Now that I have your attention, I'd like to discuss a side of surgery that often goes unnoticed, but as I have recently discovered, takes up a big chunk of time on a surgery rotation. (Don't worry, T&A will actually be discussed shortly. Pervert.) No, I don't mean OR time, hospital wards time, or even, dare I say it,
Hammer Time. Sorry, that was terrible. I'm referring to clinic time, that endless struggle where general internists are banished for eternity but surgeons only visit intermittently, where patients file in and out of exam rooms (often utterly clueless as to why they are there, which I find utterly mind-blowing...more on this some other time) to be thoroughly examined, considered for potential surgery, or checked post-operatively to make sure everything has gone as planned.
However, as I have quickly learned, not all clinics are created equal. For example, my general surgery rotation consists of many specific types of clinics, each with its own character, flavor, and uniquely horrific odor. There's vascular clinic (gangrenous foot odor), pre-op clinic (straight poo), general surgery clinic (a pouperri of rectal abscess with colostomy bag undigested poo), and so on. Today consisted of eight solid hours of two very special clinics, so special that I wanted to devote a little time to each and share what I have learned:
Proctology ClinicYes, there really is a clinic with this name, and yes, I have to be there. Having previously examined the role the rectum has played in my life (both
here and
there), I would instead like to share some of the pathology I have discovered in this delightful clinic, which, if nothing else, should at least convince some of you pre-meds out there that there are better ways to spend your life instead of being, quite literally, elbow-deep in shit. To begin, I should point out that if doing digital rectal exams (DREs) were all this clinic was about, it wouldn't be that big a deal. After all, I've developed so much as a fake doctor over the last two months that, when confronted by another medical student on my team who was in disbelief that I had gone and done a DRE on the first patient I saw without any initial suggestion by a superior to do so, I responded, quite poetically, "Ya dude, you just gotta jump right in, embrace the anus." Surely, these are words to live by. I even said that with a straight face. ("Embrace The Anus" t-shirts anyone?)
Anyways, proctology clinic is far more painful than that, because this clinic is concerned less with what's deep inside the butthole (colon, prostate, etc.) than with what is immediately inside and outside the anus (hemorrhoids, abscesses, fistulas, fissures, leprechauns, spare change, and banana residue). To top things off, in order to examine this area more completely than with visual and tactile inspection alone, some twisted genuis has developed the
anoscope (I'm not sure what's funnier/more pathetic: this website, the fact that this and not any real medical site was the only place where I could find a picture of this real medical device, or the fact that my mom is going to freak when she finds out I've been frequenting anal fetish websites...Hi Mom!). This device allows the trained medical professional to not only see all of the lovely anal ridges, folds, and associated pathology in and around the rectum, but also allows us to visualize what you ate for dinner yesterday, the brand of corn you bought at Safeway last week, and, for some patients who make their way through this clinic, your current condom preferences. Needless to say, in proctology clinic time flies by faster than you can say "Did
he really stick a gerbil up there?". In fact, the only thing more fun than getting to do anoscopies five times this morning was getting to do a final one on a woman with a
rectal prolapse, meaning the inside of her ass had fallen out and was literally hanging on the outside. (Note: the link for the rectal prolapse is to a picture that is not for the faint of heart...that is, if you're a pussy.) And that's about all I have to say about that.
Breast ClinicIn this clinic, I have not only learned a vast amount about breast pathology (what, you were expecting me to say someting like "I JUST TOUCHED SOME TITTIES!"? I guess it's not that much of a stretch.), I have also learned a valuable lesson about lowering one's expectations whenever possible. While there is nothing inherently sexual about any medical or clinical exam (while I cannot remember which post this is in, I know I have previously commented on the nature of this idea as it relates to the pelvic exam), I'm not going to pretend that me or any other guy sent to work at a breast clinic isn't always hoping and praying that the next patient who walks in the exam room has breasts that resemble the
breasts attached to Lindsay Lohan (ok, well, at least before she became anorexic) much more so than the breasts attached to her great-grandmother Mildred. Shockingly, this dream has yet to be realized. However, I have had the chance to examine many an older woman's breasts in this clinic and have come to a conclusion that will startle and disappoint Breast Men* everywhere, even potentially shaking this nation's moral fabric and the foundation of years of marketing research: Massive breasts may not be as spectacular as they are currently valued to be in today's society**.
OK, Breast Men, breath.
So why is that? Well, the obvious answer, one universally known, is gravity***. I've already had the pleasure of examining some older large chested women whose breasts are closer to their knees than their feet are, and let me tell you, no bra, stool, or forklift will make those things get to where they are supposed to be.
Yet, a more important second factor comes into play, one that may not be initially obvious to the amateur breast inspector. What you may not know is that, at least for county hospital patients who have often not been informed of the latest breakthroughs in personal hygiene, the bigger the breast, the bigger the fold between breast and abdomen, which means the more potential space there is for any number of foreign objects, bacteria, mold, or any other atrocious thing to fester in between this area for days, months, and even years at a time. You think I'm joking? You are mistaken, my friend, because I bear witness to many of the horrors I have just described, and let me tell you, it ain't pretty. Does this mean that smaller breasts are better than bigger breasts, going against conventional wisdom and pornographic standards that reach back decades, if not millenia? Tough question, one that I'd feel more comfortable opening up for comments rather than deciding on my own. Also, given my current boob-free status, I'm not about to alienate any ladies out there who haven't already been offended by the nonense I write here and suggest a personal preference one way or the other. I'll only add that when it comes down to it, boobs...umm...boobs are boobs.
Please feel free to take a moment to digest this intellectually complex postulate.
While I am tempted to end this post with that profound statement, I feel obligated to mention that in both these clinics, we can do a lot of things to really help people with their problems, however small they may appear to those of us used to doing (or, in my case, observing from afar) complex surgeries involving life and death. I'm talking about quality of life problems that may not seem as fancy as open-heart surgery, but if you've ever had these problems, they can be very big to you: reassuring women that the breast masses they feel are absolutely not cancer, removing irritating hemorrhoids, and so on. Blah blah blah helping people blah blah whatever. You get the picture.
I think I've rambled on enough, but I hope you enjoyed this glimpse into the world of the surgical clinic. Feel free to resume your lives, your breast hygeine, and your self-exploration with the extra long, rigid anoscope you just ordered from ExtremeRestraints.com.
*It is a universal truth that all men can be classified into one of three groups: Breast Man, Ass Man, or Legs Man. This is a fact. The only other acceptable category known to prowl the wild and select bars is I'll Take What I Can Get Man. And, I'm sorry, but you guys out there who claim to be Eyes Man ("The most important physical feature I look for in a woman are definitely her eyes.")...stop lying already. Nobody believes you.
**Of course, this assumes you plan on spending more than one night with these breasts, like in some sort of longterm relationship, or at least a few casual hookups spread out over the course of some amount of years. This may not apply to some or all of you, but as someone who does not adhere to the one-night-only school of relationships, I regretfully suggest that this applies to me. Excuse me for a moment while I reconsider my values.
***Actually, I have nothing worth adding here. I just don't remember ever seeing a triple star footnote marker anywhere before, and I thought I'd be a trendsetter. But if you're interested in learning more about gravity as it relates to breasts, or other obscure breast topics, I highly recommend
this public service announcement.
