As a doctor in a busy emergency department you need to be prepared for all manner of presentations, from drunken abuse and violence, to pint glasses stuck up bums.
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With decades of experience in emergency departments, Calvary Hospital's Dr David Caldicott has seen his fair share of the downright frightening and confusing.
"There are so many bizarre cases that come through emergency departments it is hard to remember individual ones," he said. "In every hospital, every month, there is something bizarre happening."
Dr Caldicott said doctors often need to determine the difference between what a patient reports and what has actually happened.
"There are people arriving with objects in their orifices that could never have made their way in the manner suggested, unless by magic or the occult," he said.
"You can either tackle their statements and extract the truth or you can just shrug your shoulders and accept they no longer want the item where it is and proceed to remove it. "
Two years ago a medical journal documented how doctors at Canberra hospital were tasked with removing a 10 centimetre fork from inside an elderly man's penis after a bizarre sexual mishap.
The 70-year-old arrived at the emergency department with a bleeding organ and told doctors he inserted the fork to achieve sexual gratification.
But Dr Caldicott said this was not the only strange and confronting presentation emergency doctors have had to deal with.
"I have had to take a pint glass out of someone's rectum which proved to be quite the challenge as we didn't want to break the glass – that was quite difficult," he said.
"I have conducted surgery on a gentleman who inserted a rolled up hot-water bottle taped to a pressure hose inside him, only for it to explode internally."
Dr Caldicott said many genital injuries were caused by the search for sexual gratification or stimulations, although doctors found them less amusing than the general public.
"These cases can be a novelty when you are a more junior doctor although when you get a little further in your career you begin to develop a little bit of pity," he said.
"As a junior doctor you can be quite critical but as you get older you realise there is a rich tapestry of humanity out there and they're probably doing these things for reasons sadder than you think."
Dr Caldicott said strange presentations still required careful attention from doctors who need to determine whether the patient may be in any danger.
"One of the most important things we are keen for junior doctors to never miss is when a story doesn't match what a patient looks like, as that can often be a sign of domestic violence," he said.
"That can ring alarm bells and if a junior doctor can spot this early on they may be able to save lives."
But the challenges of medical staff in emergency department are made more difficult by alcohol.
The Australian College for Emergency Medicine has warned that hospitals across the country are becoming battlegrounds as drunk, aggressive patients flood through their doors.
In December, a survey of 2000 emergency department staff by the college found 92 per cent had been physically threatened by drunken patients while 98 per cent had been verbally abused.
According to ACT Health figures, the number of patients presenting with alcohol related issues increased by 35 per cent between 2009 and 2013.
"The impact of alcohol on the health of Australians is hugely underestimated and runs into the billions of dollars each year," Dr Caldicott said.
