Sep 24, 2012

The Bidet

I have never considered leaving a patients room before because I couldn't control the urge to laugh.  Uncontrollably. It happened today.

I stare at the dandruff on her hairline. I imagine myself in my morning commute, frustrated and stressed and tired. I cover my mouth with my hand and clench my jaw. I will not laugh, I will not laugh, I.  WILL. NOT. LAUGH. I am the doctor, the professional this woman has come to see.

And all I want to do is laugh.

She has come to see me to request a bidet toilet. She went to her primary care doctor, who told her no, she would not recommend this so the insurance would pay for it. Undeterred, the patient came to me.

"I need you to give me a bidet."  She doesn't say hello.

I fight the urge to tell her that they are in the back, along with all of our other plumbing devices, light fixtures, and home improvement hardware.  Instead, I quell my snide thoughts and already present dislike for this patient and ask "Why do you need a bidet?"

"I can't wipe my butt."

I indulge her.  "why can't you wipe your butt?"

"my arms are too short."

I clench my jaw and try to forcibly turn the corners of my mouth down.  "how long have your arms been too short to wipe your butt?"

"about four years, since I got fat."

So, I am to assume that she has been able to wipe her butt successfully for the prior 63 years?

"I can't reach my butt.  Look, I'll show you". She starts to get up.

"No, no. That's all right. You don't have to show me."

*please note, at time of this conversation she is seated with her hands below butt.

The patient narrows her eyes at me. "I'm not leaving until you give me a bidet."

I glance through her history. No recurrent infections that would suggest that she indeed cannot maintain hygiene. A note from her PCP that I completely agree with.   So what do I do? 

I pass the buck. 

I tell her that I can put in a prosthetics request form for them to evaluate her necessity, while writing all over my note that I do not think she medically needs one. I tell her that in the meantime, I can give her a pericare squeeze bottle to help clean herself. I dont have any in the clinic, but tell her I can bring one in from the hospital if she wants to come back.

No, she will wait, she says, and proceeds to sit in my waiting room for three hours until I have it. Her problem is, she doesn't have anywhere else to be.

I get back to my office, shut the door, and howl with laughter.

My Blog

This blog started for me to write down some of the things that I was learning in medical school, to share my thoughts and experiences with others, and with myself.  Anything funny, I found joy in writing down and sharing with others, laughing again to myself as I relived it by writing.  Anything sad, I found some peace and closure in finishing my essay, clicking "publish post."  And over the years I was thrilled by the feedback- family members laughing, medical students I didn't even know writing me and saying that my writing was exactly what they felt but couldn't express.  They showed it to their spouses to help them understand.  Patients- not mine, but some searching on their internet for answers- found my writing and valued the glimpse it allowed them into a young doctor's thinking.

I kept it public for all these reasons- so it could be shared freely between students, so people without email addresses to log in could still see it, and so it could find anyone that might enjoy it.  Knowing this, I was very careful to keep anonymity, to abide by patient privacy laws and confidentiality.  But, despite this, my program director would like me to take it down, despite enjoying my "creative flair."

Who told you I had this?  And how long have you been reading it?  Shit.

But, he is as free to read it as anyone else.  I had kept it that way for all the reasons I listed above, and because of this, he was able to read thoughts that I wouldn't have otherwise shared with him.

I'm disappointed to move this to a private site.  My writing has become such an important part of my life.  I write the entries in my head, in quiet moments, when I exercise or drive, or just walk and think about what I can say to make my life make sense to others, and to myself.  They never take me long to write- maybe ten minutes, limited only by the speed of typing.  And there are always others, ones that I never write down.

I loved sharing this publicly.  It has helped me tremendously not only to verbalize my own experiences, but to hear from others that my stories mirrored theirs, or that they helped someone understand their own life a little better or that people just enjoyed them, and were laughing somewhere in front of their computers.  I will continue to write, and post under a private site, but only for those not connected with my work or medicine.

It is my hope someday to put these into a book, and to finally have it "out there" for others to enjoy and relate to.  I dream of it reaching medical students that don't know me, but feel like they do after reading my book, because my stories are the same as theirs.  I hope patients can read it and know that doctors care about them, and went through a lot to be in a position to help them.  And as always, my grandmother will read these, as she does now, and enthusiastically share them with her friends and nag me to put up another post soon.


This last weekend was our resident retreat. Last year, when I heard we were going on retreat, I imagined a quiet weekend with my co-residents, in a nice location and fun activities, with time for introspection and deep conversation.

I was wrong.

The resident retreat was a wild party, an overnight trip filled with more alcohol than id ever seen in one place other than Costco. The drinking started early, during our team building activities. Which were very stupid, i.e. working as a group to pick up a bowling ball with ropes, working as a group to create a pipeline and fill a bucket, working as a group to put together a giant wooden puzzle while blindfolded.   We decompensated a little at at the end, with someone yelling "who has the corner?  Who the fuck has the motherfucking corner?", and us throwing the puzzle pieces at each other.  But i think we did well overall.

There is a party the night of the retreat, where each class comes in costume, and presents a skit. One classes' costumes this year were all the names for a vagina. We had a pussy cat, an orchid flower, a muff diver (wetsuit with English muffins taped on), a box (girl had cut a hole in a box and wore around her waist sans pants and with a t-shirt up top saying "party all night."), and so on. You get the idea.  Box girl has not worn pants for three years running.   The attending oncologist-who treats every major GYN cancer in a hundreds of miles radius-  is walking around with a blow up doll strapped to his waist.  It's that kind of party.

The skits start.  Ours is wildly racially insensitive, involving a response-type song where the girls sang "empuje!  No puedo!" and the boys employed a baseline of "all in the bottom now, push all in the bottom now."

After the skits, the karaoke machine is turned on. And I can't tell you what glee comes with watching your attending perinatologist- who has literally written the book on critical care in pregnancy- sing "when I think about you, I touch myself" into the microphone.  Off key.

Outside, the pregnant girl and the Mormon residents are hanging out.  Drinking Sprite.  The Mormons are okay with this, but the pregnant girl  takes a sip of my wine.  Her drunk friend (also her obstetrician) comes and sits on her lap.  She taps the pregnant belly and slurs,  "I'm gonna reach up in your cervix and say hey, little baby, come on out.  Come out now baby."

The night ends with the game "two truths and a lie", where you say two things about you that are true and one that isn't, and everyone else has to guess which is which. And it's amazing what's true.  Arrests. Menage a tois.  My "I've played the violin since I was five" is not an impressive Truth. 

The next morning, we are ready. There are bottles of ibuprofen and Zofran for each class. IVs are standing by.  We go outside for breakfast and our final activity, the breaking of the wooden boards. Our director thinks it symbolizes breaking through negative self assumptions and doubt. Each chief takes an intern and shows them how to do it, and we line up, with applause after each board broken. I watch as thirty two surgeon's hands- and one surgeon's head- breaks through the board, this a good idea?

And then it's over. We drive back home, with five lucky people returning to the hospital to stay overnight on call (I was one of the Chosen). Life goes on. We don't put a lot of pictures up, for liability reasons, but tease each other about our Truths, start planning our costumes for next year, and refill the Zofran.