Difficult to be in Closet

We get called for a woman in a retirement home with diarreha. We go down the dim carpeted hallway after coming out of the narrow dim elevator, and the smell hits us. It smells like a dead body. Provided there is not a dead body on the floor, I can tell you what we will encounter. A patient with c-dif. C-dif is a bacterial infection that causes diarrhea. Let's go to the experts on this one.

"Clostridium difficile is a Gram-positive, spore-forming, toxin-producing, obligate anaerobe that is ubiquitous in nature. Over the past decade, it has become a very prominent nosocomial infection worldwide. It is notable that C. difficile infection caused ward closures in 5% of UK hospitals in 1993, and by 1996 this figure had risen to 16% [1]. However, the available epidemiological data may not be accurate. Diagnosis depends on stool culture and testing for toxin, but wide variation in practices for stool collection and in laboratory methods for diagnosis make it difficult to know the true incidence.

It was first recognized as a potential pathogen in 1935 when it was described as ‘Bacillus difficile’ [2]. However, its identification as a normal bowel commensal and subsequent association with pseudo-membranous colitis in relation to broad spectrum antibiotics was only established in the late 1970s [3,4].

Renal, oncology, haematology, geriatric, intensive care and surgical patients are particularly prone to infection with this microbe, emphasizing its potential threat to patients with depressed immunity. Infection has been noted to be of a greater severity and to cause higher mortality among patients with chronic renal failure, more so than can be accounted for by age differences alone [5]. The increasing use of broad spectrum antibiotics and the expanding population of patients with depressed immunity has resulted in an increase in the frequency of outbreaks of infection which may be prolonged and difficult to control [6].

Clinical presentation

Patient presentation can range from asymptomatic colonization or self-limiting diarrhoea through to severe diarrhoea, pseudomembranous colitis, megacolon, colonic perforation and death [6]. Most patients, however, present with passage of large volumes of watery stool which experienced healthcare workers can often recognize from its characteristic smell [7,8]."


The key line "Which experienced health care workers can recognize from its characteristic smell."

It smells bad.

Here are some other descriptions of its smell:

"characteristic horse-dung smell"

"The smell is disgusting."

"a distinctly foul smell."

"he has C diff, short for Clostridium difficile. I can’t think of a worse type of diarrhea. There is nothing else that equals the foul smell of that, nothing. Nurses are unanimously in agreement on this;"

A web site called medical memonimcs teaches people to remebemer C-dif, by the memmonic "Difficult to be in the Closet:"

"Difficult to be in a Closet with someone having explosive foul smelling diarrhea, because it would smell and there would be no air in there.
Clostridium Difficile causes explosive foul smelling diarrhea and is an anaeorbe (no air)."


I had my partner tech the call. I drove to the hospital with my head out the window like a dog.

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Did three other calls -- all BLS. A demented lady from home not feeling well, a nursing home patient who refused to go to diaylsis, and another call I forget.