One winter night, Dr. Melissa Barton was the attending physician in the emergency department of the Detroit Medical Center. Making her rounds, she picked up a chart for a new patient and read the woman's chief complaint: "eye in the vagina."
The patient told Barton she had been expecting a fight with some neighbors outside her house. Wearing only a sweatshirt and spandex pants, she needed somewhere to stow her prosthetic eye for safe-keeping.
"Those things are pretty expensive and hard to replace," Barton said. "So that's where it went, along with her driver's license."
Unfortunately, it got stuck.
Dr. Gary Vilke, a professor of clinical emergency medicine at the University of California San Diego Medical Center, saw a patient who had four Barbie doll heads stuck in his rectum.
"When you looked at his x-ray, they were looking at you, like a totem pole," Vilke said.
Ask a handful of emergency medicine specialists about cases like these, and you'll get a cascade of stories about patients with strange objects ingested or inserted in unlikely places. Vegetables, light bulbs, tools, even cell phones and reading glasses have wound up illuminated on x-rays or described on medical charts in U.S. emergency departments.
For many unlucky patients, an inserted or ingested foreign object is the result of a one-in-a-million accident or a single bout of bad judgment or curiosity. Emergency medicine doctors say they see these patients more often than you might think.
Foreign Bodies in the Body There is little data detailing just how many patients wind up in U.S. emergency departments with objects stuck in their orifices, but doctors say it happens pretty frequently.
"There's usually a good story every week or two, everything from the unique to the bizarre to the gross," said Vilke, who has practiced emergency medicine for 20 years.
Dr. Rich Dreben, Dr. Murdoc Knight and Dr. Marty Sindhian have heard enough of these stories to fill an entire book, called "Stuck Up! 100 Objects Inserted and Ingested in Places They Shouldn't Be." The three were classmates in medical school and became fascinated by the sheer number of patients they saw who came to the hospital with these problems.
"As a medical student, these cases actually helped me learn a lot about human anatomy, biology and the doctor-patient relationship," said Dreben, who is now a psychiatrist in California. "These patients really stuck with us. I guess that's a poor choice of words."
Patients with lodged foreign objects usually fall into three categories: those who swallow the objects, those who get things stuck accidentally (think cockroaches crawling into someone's ear while he sleeps), and those who intentionally insert items into their vaginas or rectums – and can't get them out.
When it comes to swallowed objects, children age 4 and younger account for 75 percent of the cases that doctors treat. On the flip side, patients with objects stuck in the rectum are more likely to be between ages 20 and 40, and far more likely to be male. Some studies have found that men are 28 times more likely to insert objects up their backsides than women are.
"I think the most common objects I've seen are vegetables," Knight said. "I've never been able to figure that one out."
Why Do People Do It?Many patients are reluctant to tell emergency doctors and nurses just how a beer bottle or a pair of nail clippers wound up stuck inside their bodies. Dreben said he's heard one excuse after another.
"Some of my favorite excuses all involve someone who was doing something in the nude," Dreben said. "'I was vacuuming in the nude, when I fell.' Usually, it's some naked activity and a resulting accident."
Generally, doctors say most vaginally or rectally lodged items are the result of an attempt at sexual gratification gone awry.
On the other hand, patients with mental illness also comprise a handful of these cases. In 2010, doctors at Rhode Island Hospital examined 305 cases of swallowed foreign objects over a period of eight years, and found that all of the cases came from the same 33 patients, 79 percent of whom had been diagnosed with a psychiatric disorder.
However, Knight emphasizes that most patients who need a doctor to remove a stuck object are not mentally ill, just curious.
"I don't think anyone purposefully wants to get something stuck inside of them," Knight said. "A lot of the patients I've spoken with said they were just curious how far they could go with the limits of their bodies. And ultimately they find it."
It's easy to laugh at an x-ray of an unimaginable item in someone's colon, but doctors emphasize that these cases can have serious medical consequences. An object that gets stuck can cut into the lining of the stomach, colon or rectum, allowing the bacteria lining the gut to filter into the bloodstream and cause an infection. If an object is sufficiently stuck, it can require surgery.
Dr. Michael West, chief of surgery at San Francisco General Hospital, said doctors deal with the patient's state of mind and emotions as much as the object they have to remove from their bodies.
"The reality is that it's probably extremely difficult, frightening and embarrassing for patients to seek medical attention, attention that they really need and sometimes delay," West said. "Trying to call the patient on an implausible story may lead to the patient's signing themselves out of ER or dangerously delaying appropriate care or trying to remove it themselves and thereby causing more damage."
No matter how or why someone gets a cell phone or a child's toy stuck inside of them, emergency department doctors emphasize that a patient's health and safety is the priority in the emergency room.
"Most people who we see are just regular people. They're working, educated people who were trying something different and it went wrong," Vilke said. "It's amazing what people will do when they're lonely or bored."