Quotes from the rectum

Ok so I have to share this one with everyone, despite how disturbing it is to me. So I had my standard male genitourinary and rectal exam a few weeks ago, and I just keep relaying one quote to everyone that asks how it went.

So we finished up the awkward exam of the male genitals (junk or twig and two berries if you will) and perenium (the taint or grundle for the anatomically disinclined). I've plucked this guys spermatic cords about 5 times and have had my finger up into his inguinal canal to feel his hernia...crossing all sorts of boundaries that I've never crossed with another man's junk, with minimal public display of discomfort. The patient/actor/educator turns around to the three of us males in the room and says:

"Hold up your hands."

We oblige. Pointing to the large-handed former football player, he deadpan says "Ok, you've got the biggest fingers, you're going to go first and open me up."

Great way to make things comfortable and welcoming for all with that visual aid...whilst I insert my fingers into your rectum...ugh.

Thanks for that again. I'll definitely be rushing to do my requisite 10 observed rectals on my surgery rotation in July after that experience.

Words of wisdom...

Usually when I relay the words of a patient, it's because they made me laugh or were so ridiculously ironic in the context of the situation that most people would have become incontinent in the situation. This isn't one of those times. Suprise...another week at preceptor, another depressing medical story.

WWII veteran in his 80's, presenting to VA Oncology clinic seeking treatment for one of his many cancer related complications. For 80 something, this man has it really well together and the history is going all too smoothly. He relays in exquisite detail the past 20 years of his medical history with exact dates and physician names...better than most 40 year olds I've worked with.

Start the physical and start to get the story about his PICC line, and in the middle of his story the patient starts to lose it. He's so frustrated with the private oncology group currently administering his chemo that he cant help it. Apparently they make him pay in full before he sees the oncologist, 3-4 times per week. During a recent hospitalization, the oncologist asked to do a series of non-invasive tests that the patient assented to, and a marrow biopsy which the patient declined until he talked to his PMD about it. Not five minutes later was the oncologist back to do all of the tests and the biopsy. It's not like you can just sneak in a biopsy without the patient noticing. Anyway, the patient reminded the oncologist that he had not consented the biopsy, that he needed to call his PMD to understand why they needed the biopsy. The oncologist apparently threw a temper tantrum and stormed out of the room.

Long story short, he is VERY dissatisfied with his oncology group treating him like a piece of meat. He feels helpless when dealing with them and the fact that the doctors wouldn't listen to him makes him very unsafe and unsettled. He made sure, in his grandfatherly tone and through the tears of frustration, to tell us to always be sure to listen to our patients, to show empathy and human dignity and honesty to our patients. It was the most touched that I've ever been in dealing with a patient and I hope that his advice never is forgotten forgotten by the two of us.

Just another reminder that the white coat isn't as impenetrable as it seems.

I'm not an angry person by nature, but...

Blowing a 7-2 lead in the top of the 8th....with two of the best relief pitchers of 2007.

I COULD HEAR MY OWN PULSE. I WAS CURSING, I WAS THROWING STUFF, I WAS CALLING MY COLLEGE FRIENDS TO SCREAM INTO THE PHONE, I WOULD CALL MY FATHER TO MAKE SURE HE'S ALIVE IF HE WEREN'T OUT OF THE COUNTRY WITH MY MOM FOR THEIR ANNIVERSARY.

Oh well...it's just a game. I'm going to get so much crap on Monday

::shakes his lowered head in disgust and anticipation of the 100 or so yanks fans consoling him as he walks into class on Monday::

Maybe the three other Sox fans will have a support group meeting Sunday night to discuss methods of anger management and self-defense.

Instead of cursing here, I'll hearken back a few weeks to one of my favorite anecdotal encounters that defines medical school for me:

I'm in the Micro department office picking up my course packet, I greet the secretary very graciously as I would any other day. From behind me I hear the distinct Brooklyn accent of my course director:

Course Director: ...how dare he wear that David Ortiz t-shirt into my department office...

Great...here we go again...be nice, he's a faculty member and ultimately will be placing your grade onto your transcript. Don't look too weak either, because then he'll know that you're kissing ass. Deep breath, and turn...

Me: Good morning Dr. X
Course Director: Good morning. Why are you wearing that around my office? What's your Name?
Me: My name's Bostonian. I'm from Boston so like half my wardrobe consists of 'these things'. Really though, I'm wearing a Dominican Republic shirt. Who could hate David Ortiz...he's such a happy person and the most clutch hitter of all time!!!

until this season...stupid torn meniscus...

Course Director: Well I have to agree with you there...

YES!!!!!!!! BOSTONIAN: 1, DR. X: 0

Course Director: I can understand where you're coming from. Actually my son is a Sox fan, he grew up one just to spite me. My first faculty position was in MA and he spent his formitive years watching the Sox. We watched Fiske wishing that home run fair in '86, and...

All I heard at that point was seagulls. --OK, so I was imitating Fiske waving his hit fair past Peske's Pole. For those of you who aren't familiar with it, I'm flailing arms like a moron in front of my Micro course director in the middle of the department office, several secretaries/faculty members stare in disgust and confusion. If I weren't 3 years old at that time it would be probably one of the single best moments of my entire life. Hell, even as it is, I've seen the highlight played at least 500 times, and I sit there every time holding my breath watching that hit bend fair by about 10 inches from the foul pole. Composing myself...

Me: I'm sorry for your loss. Do you still speak to your son?
Course Director: Occasionally. You must have been nervous after the Yanks swept you last week, eh?
Me: Not really, considering that the yanks just dropped 2 of 3 to the D-Rays.

Damn I'm good, BOSTONIAN: 2, DR. X: 0. It is taking every ounce of my self restraint not to throw down the flagrant fist pump of victory in the middle of this guy's office.

Course Director: Alright Mr. Bostonian, have a nice morning.

BOSTONIAN: 0, DR. X: 100...damn it

Me: You too Dr. X

Great...way to alienate yourself from the faculty...ASS

Boston discount...

As most of you probably know by now, I'm a Bostonian stuck in my own little slice of hell known as New York for the next 3 or so years...(PLEASE UMASS TAKE ME FOR RESIDENCY!!!!!!!!!) From time to time (3-4 days a week) I'll make the unforgivable folly of wearing one of my Red Sox shirts out into public which usually unleashes a tirade of steaming vitriolic hatred upon me from the locals. Latest episode happened today:

Walking into school to print something out. A crowd of the big wigs is walking by including the dean of the ENTIRE MEDICAL COLLEGE!
Dean of School: RED SOX? (shakes head in disapproval walking away)
Me: Sorry Dean, I'm from Boston, it's in my blood.
Dean of School: (Mutters something to his colleagues, they all smirk and look at me)
Me: (to self) Great, there goes my dean's letter.

It's around 11 and instead of going to my intro to nutrition class, I'm out with my roomates running some errands. I hadn't had breakfast yet, so I decide to run into a deli to grab a quick sandwich while my roomate is getting gas.

Deli owner: How ya doin'?
Me: Fine, how are you?
Deli owner: (Stoping dead in the midst of stocking the drink refrigerator) YOU KNOW YOU'RE AWFUL BALLSY WEARING THAT RED SOX SHIRT AROUND HERE
Me: Yeah yeah, born into it man...sorry. I'll have a turkey, lettuce and tomato with cheddar.
Deli owner: (GLARING AT ME WITH HATRED) Mayo?
Me: (Beaming back to spite him) Yeah

So I basically stare at the guy for the next few minutes while he's making my sandwich to make sure that I don't get any special sauce

Deli owner's son: HEY DAD, should I give him the Boston Discount?
Me: Very funny...
Deli owner's son: That'll be 50 bucks (register says $7.42)

I even left the guy a tip for the little ray of sunshine he stamped out of my day. The sandwich, by the way, was pretty good!

ED Quote of the night: Why dating is a bad idea...

I got stuck running some scut for the nurses the other night (drawing blood, taking vitals) on a particularly busy night. One of the murses (who I thought was gay) pulls me to the side and asks if I can talk to patients yet...

Me: Yes
RN: Good, I want you to go talk to this lovely young lady and then report back to me on why dating is bad. She's really cute...if it wasn't for the shame I would bring my family I would [naughty things]
Me: Ok...

So I go ahead and do my history taking thing...

Fairly gorgeous 21 y.o., 9/10 backpain for 3 days. Ran out of opiate of choice and needs more but isn't medically insured since her employment was terminated due to inability to perform her job due to backpain. Also treated for anxiety d/o with three different meds.

I report back to the murse:
Me: Dating is a bad idea because most beautiful women are insane.
RN: (Pointing to the meds on triage sheet) Very good, you're learning quickly. You take care of me, and I take care of you... (wink)

Quote of the Day: Absconding...

After a wonderful hour in the Adult ED, I was politely asked by the attending to hang out in fast track with the NP. Actually the conversation went something to the effect of:

Attending: "Who are you?"
Me: "My name is Bostonian, I'm a second year Med Student."
Attending: "What are you doing here?"
Me: "Observing you today."
Attending: "So following me around all day?"
Me: "Yep..."
Attending: "Yeah... That's not going to work for me. Go talk to the fast track Nurse..."

Usually, I feel pretty useless because the physicians basically ignore the fact that we summer students exist. Fortunately, the nurses are my saving grace and they actually allow me to do some of their scut, which is nice for the time being. I'd rather do stupid go-for errands than hold up the wall for 8 hours.

Anyway, second patient that I talk to has a pretty out-there triage sheet claiming that he's being abused by another person. The NP picks up that the guy is pretty out there, so he pulls me aside and has me make sure to ask the guy if his abuser is here now because he's a presumed psychotic patient.

Me: "So, why'd you come in today sir?"
Patient: putting his fingers really close to my face "There's writing in there, in the nail beds, do you see it?"
Me: "It must be pretty small because I can't. I heard someone hurt your elbow, how did that happen?"
Patient: "This guy comes in and puts me out with narcotic sedation and does things to me. See the smiley face he put on my elbow?"

You probably get how the rest of that interview went...delusions and he appeared to be lost in his own world (hallucinating? not that he would admit to it)

Long story short, at the mention of seeing a psychiatrist the grossly psychotic patient took off to the parking lot with a nurse and security in hot pursuit. When he reached his car, he took off at a high rate of speed across the front lawn of the hospital, swerving at the nurse and security guard

...never a dull moment

ED quote of the night

17 yo male walks into Boondocks Regional Hospital ED after flipping his ATV at high speed and hitting several fixed objects including a mailbox and a few trees. Transferred to our ED in good spirits, but in a little bit of pain. Head/C-spine and Spinal CT's reveal multiple vertebral body fractures along the entire spine and a crush fracture to L5...

Trauma Attenting: "I'm going to have to do a rectal exam, you're going to feel some pressure around your rectum."
ED Attending: "He's going to put his finger in your butt to check for bleeding."
...finger inserted...
Patient: "AHHH, doctor you've touched me like no one else ever has."
Trauma: "I certainly hope so."
Patient: "I have to take a dump."

ED quote of the day:

80 something year old woman, mistakenly sent from nursing home to Trauma Center ED for psych evaluation when she should have been sent to Psych ED. Completely lucid, displaying no signs of dementia...

Patient: Overly detailed story about how some other guy was getting in her personal space... "I don't like it when other people push me around, so I told him "You pick up that towel or I'll punch you in the face". So he stomped on the towel to spite me, and so I punched him in the face.

ED quote of the night

Middle aged woman, presenting with swollen right foot.

Attending: So, that looks like a bite of some sort.
Patient's Mom: Does it look more like a snake bite or a spider bite to you? I can't tell the difference.
Patient: I think it's a snake bite.
Attending: I'm can't quite tell, but it's more likely to be a spider bite around here.
Pt: I definitely think it's a snake bite. I've been bitten by snakes a bunch of times before. You know, normal snakes like pythons. I barely felt those.
Attending: (deadpan with a hint of sarcasm) Can I ask why you've been bitten by snakes more than once???

Adult ED conversation of the day

60-something yo patient, post-menopausal vaginal bleeding

Resident: Are you sexually active?
Pt: Nope, told you I was boring
Res: When was the last time you were?
Pt: Before you were born, honey

...later during vaginal exam...
Res: Any discomfort?
Pt: None at all, this is the most action I've gotten in 30 years!!

Peds ED conversation of the day

15 yo high-as-a-kite Female, bloodshot eyes, face stuck in a grin and previously diagnosed, poorly managed adjustment disorder.

Resident: "So why are you here?"
Patient: "My face is stuck in this smile..."
...hx...
Res: "Do you use drugs?"
Pt: "Just a little pot"
Res: "When was the last time you used it?"
Pt: "A few hours ago..."

Later, after patient has slept it off for a couple hours and is now impatiently glaring at the nurses station, like she's about to tackle the next person with a stethoscope that walks by.
Attending: "So what do you want to do with the patient?"
Res: "Send her home and tell her not to smoke pot."
Att: "Yup..."