Smell Series: Clostridium Difficile Colitis

    Any good clinician will accept data from the patient in any form they can get. Direct questioning, interviewing the family, and thoughtful observation are as valuable as any lab test. Of course embracing the smells of the room is part of this data set. The smell of Clostridium Difficile Colitis is immediately recognizable, but at the same time out of place. It’s a smell that does not seem organic, its character is different from any other smell produced by the human body. If you’ve read the book Dreamcatcher, it smells the way I imagine the parasitic alien fungus does. It’s a deep, inky smell, that dominates over the other smells in the room. It is not diluted by the smell of sweat or urine that often accompanies chronically ill patients. It carries strong notes of ether and organic chemicals that remind me of my time in the lab as an undergrad student. I’ve heard it described as sweet by other providers, which is not a word I’ve ever used to describe fecal matter, but I understand it. It’s a smell I’ve learned to trust, which is its only redeeming quality. Let’s break down the ratings

    Prevalence: 4 out of 10. This is a weekly smell in my experience. Found more frequently in patients who’ve recently been discharged or have been languishing at a nursing home for just a little too long. 

    Strength: 6 out of 10. When it comes to bad smells, this is perfect. It’s strong, immediately detectable when entering the room, but not clingy. A good hand wash with soap and water and the smell stays basically in the room. It does not stay on your clothes. It lingers in the background of the room after the patient has given a sample like music in a hotel lobby. 

    Effect on appetite: 2 out of 10. This smell, as mentioned previously, does not smell organic. It’s not like any other body fluid and therefore it doesn’t have a strong association with food. Think of its affect on appetite like the affect a bad smelling household cleaner would have on appetite. No long term damage. 

    Prognostic Value: 8 out of 10. If a smell can have a redeeming quality, it is this. I can walk into a room and smell this smell and we have a plan for the patient as I’m introducing myself. You cannot accidentally have this smell, it strongly correlated with the presence of Clostridium Difficile Colitis. It can be a debilitating infection, but embracing this smell can give you a head start in resuscitating these severely ill patients. 

Total Score: 20/40