Lockup Doc

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Medical training is filled with many memorable moments, some of which we probably wish had never happened.

In academic medical centers, med students are at the very bottom of the hierarchy. (In this case you’ll see that I was indeed literally at the “bottom.”) Therefore, if there is any “scut work” to be done, the buck is usually passed to them.

I’m sure you’ve heard the metaphor about how bodily waste flows downhill. Well, I’ve got a story to tell that will show you that it is indeed true part of the time, but it doesn’t always flow downhill or sometimes even “flow” at all for that matter. You’ll understand in a minute.

I can recall vividly a particular day as an eager and naive third year medical student doing my general surgery rotation.

I was walking with my team of interns and residents doing early morning rounds. We entered the room of a frail elderly woman who appeared to have dementia. She didn’t have a clue what was going on. But she also had some bowel problems. She was passing neither gas nor stool, and she already had a rectal tube in place to relieve her gas and distension.

The heroic combination of laxatives and rectal tube were not cutting it. This patient needed an intervention that only modern medicine could offer. She needed the dreaded manual disimpaction!

Manual disimpaction is a highly technical procedure. (Legal disclaimer: I am a trained expert. Under no circumstances should you try this at home!) It involves putting on a glove, adding a lubricant to the index finger, and inserting the finger into the rectum. The finger fishes around for any solid material and pulls it out. (Makes you want to go to med school, doesn’t it?)

Well, there’s a saying in medical education about learning new procedures: “See one, do one, teach one.”

And to my astonishment, even though I was racking up $30,000 per year of debt so that I would have the distinct honor of learning all of these nifty procedures, nobody stepped up to the plate to “do one” so that I could “see one.”

That team must have had great confidence in their astute young medical student that day. I was handed a glove as though it were a scalpel in the operating suite. I was then handed a small packet of surgical lubricant. Wow, this was getting exciting!

As I placed the glove on my trembling hand, applied the lube, and faked a little smile (any smart med student knows never to complain, especially during a surgery rotation), the critical moment arrived.

I carefully inserted my finger into this unfortunate woman’s rectum. (Thankfully she was out of it and didn’t seem upset or have any idea what was happening.) I hesitatingly felt around for a few seconds, and then it happened. (Little did I know that Vesuvius was rumbling!)

BOOM!

That rectal tube sticking out of her bottom may as well have been a fuse on a powder keg.

Under enormous pressure, copious quantities of liquefied, putrid human waste explosively flew everywhere!

(But mostly on me.)

Like a deer in the headlights, I initially stood motionless and in shock for a moment as everyone around me burst into laughter.

(Except me.)

What had just happened? Had I just redefined the meaning of “pulling the plug” on a patient? Or, had I just been the victim of a biological weapon? Did I need to call the hazmat team? Should we call a “code brown”?

Humiliated (and quite the sight, I’m sure), I half-heartedly joined them as I attempted to peer through my contaminated glasses. But I quickly decided that laughter probably was the best answer since it really was funny, at least at some level.

I was thankful that I was wearing hospital-issued scrubs, but I had really wished I had worn a mask and gown before this heroic intervention.

Since then I’ve never regretted my decision to specialize in psychiatry, and I became certain that gastroenterology was way too risky!

(I’ll be awaiting your clever, witty comments. For this post, I might even be a little more “lax” about accepting comments with creative, colorful language–just be nice!)

Photo by kahunapulej

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