Saturday, October 21, 2006

The Olfactory Tour

Before I started volunteering in the ER, a group of us got a tour. The woman who was showing us around said, "The hardest thing to deal with here is the smells. You've seen it on ER and you've heard it on ER, but you haven't smelled it on ER. You're going to learn to recognize the smell of a GI bleed."

She was right. I can now sniff out a GI bleed from twenty paces, not to mention other GI problems (from both ends) and leaking colostomy bags. And then there are the patients who haven't bathed for a very long time. And then there are the people with extremely high blood-alcohol levels; hardcore drinking produces its own unique aroma.

And then there's gangrene.

Gangrene's the worst. ER staff have ironcast stomachs and noses; normally, they don't even react to smells in the presence of the patient, although sometimes they'll gripe in private. (I once saw a nurse eating an onion-laden sandwich in the meds room; I commented that he shouldn't breathe on his patients after eating it, and he snorted and said, "The way some of them smell? Are you kidding?") But one evening I walked into the ER at the beginning of my shift and met a rolling wave of stench. An EMT coming towards me, and looking rather green around the gills, shook her head and said, "You picked the wrong night to be here."

We had a patient with very severe gangrene, who wound up being taken upstairs to have his foot amputated. In the meantime, the entire ER filled with the smell of rotting flesh. The ER doc treating that patient wore Vicks Vaporub under her nose. I'd only ever seen that in the autopsy scene in Silence of the Lambs. I asked if the patient wanted to see me, and one of the nurses said, "Yeah, maybe, but wait until we get him cleaned up a bit, okay?" By the time I went into the room, the stench had decreased a little, but I have to admit that I was relieved when the patient politely declined a visit.

I felt sorry for him; patients are often much more self-conscious about how they smell than about anything else. Female patients will blithely strip in front of me, even when I offer to give them privacy. "Oh, honey, I've had seven kids: I'm not shy!" (At church, many parishioners won't even take their socks off to have their feet washed on Maundy Thursday.) But people with even a little bit of body odor will apologize for it.

"Don't worry about it," I always tell them. "This is an ER. We smell worse all the time, believe me. It doesn't bother us." And most of the time, it really doesn't; or, if it does, we certainly don't hold it against the patient.

Context is everything. In church, I can't stand incense, which supposedly smells good, but invariably makes me sneeze. We don't have "smells and bells" services very often, usually only on Christmas and Easter. One of our priests is allergic to the incense; she not only sneezes, but loses her voice, so she has a hard time saying the Eucharistic prayer if the altar's just been doused with smoke. (I always refer to this as "fumigating the clergy.") Our liturgy committee recently discussed whether to have a "smells and bells" service for All Saints, when we're doing a baptism, and I said, "Can we have the bells without the smells, please?" Our allergic priest laughed and nodded. But in the ER, I'm pretty immune to smells, even downright nasty ones.

When Gary and I were in San Francisco over Labor Day Weekend, we took MUNI to Ocean Beach. Sitting directly behind us on the train was a guy who had a strong case of "I haven't bathed in weeks, and also, I drink a lot." Gary and I sat there for a while, and I thought, Hey, I can do this. No problem. I do it in the ER all the time.

And then I remembered that I was on vacation.

So we moved. I felt funny about it, because I don't like making homeless people feel any worse than they already do, but this fellow was asleep, so he didn't notice.

Once when I was a teenager, riding the New York subway, someone with a very similar demographic and aroma sat down next to me.

Then he fell asleep. Against my shoulder.

I didn't move. I didn't want to wake him up; I felt sorry for him. Other passengers were looking at me strangely and making faces at the smell, but that was their problem.

I guess I was in training for the ER even then, although I didn't know it.


  1. Hi, Susan! Your post evoked memories of stories security guards once related of a homeless person they were chasing through a garage and building. Apparently they could almost track him by his smell.

    I admit to having a squeamish nose. I gag if I have to clean up after my cat or change a dirty diaper. Thankfully, I don't have to run into nasty odors much. I did think of a good use for them.

    Today the teacher for my 2nd Saturday class handed out these neat looking witches fingers as prizes to be used as cool pointers by us future teachers. I put it on my finger and then scratched the end of my nose with it. It smelled awful. Certainly not as bad as gangrene but still not nice. Even so I liked the finger, complete with red nail, so I hope the bad molded rubber smell will discourage any students from walking off with it.

    Probably every job has its own unique smells. I remember with distaste the bad odors of the public school bathrooms. They had such a strong impact that even today I refuse to use a student bathroom unless absolutely necessary.


  2. Hi, Lee! I never used student bathrooms even when I was a student (now it amazes me that I go could go all day without using the facilities), so I can definitely relate to this.

    And the witch finger sounds very cool! Happy Halloween!

  3. I watched the Discovery Health Channel yesterday, where a woman with a 200-pound tumor was featured.

    The doctors cut and cauterized veins as large as a thumb. After I recovered from shock, what I thought about was the odor this procedure caused.

    The docs didn't wince, even though they were in the operating room for 15 hours. The woman lost 50 pints of blood and survived all of this.

    And people say miracles don't happen....

  4. Cathie says 'Ah yes, A&E . . . it just can't compete, smell wise, with a geriatric ward.'

    She should know, having loved her time on A&E and spent a long time with the elderly.

    Me, I'm just glad I can't smell most of the time!

  5. Lea: A 200-pound tumor? Wow! How much did she weigh after it was removed? Was it benign?

    Martyn: We don't have a geriatric ward per se, so I can't compare, but I'll take Cathie's word for it!

  6. The woman weighed 97 pounds once the tumor was removed. She was extremely malnourished because the tumor took most of her blood and nutrients. Fortunately, it was benign.
    A year later, she was back to health and hard to recognize from her previous appearance.
    Happy ending!


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