So something’s been eating away at me recently and I think I figred out what it was. I saw this patient (maybe last night, mabye last oyear…)

He was a very large man, over 300 pounds. He was screaming his head off and had an alien trying to burst from his abdomen. His scraggly beard framed his face like an old tattered dress might hang from an obese prostitute. I knew immediately that it was my duty to try and reduce the beastly gathering of intestines trying to escape from his crowded abdominal compartment. At 4AM, this was not an easy task.

Pairing my sedative medicines selectively, I was able to reduce the hernia at the expense of him turning a few shades darker than pink. His immense body habitus and sheer weight of fat on his chest prevented adequate chest wall excursion while he was sleeping. We woke him up and all was well..the pain controlled…until the alien burst from it’s hiding place again.

I knew that I could not continue sedating this man to either treat his pain, OR repeatedly reduce his hernia. Part of my dilemna lie in the fact that I could not obtain a scan on this patient. He was either in 1) too much pain to move him or 2) too sedated to breath well. I had to find a middle ground of not enough pain control and not enough meds to stop him from breathing, given the magnitude of his sleep apnea.

I knew instinctively that he needed surgery now. But when describing to the surgeon that the hernia seemed to be reduced, he suddenly became less acute. Nevermind that he was an airway nightmare waiting to happen.

He soon went to surgery where most of his infarcted bowel was removed.

Please, people, don’t let yourselves get so large that your intestines have no option but to try and escape from your abdomen in the middle of the night!