Give me a squeeze...

I'm on colorectal surgery at the moment.  This means poo - lots and lots of poo.

I really don't like poo.

In fact, it makes me want to flap my hands around in horror like a girly girl scared of a spider or other creepy crawling beast. However, girly girl is not appropriate in the operating room.

Rectal exams are a big part of colorectal, shockingly enough. You have to check both the resting tone and the squeeze tone.  (I also dislike this.)

My attending was doing a rectal exam a while back and he had checked resting tone.  Next he asked the patient to squeeze his finger.

We have very compliant patients - the patient reached behind him, grabbed my attending's hand, and squeezed as hard as he could.

Niagara Falls

Just like I have multiple tricks to help a patient poo, I have multiple tricks to help a patient pee.  Non-urinating also will buy you another day on my list and a catheter.  I've yet to meet the man who wants to have a tube shoved up his urethra, so tricks to pee are popular.

I was rounding with one of my attending's over the New Year holiday, and we had a patient who was failing his void trial (chance to urinate before the catheter and he became friends).  I had tried all my tricks and was out of advice.

My attending walked in the room, looked at the patient and said," Well, you aren't trying to pee lying there are you?  Stand up, my man.  Niagara Falls doesn't flow uphill."  

It worked.

Photo from Niagara Region.Com  

Poo

Doctors in general are overly interested in poo. Color, frequency, consistency.  You name it, and we probably want to know about it.  This is not really advertised when you start medical school.

Every morning when I round on my patients, I listen to their heart and lungs, push on their bellies, check their wounds or drain or both, and fire off this list of questions in rapid succession:

"Are you eating? Have you passed gas yet? Are you nauseous?  Did you vomit?"

"Have you had a bowel movement?  What was it like?  Would you like something to help you have a bowel movement?"

Occasionally a patient can't poo after surgery for one reason or another.  This is bad juju.  No poo means that the patient will be staying in the hospital another day.  Which means they will be on my list another day.  Which means I have to round on them another day.  Which means I get ten less minutes to eat/sleep/play with my pup/study/sleep.  Which makes me grumpy.

All of that leads me to this morning when I gave an 87 year old gentleman a high five for having a bowel movement.

I'm not terribly proud of that moment, but I have ten more minutes to sleep tomorrow.

Sleeves?

Today I was evaluating a patient who was post-op from a mastectomy with axillary lymph node dissection.  One of the complications we look for in these patients is lymphedema - swelling of the hand and arm from lymph back up after surgery.  This particular patient was having some occasional trouble with lymphedema when she traveled.

When I presented the patient to my attending, she asked if the patient was wearing a sleeve.

I looked at her, puzzled.

"No.  She wasn't wearing sleeves.  She was wearing a really cute sleeveless Lilly Pulitzer dress."

She looked at me, then started giggling.

"A sleeve - a medical sleeve to prevent swelling."

At least I know clothes....

Calvin Klein

He was well over 80 years old.   He was five foot two.  Tweed pants, suspenders, button down shirt and tie.  Gold tipped cane. Blue eyes.  And a huge hernia right below his belly button.

We had discussed the risks and benefits of the operation - nerve injury, bleeding, failure.  I had answered easily twenty questions about the procedure.  He looked  me straight in the eye.

"Doctor, I have just one more question.  My wife wants to know..."

"Yes?"

"Can I go back to underwear modeling after the operation?"

Seriously?

Mr. Re-pete:  I came in because I'm having an allergic reaction.  I have hives all over, I'm itchy, and I can't breathe good.

Me:  Do you know what you're allergic to?

Mr. Re-pete:  Yeah, it's something in a Taco Bell Burrito Supreme. I know because I had the same reaction the last two times I ate one.  I came in here and they gave me a shot, then they gave me a pen to use the next time I had a reaction.

Me: An epi pen?  For the reaction? 

Mr. Re-pete:  Yeah, that's it. I used it already.

Me:  Okay.  When was the last time you had a burrito supreme before today?

Mr. Re-pete:  Yesterday, and the day before that.

Me: You ate a burrito supreme every day the past three days AND had a severe allergic reaction that required shots of epinephrine all three days?

Mr. Re-pete:  Yeah.  I want to make sure that's what it is, so I keep going back and ordering the same thing to double check.

Concealed weapons

During rounds this week:

Me:    Mr. A, is there anything else I can get for you today?

Mr. A:   A gun would be nice if you have one.