Oh, poop

I remember the moment I first learned there was such a thing as a rectal tube. I was in my last semester of nursing school (a school that, it should be clear, was more focused on community rather than hospital nursing) and was in a clinical with a fellow nursing student. We were talking with a nurse manager and he mentioned a rectal tube. My schoolmate and I looked at each other. We looked at him. I asked him, trying to muster all of my professionalism, "A rectal tube? Like a Foley? But for poop?" It's hard to be professional when you are simultaneously floored and trying not to laugh.
One has to be pretty sick to earn a rectal tube. And, I suppose, to allow someone else to shove something up your butt. My husband continues to be amazed that such a thing exists and has a personal fear that I will, shall we say, bring my work home with me some fateful night. But those tubes do come in handy, because as any nurse knows a good part of the job is wiping butt. It is for the patient's benefit as well, of course- the last rectal tube I placed was in an unfortunate gentleman who was having frequent loose stools and a perineum that was getting redder and more sore with each one. I knew I had made the right decision when the small amount of fuss he made over having the tube placed was minuscule in comparison to the pleading and moaning he did with each wipe of his sore butt.
Placing a rectal tube, at least in my experience, is a nursing decision. You are the one caring for the patient, you decide, you do it, and then you notify the doctor. Most of the Drs I've worked with seem fine when I call them to inform them of what I've done. I did have one Dr tell me that she "didn't like" rectal tubes. Well, I'm sure the patient isn't a big fan either, but it sure is working isn't it?
At my facility we have a fancy new rectal tube with a fancy name that I won't mention. There are a few "fecal collection systems" on the market, and they all work about the same- insert the business end into the business and add a very specific amount of water in order to inflate the business end to an alarming size... inside the patient. By alarming, I mean donut size. Really. In your butt. Because this fancy system is so expensive, there is an actual decision tree posted to help nurses decide if the cost is worth it. Patients pretty much need to have a wound or very near one in order to justify the cost of inserting a donut up their butt, which I guess is again the lesser of two evils.
My absolute favorite thing about the fancy fecal collection system is their advertising- if you read any nursing journal you may have seen this. The bag and tubing is pictured, with a white background and some generic text that only hints at the actual usage, while simultaneously praising the product. Looking at the picture of the bag however, the bag appears to be filled with dark clouds and lightning. There's a storm a' brewin' folks, you guessed it- a shit storm. Which again, is far preferable to the Niagara falls of poop, which I have personally experienced. But that, my friends, is a story for another day.