RIGHT UNDER MY NOSE!

I am quite familiar with their kind. They can be lumpy, straight, crooked, aquiline, or Roman. But the ones I see the most often, thanks to examining them being my bread and butter, are tiny buttons which are invariably running or red adult ones, accompanied by watery eyes and a “sorry for myself” expression.  I am talking about noses, as you have probably guessed by now!

Being an ENT surgeon, I have made sticking my nose into other people`s business a fine art, where I have developed a nose for trouble. All puns aside, I must accept the fact that peering into the hitherto unchartered territory of the internal workings of people`s noses is what brings home the bacon.

Living in a satellite town of the megapolis of Mumbai, my own nose is no stranger to pollution and I tend to make hay (read moolah) when the weather changes. The sight of flowers in bloom makes me think of the amount of pollen in the air and the allergies it will cause rather than turning me jocund a la Wordsworth. And my heart does fill with pleasure and dances with the daffodils only after a patient of acute on chronic sinusitis brought on by said flowers reports a reduction in symptoms.

But what really sends my heart leaping into my throat is when there is a call for me to remove something from the nose, which has no business being there in the first place. Foreign bodies are only too common in this organ, because as someone rightly pointed out, “all that glitters is not gold.” I would go a step further to say that all that appears smooth on the outside is riddled with potholes from within.

Nowhere is this truer than the human nose whose internal workings are replete with small bony shards, pieces of gristle and blood vessels running every which way, allowing it to perform as a humidifier par excellence, but also making sure that a bleeding nose is not a sight for the faint-hearted. Thanks to its convoluted anatomy, it provides wonderful hidey holes for foreign bodies to lodge, thus ensuring that we ENT surgeons, are masters at hide-n-seek.

With my now middle aged and rather jaded bespectacled eyes, I have seen a whole gamut of foreign bodies ranging from rice grains and peas to ear studs and maggots residing or should I say illegally occupying premises from where they are rather unwillingly evicted thanks to my skills with a Vectis. This little hook shaped instrument has proved to be a life saver making many a parent and me heave a sigh of relief at the sight of the offending foreign body nestling safely in my palm rather than in the secure depths where an intrepid toddler had placed it for safekeeping.

A couple of incidents stand out in my memory when it comes to extraction of foreign bodies from the nose. When I was safely ensconced as ENT resident in a large municipal hospital in Thane, with the aim of emerging  a full- fledged otolaryngologist bent on bringing succor to the needy, with my usual luck, I was again the sole ENT resident in said hospital with the onus of a daily night duty in addition to all my nefarious activities during the day.

Modern day children think of Wee Willie Winkie as a wimp because no child worth his salt will be found in bed at eight `o`clock. This is the time they actually come into their own and start thinking up newer and newer devilments before you can say ‘imp’.  Also, fatigue makes parents, who are only human, slightly lax, and inattentive at the end of the day thus making sure that most nasal foreign bodies present in the dead of the night, with me setting to work in the struggling moonbeam`s misty light and the lantern dimly burning. With the day`s fatigue setting in, I had quite a few sharp words to say to the more careless of them, especially people who had let the foreign body either stew in its own juice for a couple of hours or had made foolhardy attempts to extract it themselves, ensuring that a simple case turned complicated.

Extracting a foreign body from the nose can be tricky at the best of times. Thanks to the mucus produced in the nose in copious amounts, a foreign body can become slippery and can slip either forward or backwards. If it slips forward, God is in His heaven and all is right with the world. If, however, it chooses to slip backward, it can slide into the throat from where it can lodge either in the airway (an unmitigated disaster) or in the food passage (an unnecessary complication). Hence it is important to make sure that the patient is in an upright position and sits still while the extraction is carried out.

Now, children are slippery little eels at the best of times. Trying to approach one with a small steel hook in one`s hand and not expecting the child to make a dash for freedom is like expecting a window seat in a Mumbai local during rush hour. Nearly impossible. And hence the cajoling and sedating which one invariably finds in such situations. It is no wonder that most ENT residents wander around with small toffees in their pockets, all the better to restrain patients with my dear!

One night I happened to encounter just such a situation, but the child in question was slightly older, probably around seven to eight years old. A cursory examination showed a round metallic object in the right nostril lodged between the septum and the inferior turbinate, the pink mass of flesh you see on the wall of the nose when you lift the tip of your nose and peer at it in the mirror. Since this child could be reasoned with, I managed to get him to sit still by dint of cajoling and some good old- fashioned threatening on his father`s part when the battle seemed to be a losing one.

I inserted my trusty Vectis and slowly pulled. The object seemed rather large. Maneuvering gradually around it was difficult and my palms were sweaty with the thought of it slipping backwards out of my grasp. Just when I was losing hope, it moved forward slowly at first, but then popped out suddenly. It was a large button, made of copper, the kind that is seen on jeans.

I was triumphant, the child`s father ecstatic, the child howling loudly and the casualty staff relieved. I was planning to pop back to my room for a well- deserved break and put the button down on the table while writing out my notes and explaining the procedure of instilling nasal drops to the father. He seemed well satisfied, all toothy grins as he was about to depart. The child had stopped howling and was quietly engrossed in something.

They reached the door of the casualty ward without much incident, when there was a fracas and the father was back with the child held by the scruff of the neck. He pointed ominously at the child before uttering a single word “Button!.” “Who…where…what?” I was flabbergasted. As I leant forward to reexamine the boy, there was the button, glinting prettily, this time from its place of pride in the left nostril!

That`s when I learnt the real meaning of something happening right under my nose!

Luckily, I managed to extract the button without incident a second time round and I hope the talking to that I gave the father-son duo helped them keep their noses clean for the rest of their lives!!!!