Why didn’t I hear about any of this in medical school?

In med school we’re taught to be thorough, caring, compassionate, understanding and to wear a white coat. But what they don’t teach us is that a lot of what we see and do is actually, uh, gross. I mean, we learn other fancy terminology, like hematemesis; hematochezia; menometrorrhagia(or is is metromenorrhagia? Oh well, buckets of blood anyway, or to be current, “blood containment problems”)to try and disguise how gross it actually is, but once you see it—well. Mostly I’ve forgotten all those fancy terms and get by with English and a few gestures when necessary.

Patients, however, frequently are better acquainted with medical terminology than I: “Noooo—I wasn’t bleeding, doctor, I was hemorrhaging!”

“No doctor, what I coughed up was not normal—I have an infection!”

“No, doctor, my bone wasn’t broken, it was fractured!”

Usually accompanied by a disdainful, “Where did you go to medical school?” look.

One five-year-old presenting with abdominal pain knew more than me. I asked if he had any trouble going poo. The child looked blank, so the mother intervened: “She means bowel movement, dear.” When it comes to BMs, unfortunately, parents often underestimate their descriptive skills and feel obligated to bring in a sample. I once saw a diaper filled with lime-green Play-Doh. After my usual Academy Award-winning reassurances, I checked a few textbooks—nothing. I believe the child is still alive somewhere.

Another five-year-old had complaints of abdominal pain and what sounded like nausea. I told Mom not to be too surprised if vomiting developed. Well, my excellent diagnostic skills were demonstrated yet again. This time, only about two minutes after I had made the prediction. Right in the waiting room. My cleaning staff was not hugely impressed with my diagnostic skills.

For the record, I am a very compassionate, caring, understanding doctor, who listens well and always believes my patients. Yet, I cannot understand why they always seem to assume I won’t believe them. I know we’re supposed to take a thorough history, but sometimes there’s just oversharing—too much information. My period talk goes something like this: “Anything is normal, bright pink, dark red, black, brown, thin, thick, clots, dots. Just not blue, like on TV.”

Subtext: “Please spare me the detailed descriptions—really, it’s all normal.”

And if they don’t think they can share adequately, they bring in samples: gross diapers, gross stuff they’ve coughed into a tissue; bottles of bloody poo; chunks of earwax; discoloured urine in jam jars; worms; ticks. . . . There should be a pay code for being subjected to extraneous gross stuff.

Then there’s gross stuff that’s not meant to be in the body, but stupid humans manage to either deliberately or accidentally insert, or deliberately insert then accidentally forget about. Worms, tampons, beans, beads, Q-tips. . . . And I’m always amazed how the body acknowledges its gross guests by coating them with gross stuff.

The human body is quite remarkable in its ability to produce gross stuff with such varied colours, smells and textures—recall the period talk, and the lime-green Play-Doh. A boil I lanced once produced thick foamy, caramel fluid, looking remarkably like an iced cap. I’ve blocked out most of my hospital internship but I still remember the smell of lemon-scented disinfected urine.

Bones can be quite gross, too—they’re meant to remain out of trouble, neatly buried beneath skin, muscle and other stuff I forget. When they dare to protrude, they look gross. And then there’s the sound of a saw cutting through bone—it makes fingernails on a chalkboard sound like a symphony.

Occasionally, gross stuff can be rewarding. Like those large boils that cause the patient such pain. A quick stab with a scalpel and instant pain relief. The patient is happy, and I get to feel like a real doctor. Warning: Contents under pressure; if not wearing your head-to-toe protection, always, always hold lots of gauze over the boil while lancing. i.e., a barrier between the boil and your eyes. Unfortunately for me this knowledge was acquired after med school.

On the subject of personal injury, I recall the gravida 11 or so(I usually stop counting after four)who delivered while simultaneously bursting her membranes just as I rushed in direct from the office. I read all the labels on laundry detergent—some of them claimed to remove blood, but there was no mention of amniotic fluid.

Although also not taught in medical school, over the years, I’ve learned to dull my sense of smell, and generally dissociate when faced with gross stuff. Another favourite technique is ignoring and deferring: “Uh, no I don’t need to see it today, but if it’s still there next week come back in. . . .” Works some of the time.

Janet Warren is a family physician in Guelph, Ontario.