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.