AU - This wont hurt a bit: my education in medicine and motherhood

The names and identifying characteristics of some persons in this book have been changed.

Copyright 2011 by Michelle Au

All rights reserved. Except as permitted under the U.S. Copyright Act of 1976, no part of this publication may be reproduced, distributed, or transmitted in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher.

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First eBook Edition: May 2011

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ISBN: 978-0-446-57441-9

To Joe, with much love.

Also to Cal and Mack, without whom life would be 50 percent more convenient but 100 percent less fun.

W HAT IS HAPPENING NOW IS THIS : I am wearing a pair of too-large latex gloves, with my right hand reaching up between an eighty-five-year-old mans legs, searching for his anus.

He is a large man, more than 300 pounds, and extremely demented, flanked on one side by my intern and on the other by his nurse, who are both struggling, holding his legs apart to aid me in the hunt. My goal is to stick my index finger into his rectum and retrieve a piece of stool, so that I might smear said stool on a guaiac card to check for occult bleeding in his gastrointestinal tract.

But I am not thinking about occult bleeding in the gastrointestinal tract, or this patient, or his multiple medical problems, or his anxious wife hovering outside, one ear to the door, listening to everything. What I am thinking about is how it is now 5:00 p.m. and I still havent eaten lunch, and how right after the ritual smearing-of-card-with-poop, I will be making a beeline to the nursing station, where I think I saw a few stale bagels laid out, left over from Grand Rounds this morning. I am going to eat those bagels, I think with a grim determination as I insinuate my gloved hand into a fold.

Help me! the patient screams. Theyre stealing my money!

ITS OK, MR. MOSKOWITZ, WERE JUST DOING A QUICK TEST, WELL BE FINISHED SOON , the resident bellows, in that tone of false, gritted-teeth cheer completely familiar to anyone who has spent any time at all in a hospital. I am a third-year medical student, and this is my General Surgery rotation. Despite the rosy notions with which I started my medical trainingthat even as a medical student I would be Helping People and Making a Difference and perhaps showcasing my flawless diagnostic acumen honed after two years in front of textbooks, making neat but never showy saves while my overtired resident sat oblivious in the corner with a pile of chartswhat I had come to learn over the last year was that in the world of academic medicine, students are viewed as being good for only three things: writing long, overly detailed notes in the charts that no one, save other medical students, will ever read; changing CDs on the operating room stereo while the surgeons are scrubbed into a case; and doing the menial dirty work that no resident would ever do if he or she could find some way to avoid it.

Help me! Help! Aaaah! Mr. Moskowitz is still screaming. I wonder what this must sound like to his roommate, who is cowering silently on the other side of the pulled curtain.

Did you get it yet? My resident looks sweaty and harassed, holding up Mr. Moskowitzs legs, trying to clear a path of flesh enough for me to get where I need to go. I can read his face and see that he is thinking about the other twenty-three patients on his list and all the things he needs to do before he can sign them out to the overnight resident and go home. His pager goes off again, the second time since weve been in the room.

Umm, almost. Not wanting to be branded as the med student who couldnt even find a patients asshole, I dont have the heart to tell him that Im not even close. Gingerly, with my left hand, I lift up Mr. Moskowitzs scrotum, figuring that whatever crack lies in the middle underneath is most probably my best bet. I find what looks like a promising track and, with my gloved hand, start to work my way backward within the fold.

Did you Surgilube up? My resident is starting to look the way I feellike he wishes that he were dead.

Surgilube? Uh no, I forgot. Silently, but with perhaps as much contempt as one can express without saying a word, the nurse rips open a pack of water-soluble lubricant and squirts a dollop onto a piece of dry gauze. I reach up, almost losing my glove in the process, and coat my right index finger with the gloppy clear goo. Thanks. The nurse just exhales forcefully through her nose.

Now go for it, my resident says to me. To the patient, about twenty decibels louder, he adds, OK NOW, ALMOST DONE! JUST ANOTHER SECOND ! Perhaps as an indictment of my skill, Mr. Moskowitz gazes off into middle distance and farts.

OK, I just need a little bit longer. I follow the same fold of skin backward, figuring that at some point I will hit a puckered hiatus, reach in, hit pay dirt, and end this nightmare for all of us. I move posteriorly, more, and then some more, until my hand is down against the bed. Nothing but a dead end. How could there be nothing there? Is it possible he doesnt have an anus?

What can we do to help? my resident asks in a tone of voice that leaves no question: finish this thing or I am going to kill you.

Maybe maybe lift him up a little more? Grunting and straining, the resident and nurse manage to roll Mr. Moskowitzs butt up a few more inches. Reaching back farther, sweaty and hungry and desperate for a chance to wash my hands, I finally feel what Im looking for. Poking one lubed finger through, I find a piece of stool perilously close to the surface, and with a small hooking motion, scrape off a small piece and pull out my hand. Panting, I look at my gloved finger with the small piece of fecal matter balancing on the tip and feel absurdly pleased.

My resident is already snapping off his gloves and heading out of the room. Let me know if its positive, he says as hes walking out the doorto the patients wife, waiting outside, he shouts, slowing down but not stopping, HE DID GREAT, WE SHOULD HAVE THOSE RESULTS IN JUST A FEW MINUTES, OK ? And then hes gone.

Im still standing there with my brown-tinged finger. Wait, now what do I do? The nurse silently hands me the card and the bottle of developer. I scrape some of the stool onto the little windows on the front of the card and drip on some of the clear developer fluid. If the test is positive for blood, the fluid around the stool should turn a grayish blue after three minutes. If its negative for blood, there will be no color change. I take the card, stick it into a clean glove, and then put the whole package into my pocket, figuring I will check it again once three minutes has elapsed. Mr. Moskowitz, the test is finished. Im sorry if it was unpleasant, I say as I pull down his hospital gown and replace the bedsheet over his chest.

They stole everything from me, you know, he says conversationally. Then, as if its somehow related, he adds, Youre a good girl. I guess all is forgiven.

I wash my hands and walk back to the nursing station, where I find that someone has already eaten the rest of the day-old bagels. I rescue a few stray poppy seeds and stick them in my mouth morosely, feeling like Oliver Twist, almost relishing this pathetic tableau. Just then, I see my boyfriend, Joe, a fellow medical student rotating through the Vascular Surgery service while Im on Colorectal. Hows it going? he asks.