Friday, August 15, 2008

La cucaracha! La cucaracha!

There are a great many things that newFNP does not want in her ears.  Wall-o-wax and slurpy tongues come to mind, but much, much higher atop that list is anything on God's green earth that has an exoskeleton.


NewFNP had almost made it to three years of practice without having had to retrieve the dreaded cockroach from a child's ear.  Her perfect record was spoiled yesterday.

NewFNP's 14-year old patient came in with the complaint of three days of ear pain.  Generally, when a teenager has an OM, newFNP sees some distress, some fever and some lymph nodes.  This young lady had nothing but distress.  As newFNP manipulated her pinna to get a good look inside, she felt a good deal of distress as well.

At initial glance, newFNP just knew that something was rotten in Denmark.  She had never seen wax look so symmetrical.  "No," she thought to herself.  "Please, no."  She looked around a bit more and saw an unmistakably roachy leg -- a little spindly tibia with its little roachy projections just sitting there, taunting newFNP and begging for removal.

After years and years of evolution, why is it that these most dreaded of pests have not developed the ability to move in reverse?  And, when entering an ear canal, why do they not sense danger and just stop?  And, once in, why do they keep going?  They have both eyes and antennal flagellae!  What the fuck?

At any rate, newFNP was faced with a dastardly combination: traumatized, crying fourteen year old who was in physical pain (to say nothing of the emotional torment one must feel upon learning that your ear is a cockroach garage cum coffin); big roach parked deeply in the ear canal; and tiny freaking ear canal.

NewFNP attempted mechanical extraction but was categorically denied.  She then moved on to irrigation in an attempt to move that M.F.-er to a more reachable place.  At this point, her patient was close to losing it.  

NewFNP made a reach and removed... a thorax.  She looked inside her ear and could easily see tissue-paper thin wings wallpapering her patient's TM.  

OK, cockroach!  You win, you fucker!  You bested newFNP.  NewFNP set up an ENT visit for the afternoon and sent the poor girl on her way, half a cockroach nestled in her tiny ear.  

Bummer.

8 comments:

Anonymous said...

oh that happened to me too! they are SO hard to get out - they get so crumbly.

Beth said...

I have heard that viscous lidocaine and saline can be mixed, warmed, and then squirted into the ear prior to removal, and that it is helpful. Don't know if there would be damage with a non-visualized perf under the bug though?

Hilary said...

OMG! I don't know how you managed not to dry heave all over your patient!

I found your blog via a comment on www.omgdgms.com and it couldn't have come at a more opportune time.

1. I'm starting pre-req's for nursing school a week from tomorrow

2. Pest control is coming to my house tomorrow to spray the outside perimeter for those little MF-ers you described in your post.

Looking forward to reading more. Come visit if you can -- www.hilarywithonel.blogspot.com

Anonymous said...

This is so positively gross. I'm not a medical person and this sort of story - along with the fact that I'm not fond of blood, pus & urine - reinforces my career decision.

In addition to getting an ENT referral, I hope your patient (or the adult(s) in your patient's life) gets some roach motels.

Anonymous said...

Last week's "This American Life" touched on this topic.

LilSass said...

I am the 'owner' of aformentiond omgdgms.com and several people have sent me this post. I have had cockroach issues this summer in DC AND I am starting a MEPN program next June.

I love reading your stories and will come back frequently. Thanks for inspiring

Laurie Anderson, RNP said...

Don't know if you'll see this but sometimes wall suction works if you have that option. Laurie

Anonymous said...

Oh God no. Anything but that. Wheres the wax or ANYTHING to plug my ears and keep the roaches out.

Thanks for just trumping every horror movie ever made. grumble bitch shudder