag on Tuesday and explain why there has been no prep done because we could not determine where to put those Fleet enemas. They, the doctors and nurses, can put them wherever they deem appropriate. John has his procedure, and it went OK — except the doctor does not look at the ostomy system at all. He looks up John’s dysfunctional anus. John tells me later the nurse administered two Fleet enemas in his rectum. None is used in his ostomy system. Raymond Abbott is a social worker and novelist. Source
