Thursday, April 8, 2010

Disgusting

Abscess incision and drainage does not disgust me; in fact, I find it out-and-out gratifying. Most clinical events which might make non-medical types blanch induce absolutely no squeamishness in myself, including hemorrhage, open fractures, limb amputation and digital rectal exams. Diagnosing lice makes my own head violently itchy but doesn't make me squirm. Contrary to the belief of every patient whom I have asked to remove their shoes, feet - no matter what their condition - will not offend me. Same goes for unshaven legs and unmanicured perineums: I truly take no notice.

As a mother, the list of biological events with potential to repulse me has long since dwindled to almost nothing. I have survived the following with grace: vomit splashed down the neckline of my shirt, infant stool jetting up the back of a onesie and beyond, nares perpetually flowing with green discharge, and potty-training errors on carpet.

Between the two professions, I've got almost all offensive agents mastered. Almost. There are a few holders-on whose power to disgust me I can't dislodge:

  1. Soiled bandages. Whether it's gauze peeled from a surgical incision or a tiny band-aid ring that's fallen from my daughter's toe, there's something about absorbed drainage that I find revolting.
  2. Eyes. Specifically: globe rupture.
  3. Earwax. Cerumen being flushed into a little basin in my office is acceptable. Q-tips dropped into a wastebasket without being shrouded in Kleenex is not.
  4. Collections of cheesy substance in body creases of those who don't wash with due diligence.
  5. Vermin. I'll examine insect bites with interest, but bedbugs scuttling from the cuffs of a patient's shirtsleeves across my desk is too much.
  6. Prolonged coughing or throat-clearing where the sputum is clearly substantial in amount but difficult to expel.

Tell me yours.

20 comments:

  1. For me, it's odors rather than sights that do me. Earwax, used bandages, body cheese, nah.... (unless they smell bad). Never saw a globe rupture though. Thanks for the images!

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  2. Not a sight, but I cannot stand the noise of a drill. I am still very freaked out by the dentist.

    Here are the others:
    Old food found between folds of fat
    The scent of c-dif

    It seems like sometimes the most disgusting stuff are the things that happen outside the realm of healthcare. One night my dog got loose, came back the next day, and vomited chunks of deer bone on my kitchen floor. I usually don't mind vomit that much in the hospital, but my dog's episode in my house was pretty repulsive.

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  3. I agree that the combination of medical practice and the raising of children sets a very high bar for disgust.
    I'll overlook just about anything in a sick, emergency patient. But my disgust flares with issues a competent patient should have taken care of. Such as the elegantly dressed, dripping in jewelry and make-up patient for routine gyn exam, who hasn't adequately cleaned off the daily BM and whose feet haven't been touched by soap and water in a long long time.

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  4. Hey Martina! As a nurse I can definitely sympatize.... especially when I worked in the ER. However most of those scenarios I loved. Blood and guts was soooo cool eg. open compound #. I loved it.
    My downfall to this day is sputum. Not just runny noses, but the kind when little ladies have so much they are spitting out onto their blankets and you have to watch where you put your hands in the morning.
    The only other thing that I've almost fainted from was a debridement of a gangrenous foot. But maybe I'd be able to deal with that now since when I dealt with that I was still in school :P

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  5. This is a hilarious post, and I find a lot of similarities between you and me. I have to add to your yuck list teeth and gum injuries and nail/nail bed injuries. A torn cuticle sends me heaving where I can cheerfully change a colostomy bag with no trouble at all.

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  6. I'm with B&K above. Sputum is my gag factor. Especially the sound of it coming up the trachea. That's on live patients.

    In the autopsy suite or in the gross room, there's been lots. First day at the crime lab - blowflies surrounding 25 or 30 people killed by nefarious means. I had to run to a diener and ask for food cause I felt like I was gonna pass out. Ended up munching peanut butter crackers in the morgue.

    Entering the decomposition room - I couldn't actually do an autopsy in there. They only made you do it if you were going into forensics. My guy was found 3 weeks postmortem in a trailer in the South. He had pets. I managed about three minutes in there.

    On the gross table - not personal experience - one of my colleagues ran screaming down the hall because her BKA (below the knee amputation) was wriggling. She thought it was still alive. There were hundreds of maggots under the skin.

    Do I win? Huh? Huh? :))))

    I guess you at least get to remove the empathy factor and express your disgust with dead patients and amputated limbs, so I had it easier, there.

    I've got more! Later.

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  7. Okay, I think Gizabeth wins.

    Can't think of anything that really gets me in the disgust dept anymore (that I am exposed to under normal conditions).

    Nothing bodily related at-least. After you've caught poop and vomit with your bare hands... Closest thing would be some taro I found in the corner of the pantry that had fallen behind the shelf and probably sat there rotting for months, now black soup and the nidus of an insect civilization. That was a bad scene.

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  8. Not sure I can top the dead bodies..but doesn't context matter?

    Pregnancy #1: first trimester. I vomit each morning, before and after breakfast, toothbrushing, lunch, then prn based on my patient list.

    My new patient has been locked up in his trailer avoiding family for many months, they find him and bring him in. I am his attending, no residents. He has an approx 8*10inch melanoma on his scalp, ulcerating, necrotic and swarming with maggots and flies. I clean it with the nursing staff because the surgeons won't touch it and it is oozing so much the nurses are freaked out. I did not vomit in the room and it was one of my proudest moments as a doctor. I round on him daily until we get him home hospice. Puke-o-rama. Poor man.

    Pregnancy #2: Trimester 1. Same vomit pattern. And grumpier.

    My new patient is a sweet old lady without a family, alone in the hospital with refractory nausea and vomiting. Usually when my patients vomit in front of me I do what any good doctor does: hand them the bucket and a rag, stroke the back, call the nurse. This little lady wanted me there with her and was scared so I watched her vomit a few times a day, prayed the zofran would help her and ran out of the room as fast as I could to vomit myself.

    I don't remember pregnancy #3 except that I would wake up, take a shower, ..ooohh soooo tired..go to the closet and nap on the pillow and blanket I left there, then finish dressing. Sorry... off topic..

    sputum-not a big problem
    baby spit up-no prob
    vomit-had it all over me of course, not a fan of the smell
    eyeballs-yuck, yuck! even if they are not ruptured. glad I did not do optho
    fingernails bent backwards-worst (happens to me daily)

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  9. I am getting such perverse pleasure from reading these stories.

    Can't believe I forgot nail/nailbed injuries (as per Nurse Heidi and Sofejanic).

    It's hard to top maggots. Tie for Gizabeth and Sofejanic.

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  10. 99% of this would get to me. Which would explain why I've chosen psychology instead of medicine!

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  11. Haha - so gross. Always look forward to your posts FreshMd!

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  12. I'm usually not bothered by much. However, one day I took a patient to the OR for back surgery. He had told me in the office that his hobby was "raising 'coon dogs." When he was asleep, we turned him prone on the OR table - and there on his back was a tick the size of a nickel, all puffed up. It had obviously been there awhile. I went to pull it off with a forceps, and it did a little wiggly dance - that's when I lost it. I don't do well with 8-legged creatures of any variety.

    Even removing a worm from the brain was not as bad as this!

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  13. Oh god. The tick thing wins. This is a fabulous idea for a post - Fresh MD. Most fun I've had in weeks.

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  14. For me, absolutely nail stuff - especially nail avulsions, nail removals... yuck.

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  15. Dr. Ursus had a timely post today:

    http://drursus.blogspot.com/2010/04/abscess.html

    Not for the faint of heart.

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  16. Dreaming Again - I think disordered minds are way scarier than disgusting bodily fluids. Good luck to you and your studies.

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  17. No one else is disgusted by nose bleeds? The kinds that won't stop - that congeal in the back of the patient's throat and then get coughed out in miserable smelling stringy clots, then keep dripping out the nares at the same time? The kinds that require posterior and anterior packing and STILL keep dripping?

    Ugh. I have nightmares about those. (Never mind the *smell*.)

    An ER doc's worst nightmare IMHO.

    ... And while pregnant: the smell of the 2-pack-a-day smokers, especially when combined with the pickled-EtOH scent of the hungover... This never failed to send me retching to the bathroom...

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  18. Kellie (General surgeon)April 12, 2010 at 3:27 PM

    Melena. UGH. Awful smell. Dead bowel. Bad smell. Neither gross me out though.

    Worst for me is the tick... when my son was not quite 2 I found a tick on him. UGH. Freaked me the heck out.

    Maggots don't bother me. They do perform a service. Flies? Ugh.

    As a resident we were treating a reimplanted finger with leeches. UGH big time.

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  19. I think Gizabeth wins. And I've even been the putter on of leeches (a lovely experience during nursing school, and one I haven't had since, thankfully).

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  20. The smell of amniotic fluid- my own, or others- it doesn't matter

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