The Q Word Podcast
Nyssa: Hi, Lisa not Nyssa!
Lisa: Hi, Nyssa not Lisa! What are we talking about today?
Nyssa: Well, since it's episode two, we're going to be talking about going number two. Everything you never wanted to know about poop.
Lisa: Well, it's funny, I knew this girl in college. Her name rhymes with Lisa and we lived together...
Nyssa: No. Nope. Let’s don’t go there.
Lisa: Well, no, we have to go there because you're the one who just introduced the topic. And this girl- I don't know if you know who I'm talking about- she never once did number two the whole time that we lived together in college. She said that she never pooped. Does that sound familiar to you, Nyssa, who rhymes with Lisa?
Nyssa: Yeah, that's vaguely familiar. Yeah, so I wonder if the Nyssa and Lisa back in the day, if there was anything in our four year liberal arts women's college education that would have prepared us decades later to be talking for 30 minutes to the public about this very, very thing. Anything?
Lisa: No, no, nope! I mean, I poop regularly. I'm a proud pooper. I'll poop anywhere, anytime, all the time. I have no problem talking about it. And I have no problem regaling random people walking by with stories of my poop. You, however, were very, very against that the entire time we were in college.
Nyssa: Yes. Well, I've turned a corner and you're going to love this episode if that's how you feel about it.
Lisa: Oh, great! Well, let's drop right into it.
Nyssa: So I wanted to start with a little bit of story time from nursing school. My first year in nursing school we were doing clinicals where a nurse is just assigned one patient to kind of start getting into the swing of things. One of my classmates had an elderly gentleman who had an episode of fecal incontinence. And that is medical speak for he pooped in the bed. So when you're cleaning up a patient, it's at least a two person job. Sometimes, depending on the size of the patient, more than that. So she recruited me and asked me if I would help her clean up this patient and because I was nurse Nancy, I said, “Yes, I will!”
Lisa: And of course, you'd already had several children by then. So you've changed a lot of diapers and you were used to little baby poops. Those cute little poops that babies have. They are cute, right? I don’t have any kids so I assume that baby poops come out like little rabbit turds.
Nyssa: Adorable. So we went into the room and she asked me- assigned me- the job of rolling the gentleman on his side and holding him there so that she could get to the business end, wipe him down, change his gown, change the sheets out. So that was my my role. When he was laying in the bed that way, his body was sort of blocking the odor of the poop and as soon as you rolled him up on his side, that odor hit me. Slapped me right across the face. And I knew it wasn't going to go well. And so I leaned down to him and said, “Sir, I need you to hold on to this bed rail really tight. I'll be right back.” And I stepped away from the bed into his bathroom and I vomited up my cafeteria hospital lunch of lasagna.
Lisa: Oh, lasagna? Ideal!
Nyssa: Yes. Perfect. Won't forget that it was lasagna. So I came out and resumed holding him. Meanwhile, my classmate is saying, “You know what? We're good here. I think I got this.” I was like, “No, no, no. I'm committed now. The lasagna is gone. We're good. Let's do this thing.” But I was devastated. I was embarrassed. I was mortified. So I set up a meeting with my clinical instructor and I asked her if I needed to change my major. She told me a great piece of advice, and that is that nursing is a team sport. And she said every nurse has the thing that they don't do; that they have an aversion to. Some nurses it’s vomit, some nurses it's phlegm. Some of us, it's poop. Others it's eyeballs. So the idea is that if someone's aversion is phlegm, I'll handle their phlegm-y patients, they help me with my poopy patients and everybody wins. When I was interviewing for a job, I was sitting in front of a panel of directors of departments. They asked me the typical interview question, “Tell us about one of your weaknesses.”
Lisa: Oh, and of course your answer to that is supposed to be, “Oh, I work too hard. I care too much.”
Nyssa: Exactly. And I knew that that was the game that you're supposed to play, but something happened to me and I blurted out that my weakness was poop.
Lisa: Did you literally say “poop?”
Nyssa: I literally said, “Poop.” Not, “My weakness is poop.” I just said, “Poop.” And there it was. Right there, plopped out in front of everyone. So the director of the medical ICU, his name is Tom, and he said, “You know, this is an interview for critical care and we have poop from head to toe, rolling down the bed and onto the floor. It's everywhere. You know that, right?” I said, “Yeah, I mean, I'll figure it out.” So somehow I got the gig and as I was precepting in one of the ICUs, surgical trauma ICU, my preceptor’s name was Shawna and I had already given her the disclaimer, “Shawna, I don't do poop. I'll need help with that. I am working through it. But, just so you know, I did vomit.” She said, “Girl, you're going to clean up so much poop, that by the time it's over, you're going to be wiping butts with one hand and eating your sandwich for lunch in the other.”
Lisa: Please tell me you have not done that. Please, please tell me that when I go to the hospital, and if I ever have an incontinence issue, I'm not going to have a nurse who is wiping with one hand and eating her pastrami sandwich with the other. That would disturb me deeply.
Nyssa: She won't do that… but she sure will take those gloves off, wash her hands, and walk right back to that sandwich. And Shawna was right. I did eventually reach that point. I was surprised. I really thought, “Listen, I'm the exception to this. I will never get over this aversion.” But I absolutely have. She was right. So I wonder if you can tell me all the names of poop that you can think of. The slang, the official, the medical… what do ya got?
Lisa: Alright. Okay. Well, the first one that comes to mind is of course “shit.” It's a good word. I use it often. Let's see... there's “number two,” like this episode. There's “poop.” There's “poo.”
In deference to my Puerto Rican roots, there's “kaka.”
Nyssa: Good one.
Lisa: I always hated “kaka.” I can't stand the term “kaka.” There's “deuce,” like, “dropping a deuce.” I say that a lot. There's “scat.” There's “dung.” There are “cow patties.” Let's see... what else would there be? How about “night soil?” That's a really good one. That's a Victorian term.
Nyssa: Never heard of it.
Lisa: “Guano.” “Feces.” That's you know…
Nysaa: Feces is medical- more medical.
Lisa: “Manure” is a good one. “Meadow muffin.”
Nyssa: That’s a cow patty, right?
Lisa: Yeah, that's a cow patty, that’s a cow pie.
Nyssa: I’m a city girl. No idea.
Lisa: “Crap!”. Oh, I think we forgot about crap. That's a good one.
Nyssa: Oh, crap. We forgot “crap.”
Lisa: Yeah, “fertilizer.” Poop is fertilizer.
Nyssa: It is. Not human poop, hopefully. But yes.
Lisa: I fertilize my bathroom regularly, several times a day.
Nyssa: That is a good, comprehensive list.
Lisa: Yeah, that's pretty good.
Nyssa: We're going to talk everything about poop. I thought our discussion of poop could be broken down using the elements of design from the art world. How do you feel about that?
Nyssa: I thought I would put that art history degree to work. So the elements of design include: line, color, shape, texture, size and direction.
Nyssa: Yeah. So let's just start with line. The definition is: the linear marks that are made.
Lisa: Oh, you mean like on the bowl?! Like, like, like, like, oh! Skid marks!
Nyssa: Skid marks! That’s it! The next one is color. Color is a pretty in-depth discussion and it actually can be a very diagnostic tool when you're looking at the color of stool. So the first thing to know is that normal color is brown. That is because of the bile that comes from the liver and the gallbladder. It can be pretty much any hue of brown- from light brown to dark brown. All of that is considered normal.
Nyssa: If your stool is black, and kind of tar-y, or it looks like coffee grounds, that's a big warning sign that you may have old blood in your stool. So that's something that you might want to follow up and check with your physician, especially if you've had multiple episodes of it or some symptoms. But think back and wonder: did you take some pepto bismol? Because pepto bismol will actually turn your stool dark- really dark colors. And so will iron pills.
Lisa: Or beats! Every time I eat beats, I feel like I'm hemorrhaging afterwards and I have to remind myself that I just ate beets. And that's what's going wrong with me.
Nyssa: Right! So that brings us to the red, maroon colors. So bright red, that looks like blood, may be blood. It may also in fact be red dye. So did you eat some beets? Or did you drink a red Powerade or eat some red jello? If it is, in fact, blood, it could be hemorrhoids, which is at the very end of the GI tract. It could be an inflammatory bowel process, like ulcerative colitis, or Crohn's. In that case, you definitely want to see your physician. What about poop that is blue or green or purple? This is something that moms often find in kids diapers. And the reason is because of the dye that they put in the fun kid food. So gummies or snacks; icing is a real big offender. Those food dyes are pretty strong, and they make it all the way through the system. If your kid has some bright, technicolor poop, think about what they what they ate in the last 24 hours, as well. Now the green that you're talking about is the dark green. And this is generally diarrhea. This is food that has passed rapidly through the GI tract. So rapidly that it didn't have time to absorb that bile that would turn it that brown color. You will probably feel that sense of urgency to go. Normally when you feel the urge to have a bowel movement, you got a few minutes. You know, you can get some reading materials and change into something comfy and then go and do your business. That's not what's happening here. This is a sense of urgency that you gotta go! If you note white stool, or maybe it's kind of a gray color or they say “clay” colored, this is likely a problem with your gallbladder. It’s making an inadequate amount of bile. That's definitely something to follow up on. Yellow stool can be an indication of malabsorption. Especially fat. So the stool, if you felt it, it would be greasy. Or it might appear mucus-y and nurses will recognize this when they're cleaning out of bed pan and it's kind of greasy in there. They're thinking, “Oh, my patient’s got an absorption issue.” Interesting, fun fact, side note: yellow stool is a normal finding in breastfed babies.
Lisa: So if a breastfed baby doesn't have yellow stool is that cause for concern?
Nyssa: I wouldn't say just the color being different because what mom eats can also impact the baby. It's going to pass through the breast milk and can impact what the stool looks like as well. But normally, and probably the majority of the time, it's going to be yellow and fairly loose.
Nyssa: So the bottom line is: diet can influence the color of your stool. So when you see something weird in the toilet bowl, ask yourself first, “What did I eat?” And then if that's not the answer, then you might need to follow up if you have other symptoms as well. So do you have any symptoms at all? Am I feeling weak? Am I feeling dizzy? Am I feeling belly pain? And then you've probably noticed before, as most of us have, that some foods don't get digested at all. There they are staring right back at you from yesterday's dinner.
Lisa: I was under the impression that when you see what looks like corn in your poop, it's probably not corn- that it's some sort of fat globule or something like that.
Nyssa: Nah, it's corn.
Lisa: Is it really? But I've seen, I mean, I might have seen corn in my stool without having eaten corn recently…
Nyssa: Then it's not corn! Then it’s definitely not corn!
Lisa: I don't really eat a lot of corn.
Nyssa: We’ll have to look into that.
Lisa: Okay, I'll send you a sample. I'll just airmail it to you down in Georgia. And you can tell me what that's all about.
Nyssa: Great. I can't wait. So, let's talk size. Size matters in poop. Size is going to be relative to the amount of food that you are eating. So a normal, healthy adult has a bowel movement anywhere from daily to every three days. Some people go twice a day, some people go every other day- all of those are considered normal. There's a great children's book that says it's simply: everybody eats so everybody poops. It's kind of funny because larger poops are actually linked to a lower risk of colon cancer, a lower risk of constipation, a lower risk of appendicitis and diverticulitis.
Nyssa: The average size of an adult poop is going to be about two pieces and they're going to be one inch by six inch or described as the size of a banana.
Lisa: We are going to lose any listeners that we may have gotten by the time we get to this. We are on episode two and already people are going to run for the hills.
Nyssa: I don't blame them.
Lisa: Yeah, it’s fine.
Nyssa: An adult male will produce about five tons of poop in his lifetime. That's really something to be proud of I feel like.
Lisa: That’s crazy!
Nyssa: What about direction? So we talked about the element of design and direction. All lines have directions, and when we're referring to the direction, it should always be out. But there are a couple of instances where it's not coming out, or it's coming at the wrong place. So when a patient has an intestinal obstruction, that's a little bit on the higher end of the GI tract, they are blocked. The stool can't get through- it will back up to the point where they are vomiting fecal matter.
Lisa: Whoa, that's disgusting.
Nyssa: That's a special, special day in the ER. The other direction, when it doesn't come out, is when constipation is at its worst, and the worst constipation is called an impaction. And that's a blockage that is caused by a piece of stool- a large, large piece of stool. So here's a little tip: if your preceptor ever tells you, “Double glove and lube up,” something's about to go down…
Lisa: ...meaning something's about to go up into somebody's rectum in order to pull something down?
Nyssa: You got it. So nurses do disimpactions. It is a very painful procedure for your patient. They are perfectly miserable. It's a very big cleanup job, so heads up on that. Once the impaction is removed, the stool behind it is often very loose and liquidy. And it has a special, special smell because it's been fermenting and marinating in there for a while.
Lisa: Don’t use cooking terms, please!
Nyssa: Oh, you're gonna love the rest of this episode. When you when you have successfully disimpacted your patient, it is likely that they are going to sleep like a baby and think that you are the best. And really, you are the best. Because who does that for somebody else?
Nyssa: Nurses. That’s exactly right. Nurses. Alright, so my favorite part: we're going to talk about shape and texture now.
Lisa: Okay. You mean other than the banana shape that we've already described?
Nyssa: Exactly. We're going to elaborate on that.
Lisa: Oh, joy!
Nyssa: There is actually something called the Bristol Stool Chart. It's also called the Bristol Stool Form Scale or, for the cool kids, the BSF scale. I've never seen this scale in the ER and I'm not sure why... it really belongs in the ER! If nowhere else, in the staff restroom. But I saw it in a GI doctor's office and I think that makes sense. Pretty obvious why it goes there. So it's a visual chart, you're going to want to look this up. We have it in our show notes, but it's got some descriptions that I think are podcast worthy for sure. This chart breaks down types of stool into seven shapes and consistencies.
Lisa: Can you see my face? I am looking at the Bristol Stool Chart right now.
Nyssa: It's something to behold... it really, really is.
Lisa: It's evocative.
Nyssa: You would think that a physician named Dr. Bristol invented it- everyone likes to lend their name to the things that they invent. But actually it was developed by Dr. Stephen Lewis and Dr. Ken Heaton. They worked at the Bristol Royal Infirmary and so they named it- I guess they didn't want their name attached to pictures of poop- so they named it after the hospital where they were working. It is a pictograph of poop. Let's just go through it! First you should know that it is an evidence based, validated scale. 1800 men and women’s stools were evaluated to create this chart. I don't know how you volunteer for this or how much you get paid to do this, but what I want to know is: who are these little research assistants or fellows or med students that are having to sift through this and categorize it and then describe it. So these descriptions are the things that I love the most.
Lisa: Okay, go for it!
Nyssa: So let's do this. Type one is described as separate, hard lumps. And that is indicative that you have severe constipation.
Lisa: Uh, you forgot the “like nuts” part that I'm seeing on the chart.
Nyssa: No, you're on the wrong chart.
Nyssa: You found some kind of special episode.
Lisa: It says: “separate hard lumps, like nuts. Hard to pass. Type one. Bristol Stool Chart.
Nyssa: Somebody expanded on the original, then. There is a pediatric scale. This has been evidenced base for ped's and it's called the “Choose Your Poo Chart,” making it kid friendly. And type one is described, for kids, as rabbit droppings.
Lisa: Okay, mhmm. There you go.
Nyssa: Type two is lumpy and sausage-like and it indicates mild constipation. And on the kids scale, it's described as a bunch of grapes. Always the food reference.
Lisa: Ok… that's great... All right.
Nyssa: So type three is a sausage shape with cracks on the surface.
Lisa: That's what my Bristol Stool Chart says.
Nyssa: And this is considered normal. Thank goodness. The kid version calls this “the corn on the cob.” Type four is like a smooth, soft sausage or snake. And this is also considered normal. So I feel like these fellows were sitting around and they were like, “I mean, really guys, how many times can we use sausage as a descriptor? Maybe we should mix it up and throw in snake... I don’t know.” On the ped’s scale, it's sausage. Type five: soft blobs with clear cut edges. This means you are lacking fiber.
Lisa: Okay, yep, I see that! “Passed easily” is what my stool chart says.
Nyssa: Yes. The soft blobs kid version: “chicken nuggets,” of course.
Lisa: Is there a one to one correlation to eating this food and what your poop
comes out like?
Nyssa: That's another research project in and of itself, I think. Type six: mushy consistency with ragged edges.
Lisa: Mine says fluffy pieces with ragged edges. A mushy stool.
Nyssa: Mushy. If you have raggedy edge stool, you are having mild diarrhea. And if you're a kid, it's porridge. Oh, the Brits with their porridge.
Lisa: Porridge? What American kid would know what that is? I want to know what the American version is. Oatmeal? No, oatmeal wouldn't be right. Grits? For our southern kids.
Nyssa: Pudding, maybe? I don’t know.
Type seven is a liquid consistency with no solid pieces. You have severe diarrhea. And the kid version says that it's gravy.
Lisa: Oh, gosh. I thought I'd be hungry for dinner. But now I'm not.
Nyssa: Yeah, so that is shape and texture.
Nyssa: There is a chart for that. Now I have a bonus element that is not listed in the elements of design- and that is smell. So when we're talking about smell, poop is supposed to stink. Smelling bad is normal. It is because there are bacteria in your gut that are breaking down the food that you put in there. It's pulling out the toxins, but the bacteria themselves cause the odor as well as the toxins. And so poop normally smells bad. However, if your poop is foul smelling, then this, again, could be a malabsorption issue. So “foul smelling” means that it smells like regular poop mixed with dead fish or rotten meat.
Nyssa: That's the description of “foul smelling.” There are some special, special smells in poop that nurses are acutely aware of. The first one is a condition called “clostridium difficile.” It's a spore that overtakes your GI system and causes horrible diarrhea. The diarrhea is clear or yellow and it's in copious amounts. This can actually put someone into hypovolemic shock and someone who's fragile... it can kill them.
Lisa: Oh, wow.
Nyssa: So “c diff” is what we call Clostridium difficile. The smell has a certain wang to it- let me tell ya. Nurses have described it as acrid, caustic, like a barnyard, or like rotting meat. And once you’ve smelled it once or twice, you can diagnose it with your own nose. So that's what nurses say. Nurses say, “I can smell a ‘c diff’ patient from down the hall.”
Nyssa: This was also put to research. There is a research project called, “The Nose Knows Not- Poor Predictive Value of Stool Sample Odor for Detection of Clostridium Difficile.” So these folks actually researched this urban legend about whether or not nurses can diagnose “c diff” correctly based on smell. And the results are in. And here are the results. So nurses who were on the unit, and could get a physical on their patient, and could get a history on their patient, and could see and smell the stool, had 84 to 89% accuracy. That's like a B, B plus, right?
Lisa: That’s pretty good.
Nyssa: Yeah, it's pretty good. And I will say, in their defense, there are “c diff” patients that have no smell to their stool; most of them do. So these guys and gals had an 84 to 89% success rate in diagnosing “c diff” based on smell with the whole clinical picture. So, the next prong of the research project was to collect stool specimens, put them in a test tube, get the nurses to smell them, and see if they could diagnose it that way. So they had 10 specimens that they had to smell: five of them were “c diff” positive, five of them were “c diff” negative. In this case, the nurses were also asked to give a confidence in their sniffing ability. They were 61% confident in their sniffing ability. And these nurses ranged anywhere from a year experience all the way up to 30 years experience. And they had a 45% success rate. So it's 50-50. Like, it’s got it or it doesn't… like you or me or anyone could have done that. Well, it was pretty much a miserable failure and there was no correlation between nurses who had more experience, less experience, whatever. They couldn't get it just based on smell alone.
Nyssa: That's kind of an interesting one. The other thing that I found that is utterly fascinating, is the Dutch trained a beagle to sniff out “c diff.”
Lisa: Oh, like in the hospital?
Nyssa: Yes. This is a “c diff” sniffing Beagle. This little puppy got 265 out of 270 cases correct.
Lisa: Wow! That's crazy!
Nyssa: So nurses were 84 to 89% correct. This puppy had a 98% success rate for “c diff” sniffing. I don't think that has really caught on. I've never heard of that until now, but it was a fascinating little tidbit. We cannot talk about the smells of poop without talking about a GI bleed. So we talked about the black tar-y stool. That's the appearance of GI bleed. You smell it a mile away. Congratulations to GI bleed because it was a fan favorite: voted the number one worst hospital smell by nurses. And let me tell you something, this is a tough category to win. And GI bleed gets it. “C diff” gets an honorable mention. Personally, I feel like there is one smell that I have smelled that is worse than GI bleed, and that is gas gangrene. You can never un-smell that. But, GI bleed is much more common. This is something that we smell a lot. It is that foul smell, but it is also a rotten smell and it has kind of a metallic tang to it. That's the iron in the blood that you're smelling. It's really bad.
Lisa: So here I'm visualizing that you're minding your own business, walking down the hallway at the hospital, and you catch a whiff of something and you stick your nose up in the air. I don't know, your feet float off the ground, and you sort of follow the wafting waves of smell into a room like, you know, like a cartoon character following the scent of fresh baked bread, and you can say, “There's somebody with ‘c diff’ down this hall.”
Nyssa: That's right. You can walk into a nurse's station and go, “Oh gah, where is your GI bleed? Wow!”
Nyssa: Our trick is that we put out bowls of coffee grounds because the coffee grounds will absorb some of that smell. It permeates the entire department when there's a GI bleeder in there. So you will see little cups full of coffee grounds sitting around- that is for odor absorption.
Lisa: Alright, interesting.
Nyssa: Here's your little bonus when it comes to scents, and that is that flatulence is normal too. According to the American College of Gastroenterology, everyone averages about 10-18 farts a day.
Lisa: Okay... 10-18... I think all of mine happen in the morning.
Lisa: And that's probably more information that I need to share on this. I'm single, guys!
Nyssa: What a catch, what a catch! So that's what I've got for you about poop. Is that more than you ever wanted to know?
Lisa: It's definitely more than I ever wanted to know. Is this something that when you collect a stool sample from someone and you take it out of the magic door that, you know, you deposit it in when you're in the hospital bathroom and you pick up this cup of a stool sample... do you sort of prediagnose? You're like, “Oh, look at that, it's hard little rabbit pellets there... this guy's constipated and may be suffering from XYZ…” Are you capable of pre-determining what you think their condition may be based on their stool sample alone?
Nyssa: Yes. I think that most nurses with a good bit of experience can say, “this constipation is due to their opioid use,” or “this ‘c diff’ is due to their immunocompromised status and their antibiotic regimen that they are on right now” or, “the GI bleed is from an ulcer in their belly.” Yeah, nurses can- and physicians too- figure out a lot from poop. You really, really can. So if you have concerns about any of your elements of elimination, you should probably create a poop blog for your poop logs.
Lisa: I see what you did there.
Nyssa: I've been waiting my whole life for that joke.
Lisa: I'll see if I can find a snare drum sound effect to add to this.
Nyssa: Ba dum, tsh!
Lisa: There ya go. That's good enough. We'll just do it verbally. It’s like beat boxing.
Nyssa: So I want to hear about your poop-related experiences, your poop-related bad puns. So share it with us on social media or send it to us via theqwordpodcast.com.
Lisa: If you send any pictures of your poop, please send them as an attachment directly to Nyssa. Be sure you put warning statements so that I don't open that up. I do have several friends who, for whatever reason, they're both medical school students- although one just graduated and is now a doctor- send pictures of each other's poop to each other. I think it's a very strange friendship that they have there. But now that I've done this episode, I'm going to assume that they were preparing for their medical school training by looking at each other's fecal matter in advance.
Nyssa: Yeah, they're basically studying, really, to be honest.
Lisa: That's totally what they've been doing. It's been studying all along. It's not weird. It's completely normal.
Nyssa: Totally normal.
Lisa: Totally normal.
Nyssa: Totally not.
Lisa: Alright, so now I know more about poop! And when I go tomorrow morning, I will know a little bit more about what's happening in the bowl. That's really good to know. Thank you so much for educating me in this way that I really didn't want to know about.
Nyssa: You are welcome.
Lisa: Well guys, if you enjoyed what you heard today, please rate us on social media or go to Stitcher, or Podbean, or wherever you listen to your podcasts and give us a glowing, five star review. Please don't tell us about your poop in the review. Nobody cares about that stuff. Your doctor will, but we don't. But we would love to get those five star reviews so that we can be more popular amongst all these podcasts that are out there who are not talking about poop.
Nyssa: If you thought this was a pretty crappy episode, give us another try on episode three, please.
Lisa: Absolutely. We haven't done a number one, but we'll talk about number one. Maybe down the line somewhere.
Bomers, M., van Agtmael, M., Luik, H., van Veen, M., Vandenbroucke-Grauls, C., & Smulders, Y. (2012). Using a dog’s superior olfactory sensitivity to identify Clostridium difficile in stools and patients: proof of principle study. BMJ. Retrieved from https://www.bmj.com/content/345/bmj.e7396
Rao, K., Berland, D., Young, C., Walk, S., & Newton, D. (2013). The Nose Knows Not: Poor Predictive Value of Stool Sample Odor for Detection of Clostridium difficile. Clinical Infectious Diseases. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3571629/
poop, stool, smell, nurses, patient, GI bleed, constipation, c-diff, hospital, ER, diagnose, odor, stool sample