The Textbook Says It Should Work

This week held an interesting patient, Brunhilda. Brunhilda presented in clinical stage four HIV, or AIDS. In addition to her admitting diagnosis and being treated for thrush, HIV gastroenteritis, cachexia and having a hemoglobin of 3 (normal is above 12) and platelets of 40  (normal is above 120) she decided to have a sigmoid volvulus. Now the initial treatment, assuming there is no dead bowel is to try to reduce this with a colonoscope.  After explaining what I needed to a nurse it was decided there was one of these "strange instruments" in a closet but unfortunately no one had a key! Seriously! They wouldn't let me practice my Tai-Kwon-Do skills and break the door so patiently, three hours later, the key was found. 

Now, I have done many colonoscopes but I have never had to attempt to pass a scope through a volvulus without isuflation, a monitor, or electricity. It was the only hope that could be done as there was no way this woman could go "under the knife". So the textbook says it should work...  and let me tell you the relief I got when after passing the scope I got the biggest shot of stool in the face! Thank you God and Thank you to the gastroenterologist who left a closet of dysfunctional yet life-saving scopes!! 

Brunhilda  started tolerating clear liquids today and maybe just maybe if her HIV gets in check she can have definitive surgery for her sigmoid volvulus  before I depart.