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.
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.
Her eyes, wide with surprise. Her strikingly elevated eyebrows. Her open mouth, wordlessly forming a perfectly round “O.”
Those were my clues, right there.
About half of the large bag had energetically churned its way into her when my preceptor peered closer, then elbowed me suddenly and violently. “Carol!” he hissed. “You’re in the vagina, not the rectum!”
I wasn’t giving her an enema.
I was giving her a douche, and a lively one at that.
Tip to new nurses: If your female patient has a rapt, surprised, grinning, or otherwise unexpected expression on her face while receiving an enema, odds are you ain’t in the rectum.
I hastily stopped the procedure. Apologized profusely, which she accepted with grace. Retrieved a new enema bag, with strict instructions from my preceptor to properly locate the rectum.
That’s key, it turns out, to correctly administering an enema: locating the rectum.
My patient nodded kindly to me as I approached for the second time.
Her eyes were twinkling brightly, and a little smile played on her lips. I suspect she was secretly hoping I would repeat my mistake.