My patient had a fever. He needed Tylenol.

He was a confused little old man, bedbound. And he couldn’t swallow. He was NPO, meaning no food, no water, nothing by mouth. He would choke. Choking was not good. Even a new nurse like me knew that.

So I needed to give it rectally.

I asked the more experienced nurses: “How do you give Tylenol rectally? Just … ???” Wondering how you put a little pill up there.

“Yes!” they assured me cheerfully.  “Just give it rectally.”

I wanted to be clear. “Just put it in? Just … ??”

Their confirmation was unequivocal, unanimous. “Yes! Just stick it up there!”

Sounded easy enough. Unfortunately, the experienced nurses left out one small but vital detail: Tylenol comes as a suppository.

I was a new nurse. It would have been helpful to know that.

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I was a student nurse, and my preceptor was watching as I filled up an enema bag with warm water. “Just insert the tubing carefully into her rectum, up to this little black mark – see? – and then open the clamp,” he advised me. “The water will flow in. If she experiences any cramps, stop the flow for a minute.”

I nodded gravely. I was a serious student, learning how to administer an enema. I wanted to do things right. I went over it in my mind: Insert the tube. Stop at the black mark. Open the clamp. Pause if she cramps.

Got it.

We approached our patient, an alert and oriented, bright-eyed 82-year-old lady, slight, bird-like, cheerful. We explained what we needed to do. She nodded. No one much likes an enema, but she knew she needed one.

I lubricated the tip, then gently inserted the tubing up to the black mark. I opened the clamp. Warm water gushed and gurgled noisily into her. She didn’t report any cramps.

But perhaps I should have noticed her expression.

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