Ramblings On Patient Care

Hoover  12 Mar, 2007  Medical School

Back when I was doing my clinical rotations, I would dread waking up and going into the hospital. I simply did not like to see patients. There’s something about the early morning that makes me not really want to have contact with too many people. It’s just the way I am.

I’m not anti-people. In fact, I enjoy working with people. I feel that I communicate well, and I don’t stumble when meeting somebody new. It’s just the intimacy that’s involved with patient care that really turned me off.

Hospitals and Elevators

Upon arriving at the hospital, I would take the elevator to one of the high floors where my team’s “office” was located. I quote the word “office” because it’s actually a very small room with a table. If you’re lucky, they’ll be a computer in there for looking up information or killing some time on the net.

It never failed, but somebody would always say “good morning” to me in the elevator. Yes, I realize that they are just being polite, but since I knew I was in for yet another day of dealing with patients, there was nothing “good” about it. I’d prefer they not say anything at all.

Pre-Rounds

Pre-rounds. Just another word for why you, the medical student, has to come in (along with the residents) a couple of hours before anybody else. I don’t even have time to finish my coffee before I need to start waking up patients.

I don’t know, but there’s just something about dealing with people after they have just awakened that’s kind of creepy to me. And when you’re waking people up at 5:30 am, there’s nothing you can do about it.

Pre-rounding always involves questions. Questions about bowel habits, stool consistency, and wound discharge. Information including urine output, and if the patient has vomited since I last saw him. Why did I ever think that I would be interested in finding out this information from a complete stranger? Answer: I was never fully informed.

I Feel Dirty

The physical exam on hospital inpatients is one that I have learned to hate. I just arrived to work in a nice shirt and tie, and now I have to poke and prod some poor guy in a hospital gown who hasn’t bathed properly in days. I feel dirty. The sights. The sounds. The smells. Even the sterility of the hospital makes me feel unclean. The scent of breakfast trays mixed with the smell of sterility, and the patient in room 902 who needs his diaper changed all remind me not to eat.

All Hands On Deck!

The attending arrives, just as we’re finishing up with pre-rounds. It is now time for “attending rounds.” It’s just more of the same, this time with pimping and humiliation involved. Same sights, same sounds, same smells. My day doesn’t get better. I’m more awake now, but I feel like a walking zombie.

“The patient in room 904 needs a disimpaction.” I know who will do it. Nobody else wants to, and I’m the low man on the totem pole. The medical student. Should I refuse? Is it a learning experience? Maybe, but it isn’t for me. Anyone can disimpact.

Dry Heaving

I gather the needed equipment, which is simply some type of covering to catch the shit that’s about to fall out of this poor guy’s rectum. He’s a big guy, so I make sure it’s an extra large.

He hasn’t passed stool in some time now, and the rectal exam reveals that he is, indeed, stopped up. Why can’t they get nurses to do this type of work? Because I’m there and will do it for free. Actually, I’m paying for the privilege.

I always double glove, and this is certainly no exception. I manage to roll 350 pounds of human on top of the covering, and reach in with one finger and start to scoop.

Stool comes out, but it’s slow. I scoop some more.

A minute or so passes, and I begin to dry heave. Here I am scooping feces out of a complete and total stranger’s rectum, and I heave some more.

I step out of the room for a breath of fresh air and sit down. I knew this patient care business was never for me, but the experience has just solidified my thinking.

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12 Comments so far »

  1. Paul Y said

    March 13 2007 @ 3:15 am

    +1 for dry heaving…It happened to me on a call (volunteer EMS) and I almost vomitted all over the patient, who defecated all over herself and rolled around on the floor.

    What if you didn’t do the disimpacting? Would they give you a bad evaluation?

  2. Hoover said

    March 13 2007 @ 7:34 am

    It’s hard to say whether or not that they would’ve given me a bad evaluation altogether. I do believe they would have mentioned it though.

  3. Cherokee said

    March 13 2007 @ 1:01 pm

    I thought your “Good morning” comment was insightful. You feel like saying, “Since I’m here, no, it’s not a good morning for me.”

    I always try to be polite, but on clinical/hospital rotations it’s mostly all fake. I hate being fake.

  4. CobraCommander said

    March 13 2007 @ 6:37 pm

    Ah, disimpaction…one of the many wonderful things they never told you about medical school. Aren’t you glad you studied so hard and put all that effort in years 1-2 so you can prospect for shit in some guy’s rectum?
    You’re not? But why?

  5. Accepted Admissions Almanac said

    March 13 2007 @ 8:40 pm

    Med School Admissions: Medical School Mentionables…

    The medical student community is a highly articulate bunch pouring out its heart and soul in blogs. I would like to point to several medical blogs that have posts of interest to pre-meds. …

  6. Road Kill Ninja said

    March 13 2007 @ 8:58 pm

    I had to do a heme-occult on a guy with fecal incontinence/diarrhea last week. There is nothing worse than the dry heave in front of a patient. Luckily, he was 90 w/dementia so he had no idea what was going on.

  7. Tim said

    March 14 2007 @ 12:17 am

    So how often do you have to do crap like disimpaction in 3rd year? Or will we constantly be subjected to some of the most disgusting situations imaginable, thus making that question pointless?

  8. Hoover said

    March 14 2007 @ 8:59 pm

    It only happened to me once, Tim. But, I tried to stay in the back and out of site for most of my third year. I figured I would have to do the least possible this way. I think it worked out pretty well.

  9. mqsmith said

    March 16 2007 @ 9:41 pm

    I read this with interest, being a psychologist. My life seems tame compared to this immersion in poop, but i recollect being faced with a child whose hands were covered with finger paint, and he was in an angry mood, and I had on some pretty nice wool pants; and then there was a boy in play therapy passing gas and preparing to go encopretic because he was not winning our checkers game. Once I was hiding under a chair (play therapy)while a kid was shooting plastic darts at me, and it occurred to me that I actually had a PhD, and this was not what I went to grad school for, and I can say, like Bill Clinton, Ah Feel Yore Pain, and doggone, maybe the lawyers are the ones who stay clean while practicing their profession.

  10. Hoover said

    March 16 2007 @ 11:37 pm

    LOL mqsmith, I think that’s the best comment ever in the history of MSH. It seriously made me think “WTF?”

    You rock.

  11. getovershit said

    April 7 2007 @ 11:12 pm

    You seem like a rather whiny person. Maybe you should be greatful you were accepted to med school, are relatively healthy, and will soon be earning more than enough money to stay financially secure. Honestly, think of how it felt for the 350 pounder with your finger pulling shit out of his ass.

  12. Hoover said

    April 7 2007 @ 11:26 pm

    I was accepted to medical school because I had what it took on paper to get accepted. I worked hard to look good on paper just like everyone else who was accepted did. Just because I was accepted doesn’t mean I’m grateful for that. Hell, looking back I wish I was never accepted.

    I’m sure it wasn’t pleasant for that guy, but it was just as unpleasant for me.

    Also, if you read the rest of the blog you’d learn that I didn’t pursue medicine after graduating from medical school. I’m running a company doing something totally unrelated to medicine, making incredible money, and have more free time than I know what to do with. At this rate, I’ll be ready for retirement many, many years earlier than if I would’ve stayed in medicine.

    Everything worked out great.

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