Reflections on a bowel full of stool

Somewhere in this land, an owl-eyed pre-med sits in an undergrad auditorium, considers the doctors she has known and thinks, “Wow. Isn’t that the life.” Another one daydreams, “Think of all the respect I’ll get!” A third has dollar signs in his eyes.

They need to come out here and hang with me for a while. I’ll tell ’em stories.

***

I was the floor intern on call that Saturday. No admitting duties, but the floor could keep you hopping with one idiot request after another. County had one professional phlebotomy draw per day, so if someone needed a test that wouldn’t wait until morning, I was the phlebotomist. If a patient’s IV needed changing, I got it done. (The nurse would set out supplies for me — on a good day.) I was the one they called for fever workups and rule-out MIs and whatever else the nurses didn’t feel like doing.

Like, for example, disimpacting a constipated woman.

***

Seven years later, when I was on faculty at UT, I interviewed the undergrads who were doctor wannabes. I liked asking them, “What was the last book you read for pleasure?” (most common response: a blank stare) and “What’s your favorite movie?” (most common response: The Princess Bride). I managed to impress one pre-med; on his app, he’d noted he was President of his college’s Jain Society. Not only did I know Jainism was a religion, I was able to discuss it intelligently with him.

He liked me, I suspect. The rest of them felt they had to like me because I had power over them.

But I’m a low key kinda guy. Not for me to twist their gonads even if my interviewers did that to me, back in the day. Certainly not for me to administer The Ethics Test (which is what one of my colleagues liked to do!) I wanted to get to know them as people. In, um, the space of fifteen minutes.

Sometimes I would interview a candidate whom (A) I liked, and (B) didn’t have a chance in hell, in my estimation, of getting a slot in anyone’s med school class. I would say to that person:

Medicine isn’t what it used to be. I don’t need to tell you how things have changed — how we’re not our own bosses anymore, how the government and the HMOs dictate our practice of medicine. But it’s changed in a million other little ways, so many ways I doubt it’s anything like what you imagine it to be. So here’s the thing: if you’re bright enough to become a doctor, you’re bright enough to do a lot of other things, too. Things that may pay better, be less of a headache, take fewer years of education.

In my opinion, you should only become a doctor if you can look within and say to yourself, with complete honesty, “I have to become a doctor because there’s nothing else I want to do.”

No, I don’t think I changed any minds, either.

***

“It’s a surgical procedure, doctor.”

This was news to me.

It was early in the internship year, though, and I was deathly afraid of making mistakes. Later, I would learn a million tricks for getting a stopped-up patient to poop. MOM with Cascara chased by 200 ml of warm water, for example (by mouth, okay?) A dookie or two (Dulcolax suppository). But I was still a noob who thought he had to do anything the nurses told him to do.

It rankled, of course. I felt abused. But I did it, and was that one happy ex-constipated old lady? You bet. Still, the episode embarrassed me, and I only admitted it to my classmates several years later, after a few beers.

Looking back on it, I don’t think I did anything wrong. Quite the opposite. I solved the problem in the quickest way possible and I left behind a grateful patient. If I had shifted responsibility to the nurse (as most of my classmates would have done) — clearly a reluctant nurse, otherwise why had she called me to do the job — would she have been as gentle? Would she have left the job undone, a little surprise for the next shift?

***

Illness is an indignity. For many of us, before we leave this planet, we’ll have everything stripped from us: our senses, our ability to tend to our own needs, our minds.

People joke about hospital gowns. You know, butt-hanging-out, that sort of thing? Hospital gowns are merely the concrete embodiment of the sign that should hang over every hospital’s admissions desk: Leave Your Self-Respect at the Door.

Don’t get me wrong; we need to treat our patients and each other with respect, we need to accord everyone the dignity they deserve. This is not about the way medical professionals treat (or mistreat) patients. That’s a whole ‘nother story.

It’s illness, disease, which tears us down. It’s the rebellion of the body: the renegade cells, the haywire immune system, the tangled neurons, the tired heart. Consider my constipated patient. If it was an unpleasant procedure for me, how must she have felt having to tell the nurse, then tell me, then endure me doing it to her? Do you think she felt like she had retained much dignity?

How we (medical professionals) approach such patients can mitigate the damage, of course. I’ve already told the story of the urology resident who had to squeeze the priapic penis of a patient with sickle cell disease. That’s one way to treat priapism; poking the penis multiple times with needles is another. Understandably, both he and the patient wanted to try the squeezing technique first.

Midway through, he told the patient, a teenager, “Bet you never thought a guy would be doing this to you.” To his credit, he realized his error immediately and apologized, but I suspect the damage was done. Filed under “how not to preserve dignity.”

***

In the end, our bodies turn traitor. I can well imagine dying; and, in dying, I would say to myself, “How dare you do this to me.” At that point, my health care providers would have become irrelevant.

No amount of empathy and respect from the medical profession can make up for the indignity of our deaths.

***

One of these days, I’ll learn how to write a coherent single-topic essay.

D.