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.
So I dutifully removed a Tylenol tablet from our stocked medications, lubed it up generously, and made an important discovery.
It is not easy to shove a pill up someone’s ass.
Especially a slippery lubed-up one.
The tablet slips and slides around in the lubricant. I get it poised at the anus, pointing upwards, give the tablet a shove – and bloop, my finger slides past the medication, disappearing up into his rectum, while the tablet just sits there, grinning at me.
I retrieve my finger, reposition the pill, and try to inch it in delicately this time. It twists and turns happily, spinning away from my wet finger, doesn’t go anywhere. I try gripping it with my thumb and finger — a challenge in itself, the way it wants to squirt from my grasp like a watermelon seed — but my thumb doesn’t allow me to insert the tablet very far.
I poke at it. Get up there! My finger vanishes into his rectum. The pill doesn’t.
I hold it fumblingly between a couple of fingers, like a cigarette. It rolls this way and that, slipping off my fingertips, fingertips now slick with a slimy mixture of lubricant and stool. The pill just giggles at me. From outside his body.
I think distractedly, What can I use to stuff this thing up there? A tampon, maybe?
You know there’s a problem when a nurse contemplates sticking a tampon up a man’s butt.
Pretty soon you can see me bent over, sweating, peering into his rectum, grappling at it with both hands, desperately trying to cram that damn thing up there.
With very little success, I might add.
Tip to new nurses: If you’re preparing to shove a pill up someone’s ass, stop. There’s almost certainly something wrong.
I eventually got it. With great effort and a measure of frustration, hair awry, panting, I jammed that Tylenol pill up there somehow, and got it to stay.
I felt very satisfied with myself. Good job, Carol! Way to get it done!
Months later I saw, with a jolt, the Tylenol suppositories staring at me from our medication cart. I felt a dawning realization. Uh-oh. . .
I often wonder what the aide thought after his next bowel movement. I’m sure the Tylenol tablet was clearly visible, whole and intact, winking happily in his stool.