Sticking Up For The Underdog

So the other day I was zinging around at work, in a freakishly cheerful mood (and after several days of that, I think I'm starting to annoy the more sour-puss types at the clinic), and for some reason it reminded me of this from my intern year.

As an intern, I worked at a hospital group htat had several different hospitals including two 24-hour care centers. One weekend day I'm manning one of those, and L, my tech, comes back and says I have an appointment in room one.

"What is it?" I ask him. He gets A Look on his face.
"A woman with her finger in a dog's mouth," he says.

Eh?

"Ummm... did she say WHY she had her finger in the dog's mouth?" I ask, wondering if we should be calling the human ER, plus or minus the local nut hatch.

"She says if she takes it out the dog will die," L reports, shaking his head - just the once, mind you, but that's a lot coming from him. Apart from being a top-flight tech, he is also well-nigh unflappable. I've seen him take the most hysterical and unreasonable clients, not to mention the most difficult patients, right in stride. I can only imagine the bizarreness that has him shaking his head.

Well, as it turns out, I CAN'T imagine the bizarreness. Even with the description, I wasn't QUITE prepared to see a woman standing calmly in the exam room with her index finger inserted to the last knuckle into the mouth of a Chihuahua.

Now, you have to picture this. Here's this little Chi standing on the exam table with an entire human finger in his mouth. Naturally he can't turn his head, thus restrained, so when I walk in he rolls his buggy and protuberant little eyes (perhaps a bit MORE buggy and protuberant than usual, in view of his current oral circumstances) in my direction. I detect a distinct note of alarm in them, but for once it seems not to be directed at me - arriving in my white coat and no doubt armed with an absolute plethora of rectal thermometers just waiting to be pressed into duty (so to speak) - but instead to be focused on the woman who has his little head gripped firmly in one hand, and the (handsomely be-ringed) index finger of the other pushed quite far into his little mouth.

"What seems to be the problem?" I inquire with a cheerful grin (which is mainly engendered by the ridiculousness of the tableau, but which luckily passes for bedside manner).

"He's having seizures. I stopped them by putting my finger in his mouth, but if I take it out, he starts having another one. I'm afraid he'll choke to death," the woman reports.

Hmmm. Well, apart from the fact I don't recall the head of Neurology ever mentioning anything about finger-down-the-mouth being a preferred treatment for epilepsy, I am having a hard time imagining what kind of seizure might be precipitated by NOT having a finger down your mouth. Hence (and here I know you'll think I'm being rash) I conclude that the dog is not having seizures and instead has some other problem, as yet undetermined.

I get a bit more history - young dog, no prior seizures, otherwise healthy, but as it turns out, not her dog. He belongs to some friends, currently waiting in the parking lot, too upset to come in, in case I say the dog needs to be put down. It just happened that she was with them when the behavior started and was the only one cool-headed enough to do something when they all returned to their respective cars after getting Slurpees in the 7-11. She's had her finger in the dog's mouth ever since, though - this having understandably impaired her ability to drive her own car - they all piled into one to make the trip to the hospital. I nod as she tells her story and do a physical exam, working around the woman's fingers. The Chi watches me as best he can, rolling his eyes to and fro to follow my movements, now more white-walled than ever with fresh alarm.

"Okay, take your finger out of his mouth, " I tell the client.
"I can't, he'll have a seizure," she protests.
"You have to; I need to complete my exam," I tell her patiently. "Besides, you're at the hospital," I add soothingly. This apparently does the trick, because she removes her (somewhat dog-slimed) finger from the Chi's mouth.

The effect is immediate. The dog throws his head back and whips it from side to side, making gnashing motions with his diminutive jaws, at the same time as tongue-thrusting so vigorously that it appears he is hoping his tongue is all grown up now and ready to be out on its own.

"Okay, you can put your finger back," I say, which the client does promptly, because I have ascertained the source of the mysterious seizure disorder. There is a stick jammed between the upper carnasial teeth, and the dog's gargoyle-esque facial contortions are his attempt to remove it with his tongue.

"Hmmm, I think I have something in the back that will cure him completely," I tell the client, who is suitably impressed that I can cure seizures with some exciting new advancement in medical technology. "Wait here."

I go in the back to grab a hemostat. L looks up from his treatments.
"Did she take her finger out of its mouth?" he asks; I nod. "What is it?" he asks.
"Stick in mouth," I reply, to his chortling glee. I snag a handy pair of hemostats and return to the room.

"Okay, take your finger out, " I say, wielding my hemostats. The dog goes immediately into his gargoyle routine, jaws helpfully opened to their fullest extent, and I nip in and pop the stick out in under two seconds.

"There," I say with satisfaction. "Cured."

The client goggles at the stick, now clenched between the jaws of my hemostats, and then at the Chi, who is magically restored to complete equanimity by stick removal, and is now standing quietly on the table having his first unimpeded look around. The woman bursts out laughing.

"Oh, I can't WAIT to tell them," she says. Evidently her friends had gotten some kind of jerky which is impaled on a stick like a kebab skewer, and the Chi, yielding to his gluttonous instincts, decided to eat it. All of it, including the stick.

With admonitions to watch for other stick-related disorders, we release our miracle-cure Chi to his grateful (and uproariously relieved) owners. That was by no means the only stick I've pulled out of a dog's mouth, but I have to say it was one of the most dramatic, thanks largely to the patient's facial gyrations. It's also not the only time I've cured "seizures" by taking something out of a dog's mouth, but that's another story....