Three Little Words
Tuesday, January 17, 2006
There are no eyeballs or buckets of blood or protruding bones involved here, but you will still be shuddering for hours afterwards. You have been warned.
This story is of possibly the most horrific experience I had as an intern. And I am not talking tragedy or violence or viscera here. I mean just... yuck. And as far as I can recall, it is the only time I’ve ever transferred care of a patient to another physician, which is a nice way of saying I refused to see the patient again after the incident.
First of all, regardless of what you see on "ER" or "Scrubs", internships are no fun, and there is no time for intrigue with your colleagues, or sex in the janitor's closet. In fact, one of my advisors at medical school described the medical internship year in four words: "Too tired to f**k." Now, this was before they passed that law that limits the number of hours an intern could work. My ex got 4 hours of sleep every other night during his surgical internship. I did a medical internship, so I did a little better. But yes, we were too tired, and we were newlyweds! In fact, my son was conceived two days after our internships ended. Mostly because we got some sleep.
Wow, too much information. Sorry. But if you’ve read this far, I know you aren’t easily shocked.
Seriously, you might want to turn back.
Anyway, I did a medical internship, which meant I rotated between all sorts of services, the ICU (Intensive Care Unit), the CCU (Cardiac Care Unit), the ER, the wards, everything. Which meant that I saw probably 10-20 patients a day, and did 5-6 admissions a day if I was on call. Which also meant I did at least 5-6 full physicals a day.
*Warning: Here's a yucky part about poop. You might want to skip one paragraph down. One part of every physical was to do a rectal exam, which basically involves jamming one finger up your patient's backside, checking their prostate or vaginal canal for lumps through the anterior wall of the rectum and then smearing your gloved (and now poop-covered) finger onto a little card which checks for the presence of blood. It's a great screening test for colon cancer and you should get it done yearly once you are older. Patients can do it themselves at home to reduce the embarrassment factor if they want, but in the hospital we did it routinely on all admissions. It was required that we do so; in fact, we were given a card with "It is necessary to examine your rectum" in several languages so we could do one on any patient, regardless of nationality. (There's a phrase you won't find in your Berlitz Travel Guide Phrase Book.)
Anyway, you might think it sounds gross, but again, once you've stuck your index finger up the 500th patient, the process loses its yuckiness factor, and you just go into "I-am-a-doctor-and-therefore-am-emotionally-detaching-myself-from-this-situation" mode and it is totally no big deal.
Okay, so with that preface, the story goes as follows:
So, I had to admit this guy to my service, I can't remember what his problem was. He was in his late 50s, and he was really loud and obnoxious, and was wearing lots of gold chains, you know the type. And he had a wife who looked about 35 who he ordered around and treated really rudely. The guy was a jerk. But, as a physician, you have to treat every patient the same. Anyway, I do the physical and then I come to the rectal exam and I tell him the usual, "I have to do a quick rectal exam, please roll over on your side." and he shrugs "Okay" and I go ahead and do the exam. Then, as I withdraw my hand, he looks over his shoulder, smiles coyly at me and says three words that still give me the willies, twenty years later. He said,
"Thank you, Mommy."
I got the heck out of there and transferred his care to my chief resident.
I feel there is nothing more I need to say.