Friday, April 15, 2011

That's Pure Hell

Another week in the record books; another system completed.  Today marked the final exam of the reproductive system.  I'm relieved and quite tired.  Sleep beckons but I've got a story to tell...

This Is Probably Going To Sting.  I Mean Really, Really Sting.  Badly.
This week, all the students did a male genital exam.  This consists of doing a physical inspection of the genitals, palpating the testicles for masses, feeling for hernias with the old "turn your head and cough" maneuver, and the prostate exam.  For these male and female genital exams, the school hires "patients" who are compensated for their time in helping further our education.  Let's just say that these folks come from various walks of life: some are dedicated to helping us learn, others are on tough times and need the money.  Regardless, it's a pretty unique thing and, for sure, is one hell of a tough way to make some money.

When it was my turn to go, I was grouped with two other students and a preceptor who would oversee the process.  We walked into the room and saw our patient: a young man in an exam gown, a little nervous looking. He was pretty fit and looked like he'd seen some scrapes in his life as evidenced by some visible scars and plenty of tattoos that covered his arms.  He reminded me a little of a down-on-his-luck Manny Pacquiao.  Behind us on the counter was a box of gloves, a few tubes of Surgi-Lube, and a paper towel with a huge mound of gel (similar to what you might see when you're preparing to insert a catheter).

After a little chat, the exams began.  The first student started out, asked the patient about his health history, did a fine job with the exam, and was cruising with no hiccups until it was time to do the digital rectal exam.  He grabbed a tube of lube from the counter and fumbled with it a little while trying to get it on his fingers.  To make matters worse, the patient wouldn't quite bend over far enough on the table to allow for a easy exam.  (Honestly, can't say I'd blame him.)  Undeterred, [student 1] continued and the patient did his best.  Prostate examined, hands washed, sighs of relief sighed.

The next student moves in to the repeat the exam and, as expected, sort of built on the what we've just seen by incorporating feedback in real time, if you will.  He was very precise in his exam and his technique.  When it came time for the prostate portion, he turned to the preceptor and asked if he should just use the lube on the paper towel.  The preceptor gave his approval and the student easily got his finger lubed up and ready for the exam.  He asked the patient to bend over and, confidently, began the exam.  As he conducted his exam, [student 2] asked the patient to relax and tried to reassure him.

As I stood there with the first student, I noticed that the patient's toes had curled under his feet, and that his hands had clenched the table, and that his arms were quivering.  Truly, his feel had curled up so damned much that I though [student 2] was going to be wearing Dorothy's ruby slippers.  We looked at each other for a split second and the first student asked the patient if he was uncomfortable or if he was doing okay.

"I think ... it's ... alcohol," the patient said through gritted teeth.

Everyone in the room gasped and blanched, including the second student who, by the way, immediately ended the exam.  We all leaned over the paper towel on the counter and smelled the mound of hand sanitizer on it.  It was never lube!  Someone had prepped a bunch of hand gel and left it by the lube ... while we were doing prostate exams.  Needless to say, we apologized profusely and asked if he needed some time to go wash up or if he was still in pain.  He said that he was fine and that we should continue.

"Holy crap, this dude is prison strong!" I said in my mind as I gloved up.

I will admit that it's a hell of a thing knowing that you're batting cleanup and having to do another exam on a patient who's just had a bolus of Purell introduced into his rectum.  During the genital exam and hernia check, I talked with the patient while explaining what I was doing on the exam.  When I asked him about the prior hernia that he mentioned, he pulled up his gown to show me the scars on his chest from the repair of a surgical hernia after he'd been shot.  "Shot," as in "with a gun."

"Damn," I thought, "[student 2] is gonna get his ass killed tonight."

When I got to the prostate check, I made sure to grab the tube of the lubricant and apply a liberal amount.  I did the exam, discarded my gloves, and, with the other students, thanked the gentleman profusely for his time and involvement in our education. We offered our most sincere apologies and left the room.  He mentioned that it was like something from SNL and told us his nickname as we were leaving.

After our debriefing session with the preceptor, the three of us students walked, shell-shocked, back to our study carrells.  [Student 2] remarked about how I charmed the guy and how we were best buddies by the end of the exam.

"It wasn't that hard, really.  All I had to do was not put a handful of Purell in his ass and we were buds."

It really is the simple things, isn't it?