let me buzz...

Medical care includes a whole range of gadgets, some simple and many complex. Hollow tubes of different sizes and materials are recruited by us, be it in the form of a slender and puny iv cannula or a stout and rigid pain in the backside, flatus tube! A nasogastric tube is one such wonder for physicians who swear by its “hollowness”! I could never imagine that this wriggly worm like length of modified plastic could test my patience and the patient.
The first time I came across this entity was in undergrad when we went for bedside clinics. Frail patients would have one of these sticking out of their noses. Some would just wear it on their faces after contriving that all efforts to yank them out would be promptly rewarded with a stiffer newer tube assisted by the heavenly ambiance that the nurse threw in with her sharp retort while fidgeting with it.
As an intern, my sacred duty was to see that tubes of all sizes once in,stay in! patency is an emotional and sensitive issue in anesthesia,if you didn’t know.. Each defective cord would have to be replaced before the deadline that the nurse established before her ceremonial drug and tube feeds. Stepping into anesthesia by choice, encounters of the ryle tube kind became more frequent in the name of securing airway and beyond.
My tryst with the whim that a nasogastric tube is capable of became evident on a dull routine day in the ICU. Most of my patients stable (I hoped!), there was me sitting at the counter sifting through patient details before I handed over management details to my reliever hours away. The inevitable scene of a patient zonked on opiods suddenly waking up to find a tube down his mouth and a tube down his nose happened just then. With one swift yank,our dude yanks it out and hands it out to the nurse! The cacophony that followed had to be resolved with a brand new ryle tube being inserted after convincing the patient that it was for his own gastronomical good.
Fast forward into PGship where we received intensive training in the intensive care unit, a fresher had to do the odd jobs as we didn’t have subordinates. The universe would now and then intriguingly conspire to block the ryle tube in patients. And I mean patients who are zonked on sedation and ventilators “taking their breath away” kinds at that. Threading down a new one down his nose and throat would either be like a piece of cake job or end up like threading a needle in the dark! We require umpteen maneuvers and aids such as the light in your throat( laryngoscope) and my metal fingers (Mcgills forceps). Working at the depths of a patient’s tosilled throat can become tricky given the prompt efficiency that the scope boasts of, refusing to light up when I ever so desperately need it to work. A bad works man blames his tools,goes a famous saying.. well the guy wouldn’t have been an anesthetist now,would he ?! fidgeting with jelly and gloves, each contraption is guided into its glorious orifice to rest therein for aiding two way transit to fluids of weird compositions.
All the tubes in,I sign off for the day… until new challenges of the hollow kind beckon.