Удушье (Choke)

A typical patient presenting colorectal foreign bodies is a male in his forties or fifties. The foreign body is almost always what the doctors call self-administered.

And Ursula says, 'What am I listening for?'

Positive bowel sounds.

'Gurgles, squeaks, rumbles, anything,' I say. Anything that indicates I'll have a bowel movement someday, and the stool isn't just packing up behind some obstruction.

As a clinical entity, the occurrence of colorectal foreign bodies rises dramatically every year. There are reports of foreign bodies that stayed in place for years without perforating the bowel or causing significant health complications. Even if Ursula hears something, it won't be conclusive. Really this would take an ab­dominal roentgenogram and proctosigmoidoscopy.

Picture yourself on the examining table with your knees pulled to your chest in what they call the jackknife position. Your buttocks would be separated and held apart with adhesive tape. Somebody would apply periabdominal pressure while somebody else would insert two tissue forceps and attempt to transanally manipulate and extract the foreign body. Of course, this is all done with regional anesthesia. Of course, nobody is giggling and taking pictures, but still.

Still. This is me I'm talking about.

Picture the sigmoidoscope view on a television screen, a bright light pushing along a clenched tunnel of mucosal tissue, wet and pink, pushing into the puckered darkness until it's there on TV for everybody to see: the dead hamster.

See also: The Barbie doll head.

See also: The red rubber butt ball.

Ursulas hand has stopped its up-and-down jumping, and she says, 'I can hear your heart beat.' She says, 'You sound pretty scared.'

No. No way, I tell her, I'm having a swell time.

''You don't feel like it,' she says, her breath hot on my periabdominal region. She says, 'I'm getting carpal tunnels.'

'You mean carpal tunnel syndrome,' I say. 'And you can't be­ cause it won't be invented until the Industrial Revolution.'

To keep the foreign body from moving higher into the colon, you can provide traction by using a Foley catheter and inserting a balloon into the colon above the body. Then inflate the balloon. More common is a vacuum above the foreign body; this is usually the case with self-administered wine or beer bottles.

Her ear still against my belly, Ursula says, 'Do you know whose it is?'

And I say, that's not funny.

With bottles self-administered open end first, you have to in­sert a Robinson catheter around the bottle and allow air to flow past it and break the vacuum. With bottles self-administered closed end first, insert a retractor into the open end of the bottle, then fill the bottle with plaster. After the plaster sets around the retractor, pull it to remove the bottle.

Using enemas is another method, but less reliable.

Here with Ursula in the stables, you can hear it start to rain outside. The rain pat­ter­ing on the thatch, the water running in the street. The light in the windows is dim­mer, dark gray, and there's the quick repeating splash of somebody running for cover. The deformed black-and-white chickens squeeze in through a broken board in the walls and fluff their feathers to shake off the water.

And I say, 'What else does the TV say about Denny?'

Denny and Beth.

I say, 'Do you think Jesus automatically knew he was Jesus from the start, or did his mom or somebody tell him and he grew into it?'

A soft rumble comes up from my lap, but not from inside me.

Ursula breathes out, then snores again. Her hand goes limp around me. Limp me. Her hair spills across my legs. Her warm soft ear is sunk into my stomach.