The text message on my pager read:

“New pt - Renfield - foreign obj ingestn”

Mr. Renfield was a 30-ish psych patient from the forensic facility, a.k.a. The Crazy House. I have no idea what forensics (the use of science to establish facts in a court of law) has to do with psychiatric patients but that’s what they call it. As an aside, the prisons and the psych/forensic facility share the same insurance company in this area. Prisoners actually have better insurance than many non-incarcerated Americans. The only catch is that we (the doctors) have to call the forensic/prison coordinator lady, Ms. Conduct, every day to tell her what the plan is. She has a pleasing voice but I can tell I wouldn’t want to be on her bad side.

From the history, this patient had swallowed a door hinge at the forensic facility and it wasn’t his first time either. Previous times, he had swallowed a mini shampoo bottle and a thimble. We already had two X-rays showing its progress from the esophagus to the stomach. The surgeons had seen him last night, recommending we keep watching for now. They also noted how the patient told them he wanted to be a woman. You could almost see the smirk the surgeon must have had dictating that surgically irrelevant detail.

Mr. Renfield was dishevelved, long and lanky with that far away thousand-yard stare these patients so often have. I nodded to the psychiatric babysitter across the room that these high-risk patients also often have.

“Hello Mr. Renfield. I’m Dr. Scott. How are you doing? Any pain, sore throat, nausea?”

“Oh hi,” he looked away from the television, “Nope, I’m good.”

“Have you had a bowel movement yet? That door hinge pass through yet?”

“Nuh uh.”

“Were you trying to hurt yourself when you swallowed it?”

“What? Oh no, nothing like that….”

“….”

I waited for him to elaborate but his attention was diverted to the television. It had been off the entire time.

“….”

“Okay, well, we can’t let you eat for now. We’ll keep you on I.V. fluids and repeat an X-ray in the morning.”

“Psst. Can I see a psychiatrist while I’m here?”

“Sure. That is a good idea, Mr. Renfield.”

This wasn’t a surgical problem yet so I consulted G.I., the gastrointestinal specialists, to scope him as well as a psychiatrist to unravel his mental drawer of disconnected computer cords.

Some of the gastro docs are pretty laid back, like fat jolly uncles. Some are Just-the-facts Joe Fridays. But there’s always one that’s wound tight like an intestinal volvulus in every gastro group, the brilliant yet anal-retentive one. Dr. Orange was that guy. He jumped me in the hall.

“I scoped him, Scott, it’s gone. Gone! The hinge is in the small intestine, no way to retrieve it now, past the pyloric sphincter, all gone,” he said in his ominous almost-red alert voice. Then he became even more intense,

“Scott, this is an EPIDEMIC. I don’t know what’s going on in those facilities but I’ve scoped a dozen of these object ingestion cases this month alone! It’s insane. In. Sane! It’s not just this facility either. It’s happening all over this month. I’ve called them to complain.”

“Wow, I … that’s weird.”

“Last week I had a guy who swallowed a toothbrush. Who’s watching these people?! Another one swallowed a remote control. A remote control, Scott.”

That would have been a good place for a TV dinner joke, but these things only come to me days after the fact.

“So what happens now?” I asked.

“We wait for him to shit it out.”

It can take from twelve hours to three days, sometimes longer, for food to make it from mouth to anus. When you eat and then have to go to the bathroom a short while later, that’s not the chili you ate running through you. The chili just triggered the peristaltic process, moving out the old stuff and making room for the new stuff. We kind of expected Mr. Renfield to pass his door hinge out in three days. It didn’t. Everyday I called the facility coordinator lady, Ms. Conduct, to tell her the same frustrating news. She had one request,

“When that door hinge comes out of him - we want it back.”

“… Really?”

“Yes.”

We even let Mr. Renfield start eating again to try and induce that peristaltic push. The X-rays showed it moving along through the small intestine slowly and then it seemed to get stuck. After a week, even the surgeons stopped making jokes about his gender confusion and were considering taking him to the operating room.

“So if it’s not out after this weekend … they’ve booked an O.R. time for you Monday, Mr. Renfield,” I explained to him.

He nodded, unphased, “I don’t like the food here.”

Monday morning the nurses said he hadn’t expelled the hinge yet. The O.R. was at noon. I paged the surgeon to tell him the disappointing news.

“I was just about to page you,” the surgeon told me instead, “he passed it. It’s not on this morning’s X-ray.”

That was a relief. Mr. Renfield didn’t tell the nurses he crapped out the door hinge. He didn’t save it either. No forensic evidence for the forensic facility. Eventually he admitted he passed the hinge after we mentioned the X-ray findings.

“There’s something new on the X-ray though,” the surgeon told me, “Now there’s a paperclip in his stomach. He must have swallowed it right after he passed the hinge.”

“I don’t believe this. Now what?” I asked.

“If a door hinge can get through, a paperclip won’t be a problem. Send him back.”

I guess the thought of surgery just scares the shit out of some people.