The chief grabbed a latex glove and snapped it on his hand and with great manual dexterity took his index and middle fingers and stuffed the red mass back up this lady's anus. He then proclaimed,
“It's a prolapsed rectum,”
… and then he quickly yelled “Grab some gloves,” and pointed his clean fingers at me (he didn't know my name). I was terrified but excited that I was the chosen one, yet I was not sure why he chose me. He withdrew his fingers and Mrs. Jones's rectum quickly squirted out again onto the sheets. The chief then bellowed,
“Stuff it back in like this,”
… and he proceeded to show me the proper technique using my fingers. So now my fingers are firmly up this 90-year-old demented lady's butt in the middle of The Barn. I thought,
Wow! this is REAL medicine.
The chief then quickly walked out of the room with the rest of the house staff in tow. He said “We'll be right back, don't move your fingers.” I sat there in that room with my fingers in this lady's rectum listening to the soft music and the sound of demented folks talking to themselves.
This went on for about an hour before I realized that the surgical service was not coming back. Yes I'm an idiot. Bastards! I finally got the courage to withdraw my fingers, wash my hands, and return to the surgery department to check in with the guys. Needless to say, they were all pissing themselves laughing and giving me
THE
TWO-FINGER
SALUTE.
I hate surgery.
Why I'll NEVER Forget the Summer of ‘92…
The summer of 1992 was the start of my third year of medical school and therefore the start of clinical rotations. You remember when you were so excited that you didn't have to sit in classes anymore, but you were also scared shitless that you actually might have to touch a patient. Or worse yet, you might have to touch a certain part of that patient. This, my friends, is my story.
My first clinical rotation was the lovely and ever popular internal medicine (in other words Gomerville in the inner-city Philadelphia hospital my roommate and I were assigned to). It was still our first week of the rotation when the senior resident grabbed my roommate and me and said we had someone to admit in the Emergency Room. So my roommate looked at me, and I looked at him and we I headed off to our destination. Now was the ER on the first floor? Or was it J the next level down on the ‘ back side of the building? Crap, I'll never find my way around this maze! I just told my roommate to keep the resident in sight because if we lost him we were screwed.
As we were trying to follow the wake of the senior resident gliding effortlessly through the halls with that magnificent long white coat flowing behind him (looking like Nicolas Cage in the that scene from Face Off), I proceeded to drop my patient list, EKG calipers, stethoscope, and Washington Manual (twice) out of my overstuffed short white jacket. Then we arrive. This is no Valhalla. The place is huge yet looks tiny with the incredible amount of people and stretchers crammed into any nook and cranny available. The resident stops at this stretcher that is unceremoniously parked in front of the main control desk. People are flying by every which way. It is total chaos. The senior resident tosses the chart at us. After quick review, the little lump under the sheet (head and all) turns out to be a 91-year-old man from a local nursing home.
I honestly don't even remember the chief complaint of the nursing home staff; but frankly it isn't really important to this story anyway. The patient is a demented, nonverbal, multi-system-involved train wreck. As House of God would put it – a typical gomer. After the resident does his physical exam, with the wide-eyed third-year students behind him nerdishly taking notes on the far superior resident's exam, he turns to me and says those fateful four words,
“Put on some gloves.”
The words struck fear in my inner core. I looked over at my roommate with that “deer in the headlights” panic in my eyes. All I get back from him is the “thank God it isn't me” look. I froze. Again the resident says, “Put on some gloves” and pointed to the nearby cart where the typical assorted boxes were stacked. The sweat started to bead on my forehead and upper lip as I tried to squeeze into these incredibly tight blue gloves. I later found out they were a pair of small gloves. How was I to know they came in different sizes? I thought one size stretched to fit all.
So there I was. I was going to touch a patient. OK, remember the heart sounds, the location of each organ and how to percuss them. Don't forget the deep tendon reflexes, etc. Don't forget anything because you just know some pimping is coming. But as if it all happened in slow motion, the resident flips me this little blue and white packet, the size of a ketchup or mustard packet. With the same motion, he then whips back the sheet to expose this saggy, deflated 91- year-old ass. I catch the packet and look down. It reads “Surgilube.” The instant knot in my stomach felt as though someone had just punched me in the pancreas.
He wanted me
to do the rectal! Me!?!?!
But … but, I … I've never … Oh shit! Again my roommate gives me the “thank God it isn't me” look. Bastard. The resident grabs my white jacket and pulls me to the stretcher again dislodging my Washington Manual and patient list. My roommate quickly picks them up off the floor. Gee, thanks. What a pal. At this point my resident tries to calm me …
“Don't worry,
he won't even know
you're in there.
Just lube up and
stick ‘em in.”
Where the nerve came from I will never know, but I opened the Surgilube ketchup packet and totally lubed my right hand. Yes, I said right hand. As I said before, how was I supposed to know? With my left hand I grabbed his top sagging cheek and lifted to expose the Holy Grail. A quick look around the Emergency Room revealed that the chaos was still in high gear. The noise was deafening. I don't think anyone even knew we were there, even though we were right out in the open in front of everyone. There was medical staff, patients, family members, and on and on. I mean everyone.
So I pointed my fingers, took a deep breath and plunged those fingers right in. Immediately this demented, nonverbal, noncommunicative 91-year-old screams out at the top of his lungs …
“HEEEYYY,
GIT YOUR FINGERS
OUT OF MY ASS!!!!”
Yes, I froze again, with my fingers still firmly implanted in his ass. Just to remind me that my fingers were still indeed firmly implanted in his ass, the nonverbal 91-year-old gentlemen kindly repeated himself. Only this time louder …
“GIT YOUR FINGERS
OUT OF MY ASS!!!!”
This time the cursory glance around the Emergency Room revealed not a single person moving. I don't recall any more noises and everyone now had their eyes squarely on this third-year medical student with his bulging short white coat, sweat pouring off his face, his totally lubed right hand with one finger in the elderly man's rectum doing his first rectal.
That's why I'll NEVER forget the Summer of’92.
A MEDICAL STUDENT
TRANSLATION GUIDE
FOR PATIENT COMPLAINTS
Yes, I'll try to lose weight!
I hope Burger King has the lunch menu up when I leave here.
Doctor, I have a very high tolerance of pain.
I am an absolute wimp who needs general anesthesia for a hangnail.
Yes, I exercise around the house.
I do nothing and the only sweat I get is with each bowel movement.
I only drink three or four beers a day.
I actually drink eight or nine beers a day; maybe 12 or 13.
I left my last doctor because he never listened to me.
No one ever listens to me; not even my friends or family, no one! Doctor, are you listening?
By the way, Doc, what do think of that Viagra stuff?
My penis has been dead on arrival for years and I miss it so.
My cough is not due to my smoking!
Just give me the damn antibiotic so I can go get a smoke right outside the office!
<
br /> I am not a drug seeker!
I am a drug seeker!
It hurts really bad in my back and neck and ankle and
How about getting me on disability?
I want the best medicine you've got,
my insurance pays for it.
I want the best medicine you've got because I've got Medicaid.
Doctor, I only eat healthy foods!
I hope Burger King has the lunch menu up when I leave here.
The following occurred in my junior year on the OB service at a prominent hospital in Dallas in the 1960-61 academic year.
SYNCHRONIZED
SWIMMING
“Joe Bob,” a medical student famous for gaffes and wit, was charged with monitoring the labor of a teenage primigravida. His sole task was to call the resident when the patient was fully dilated.
As labor progressed, he snoozed until awakened by the patient's urgent request to visit the commode for a bowel movement. He obligingly helped her to a seat, whereupon she delivered a healthy, Apgar 9 male -
right into the toilet bowl
After hysterics and hysterical laughter subsided, the case was presented to the chairman of the department at OB Complications rounds the next week. The chairman was a notoriously ill-tempered taskmaster who demanded perfection from his charges and was fuming about the incident. The room was packed. Poor Joe Bob recited the awful facts as the chairman grew increasingly impatient with the unfolding scene. Finally the ordeal ended with Joe Bob slumped against the wall, overpowered by the steely gaze of the chairman, who boomed,
“So, doctor …”
sarcasm dripping,
“what do you
have to say
about this
matter!”
“Well”
Joe Bob deadpanned,
“I think they should
have scored him
Apgar 11 because he
could swim.”
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MEDICAL STUDENT RECOLLECTIONS
There I was, a third-year med student at the University of Kentucky, doing my first ER rotation. Recently, I had gotten to do chest compressions during a code and felt puffed up with pride when the nurse declared, “I can feel a good femoral pulse.” On the other end of the spectrum, I had also seen the mother who brought her kid into the ER at 11 p.m. for his school immunizations because she had forgotten them and the child couldn't start school the next day without them (she was politely turned away and told to contact her child's pediatrician).
The good stuff, however, was yet to come. This shift, at about 2 a.m., we got notified of an alpha trauma calldown. All we knew was that it was a single-vehicle rollover accident with injuries.
The trauma team gathered, we all “suited up” and soon the patient was wheeled into the trauma bay. He was a young male, 25 to 30 years old, conscious, and not really in very much distress. By his own admission, he had been getting high on pot all night with his buddies (he didn't drink, he said, because he thought it would violate his probation). After the party had wound down, he hopped into his pickup, drove faster than he ought to have, lost it in a turn, and was ejected from the vehicle as it rolled over.
Now imagine your arm in front of you, as though it were held in a sling. This man had a mossy, splintered 1 × 6 foot timber that went through the lower side of his forearm, exited through the top, continued on, went through his upper arm, and again exited the other side. There were rusty nails and grass all over this thing, but surprisingly little blood considering the amount of loose meat flapping around. He could even twitch his fingers a little.
It was time to act. After going through the ABCs of an emergency medical exam and looking in amazement at the wound itself, we proceeded with the secondary survey. We checked his other extremities.
“Does this hurt?,” we asked.
“No,” he responded.
We checked his cervical spine, “Does
this hurt?” “No.” “Does THIS hurt?” “No.”
We checked his abdomen, we checked his pelvis. We log-rolled him to assess his back, and asked as we were palpating, “Does this hurt?” to which he replied, “I'm telling y'all, ain't nothing hurtin’ on me ‘cept my arm!”
Incredibly enough, this guy had no broken bones, no major vascular injuries and there was very little neurological damage. Our friend, let's call him Bubba, barely avoided complying with the axiom: What's the last thing a dumb redneck says? “Hey y'all, watch this!”
EDITOR’S NOTE: Do not try this at home. Bubba was lucky he didn't have the fence post jammed up his …
BOT FLY ON THE BRAIN
I picked the patient's chart up off the door. It read, “Infected bug bite.” “Alright! One I can handle,” I thought. You see this was the first week of my first rotation of my third year of medical school and I was GREEN. I walked in still looking at the chart as I noticed that this “bug bite” had failed a first course of antibiotics … Hmmm.
The patient was your young surfer-dude type. He told me he had been traveling in Costa Rica two months before when he received this bite on his leg. Though he didn't see what bit him, he thought it was a mosquito because it itched like hell, and of course he had been scratching it.
The bite had been growing in size ever since and occasionally caused him a sharp pain, like something was biting him. He had seen my attending's partner two weeks prior and had received a course of antibiotics to cover for infection. There had been no improvement in the bite according to the surfer-dude. In fact, it had grown significantly. The bite mark itself was a small hole and there was a golf-ball sized raised mass underneath it. The mass had been growing up away from the bite – against gravity … Hmmm.
I asked him if he had squeezed it and if he had gotten anything out. This is when he broke down and confided in me his worst fears. “Dude, I was so pissed at this bite. It hurts! I squeezed on it really hard one day and I got out what looked like a piece of segmented body or something. I think there's something growing in there! I can feel it moving sometimes! You got to get it out!”
“Okay, relax, we won't send you home with just another course of antibiotics. Let me get my attending and we'll check it out.” When I showed her the bite she responded, “We're going in.”
A few minutes later with some local anesthesia and a scalpel my attending was cutting through the superficial layers of skin, then the fascia, then we saw it … a thick segmented body. I forgot myself and said out loud, “Oh, man!”
Our patient's head popped up instantly, “What?!” he asked. I looked over at him, realizing that all chances of me appearing professional to him had been shot and said, “Did you declare this thing at customs?”
“No way!” he responded, “I knew there was something in there.”
My attending grabbed a pair of forceps and proceeded to remove a grub-like entity, 2 cm in length, 1 cm in diameter,
tapered at either end, from the surfer-dude's leg. She didn't know what it was but she sent it off to pathology. I went home and asked a friend of mine who works in a travel clinic what the hell it was and she said, “Bot Fly! Apparently they're pretty common. I'm so jealous you saw one! I've heard once you see one you see them all the time.”
I relayed this info to my attending and sure enough the pathology report came back, “Bot Fly.” This story got around the office and my attending's partners were all a little jealous, too, that they had missed the Bot Fly Incident. It had certainly made my week.
On week two of my rotation I picked up a patient's chart off the door and it read, “Painful lump on back.” Hmmm… I evaluated the patient, who had a lump growing for six weeks. It was becoming painful when he put pressure on it. I asked him if he had been traveling recently and he said, “Why yes, I got back from Costa Rica about two months ago. Do you think that has anything to do with it?”
“Could you have been bitten on your back?” I asked.
“Well, yes, I was walking around without my shirt on!” Hmmm …
On examination, he had a golf-ball-size mass under a small hole! BINGO! The words of my friend came floating back to me, “Once you see one you see them all the time.” Excitedly, I ran out to get my attending. I told her I had another Bot Fly for her. She, two of her partners, and a nurse that had missed the first Bot Fly, all returned to the patient's room with me. My patient was a little surprised at the entourage. I was a little mortified when they lifted up his shirt and immediately surmised “Boil,” turned and left.
The Placebo Chronicles: Strange but True Tales From the Doctors' Lounge Page 3