Even the most out-of-it patients raise a mighty ruckus when you try quickly jam two feet of plastic down through their nose, down their esophagus, and into their stomach. In the handful of NG tubes I've inserted, I've seen patients gag, spit, grasp, cry, and moan -- and that's before I even unwrap the kit.
The other day I was charged with this task. The patient was a frail, elderly immigrant who needed small bowel decompression. She'd been given an NG tube on admission, but GI took it out for her ERCP. I had to put a new one in, so that, you know, her vomit and gastric secretions could be efficiently extracted and measured.
The patient and I got along well enough; I think I'd made her smile once or twice, despite her pain. She had a large family who was often around to help with translation, and today her nephew was in the room with us. The patient remained silent but eyed me suspiciously as I informed her of the need to reinsert an NG tube.
I set up my supplies, got the patient into position, lubed the tube, and began. Initially, things went well. There's always a little resistance as you round the bend past the nasal vault, but I passed it with relative ease. My patient was gagging and drooling everywhere, and I think at one point, she actually hissed. But I was quickly making progress when the tube just stopped. It was a good 6 inches from my selected marker. I pushed a little more but got nowhere.
My patient was not pleased. Her eyes were bulging, she coughed repeatedly, and tried to swallow. Her wrinkled face was disturbingly animated.
Maybe I marked the tube's endpoint too liberally. I chalked it up to a rookie mistake. My intern agreed and pushed some air through the tube, while listening for stomach inflation. Satisfied, we taped the tube to the patient's nose, and made the standard call for an x-ray to verify placement. With some apologies for the discomfort, we headed out.
I was paged twenty minutes later. The x-ray team was ready, but the tube had come out. What's more, the patient was vomitting. Could someone try this again?
This time, the third-year resident took over. He wordlessly moved into the room and quickly began to set up. When my patient saw we'd try again, she started to shake her head and gesture to her nephew. She spoke to him in a resigned tone with her raspy voice.
"No more!" he interpreted. "It hurts, it gets stuck."
My resident, himself a non-native speaker of English, looked up and said, "No more pain. Won't get stuck. Ready?"
The tube went in quickly and effortlessly. I still don't know what he did differently. My patient's eyes were closed, and she opened them when she realized it was over so soon. Her expression was one of surprise and relief.
I shook my head and remarked, "He's really good."
With her pan of vomit still in her lap, she turned to me and her expression changed. In her crackly voice and broken English, she nodded and said, "Better... than you."