A Coming of Digital Age Story

It's the scariest time for a shiny, brand new doctor: July 1, the day after four years of residency and the first day as an unsupervised doctor (or, actually, less supervised). You're thrown into the emergency department for the first time--let go--released--at large, daring disease or injury or mystery illness to best you.

At the beginning of that first day you feel ready, that you know everything. At the end of that first day, you feel completely unprepared, and you don't really know anything.

It's the scariest time for a patient: July 1, when shiny, brand new doctors will engage with them willy-nilly, whether they know the significance of that date or not. If you're going to get sick, you really should wait until June 30, the day before the most experienced doctors leave to hang up their shingles. (They don't do that anymore, but they still leave, looking for a life.)

"So, what's the grossest thing you've ever had to do?" I was asked once.

We have an abbreviation in medicine--TNTC--meaning, too numerous to count. As in, How many malignant cells on the slide? TNTC.

The grossest thing I've ever had to do? Seemingly impossible, because of TNTC. Yet, there is one particularly gross thing I did one day that has stayed with me. (Details to follow.)

I was on the internal medicine rotation, just finishing my rounds--12 patients to a ward. It was the winter, which means that I went 9 weeks never seeing the sun--12 hours each day, arriving before dawn and leaving after dusk. A smarter doctor would have taken vitamin

D supplementation.

I was so ready to go home. The early darkness outside made me feel I was shortchanging myself my time away, so I hurried out. As I passed the door of another ward, I heard her.

"Oh, Doctor, please, please..." and it faded to crying. First with sniffles, then overt weeping.

It wasn't my ward. It wasn't my patient.

I engaged my tunnel-vision and walked past. "Oh, please." I stopped.

Wasn't I a doctor? Didn't I write in my admission essay I wanted to help people?

I turned. I returned to the door and looked in. She was in the first bed, the better part of 500 pounds of postop female.

"Yes," I asked tentatively.

"I'm so blocked up. It hurts so bad. Please help me. My bowels--" and then she let out a yelp of pain. There's suffering, and then there's suffering.

"Call your nurse for an enema, " I offered.

"No, they did that. Twice. It's right there, but it's backed all the way up and--Oh!" she screamed.

I stepped in and retrieved her chart. Postop gallbladder, 5 days after, and loaded with narcotics ever since.

Here's a little science: narcotics slow up the bowels. They constipate. If it continues without some sort of resolution, a fecal impaction grows, making the problem worse.

It gets worse: the bowel wall is weird. It only has pain nerves for distention. You can cut it, burn it, laser it, even remove it...nothing. But if it distends, all hell breaks loose (as opposed to the impaction, which doesn't). This is why babies cry bloody murder when just a little baby fart tries to cross those little baby bowels. We are gas-producing animals, and when there is no way out, the gas begins distending. It won't go back up, because sphincters make bowel traffic one-way.

If the impaction isn't dealt with, rarely, the bowel can even burst, resulting in peritonitis or death. But before all that, it hurts. It hurts really bad--in fact, unimaginatively bad. There is colic, and then there is colic. On a scale of 1-10, it's, right, TNTC. You even wouldn't want Hitler to have this kind of colic. (Well, maybe--I'll have to think that one over.)

So, should I be a shit bigger and harder than the one she couldn't pass and just leaver her? Not my problem? That's when I realized, if I don't do it, no one else will. She will lie in agony all night and maybe be given just what she didn't need--more narcotics.

I knew what I had to do, and she had a pretty good idea what I had to do.

I found gloves and approached her with gloved hands raised. (It's this thing we do.) She raised her knees. I used both my hands to serially move back the fat folds on her thighs and slowly made progress to her anus. A long and winding road. Once I found it, I looked back up at her.

"Please," she pleaded. For her, it was an emergency. "Please," she repeated more frantically.

And I did. I digitally explored her rectum and dug out the TNTC rock-hard fecal boulders piecemeal. I made progress slowly but surely. Finally, I must have struck gold, because a huge whoosh of gas decompressed her abdomen.

I rolled up the sheet under her, top and bottom and side and side, making a tidy little basket of surprise for the linen people.

I looked at her again, and she was crying in gratitude. She thanked me TNTC. She asked my name. (But did I really want to be the go-to guy to dig out her impactions from now on?) I gave her my name, and I could tell by the way she asked she would never forget me.

And I would never forget her. Gloria was her name.

So, when I'm asked what's the most unsavory thing I've ever done in my profession, it's Gloria. And as disgusting and gross as it was, it's also the thing in my profession of which I'm the most proud. I had stepped in when no one else would. I was true to my admission essay.

All the doctors who had deserted her--even her doctors--are the shits in Medicine--the hard, rocky shits--that cause the moral impactions of the profession. For them, no enema is strong enough; and for folks like Gloria, no enema is worthy.