I will beat you every time

Disclaimer #1: This post is not for the squeamish. If your delicate sensibilities preclude your tolerance of frank references to saliva, mucous, vomit, bile, excrement, urine, blood, semen, pus, or any other bodily fluid for that matter, you may want to skip along to a more light-hearted post like this one or this one. I know, I know. You may THINK you want to challenge yourself just this once. But seriously. What follows is considered by many to be truly gross. As the t-shirt that my brother gifted me with a few years back reads: trust me, i’m a doctor.

Disclaimer #2: Do not mistake any of the satire below for a backhanded insult to my profession or any of my patients. I love what I do. But every job has its mundane or less-than-glamorous tasks. Every job. For a secretary, it might be filing. For a stay-at-home mom it might be laundry. For an accountant, it might be accounting. For me, well, the scenario below definitely constitutes one of the less-than-glamorous things I have to do in my profession. For the purposes of patient anonymity, details are changed slightly. Enjoy. (Though if you do, you’re sick.) (Or, alternatively, you're meant for a career in colorectal surgery.)

In a recent visit to Mamichki’s house to see my Dochechka who is recovering from a recent lumbar spine operation, I bumped into a good friend of hers. One who, through the years, I’ve become friends with. (For the purposes of this post, we’ll call him Mr. KnowItAll.) (Which, for the record, he normally isn’t. Well, not seriously at least.) Mr. KnowItAll had just brought over a sushi lunch. My timing couldn’t have been any more impeccable. Free lunch! Woo hoo! As we sat down to a smorgasbord of raw fish, Mr. KnowItAll skillfully managed to redirect the topic of discussion from Doch’s recovery to the topic of the worst smell ever. Seemed a bit random at the time, but it’ll all tie together in a sec. Apparently he thought himself the authority on the worst smell on earth. Now…he knows what I do. And he knows where I work. Surely he knew that I’d have a story or two about foul smells. As I looked at him skeptically, he assured me he could top any story I might dig out of my surgical archives. I was all ears.

Mr. KnowItAll had volunteered in the ER at a county hospital about ten years ago. (Formerly an aspiring medical student, apparently this was the incident that changed his mind about his career choice.) He got called into an exam room. One with four other volunteers, a resident, and an attending physician already in it. Along with the 500 lb female patient who’s nudity was feebly concealed behind the less than adequate paper napkin they provided patients to change into for the physical exam. There were no stirrups on the exam table and this patient needed a gynecologic exam. Two volunteers on the right. Two on the left. They lifted and spread her mammoth, weighty legs. Mr. KnowItAll was assigned the task of holding up a flashlight, so as to illuminate the field for the resident performing the exam. Apparently, the patient, as evidenced by the aromatics that flooded the room upon the uncrossing of her legs, had not bathed in quite some time. Upon hearing this, Mamichki set down her piece of salmon nigiri. I ended up eating it for her since poor Mamichki proceeded to lose her appetite. (What can I say, it takes a lot to gross me out. Exhibit A: See below.) So that was it. An unsavory vulva. Foul, sure, but…

“Childsplay!” I chortled. I didn’t know I could chortle, but turns out I can. And haughtily. “That’s weak.”

Mr. KnowItAll looked at me with fish eggs stuck to his lips and eyes that shouted: Bring It On.

“Are you sure?” I always ask this of my willing victims. He nodded. And continued to shovel fish into his mouth.

I dug into my mental cabinet of Grosser Than Gross stories. I got to the P file. And pulled out one of the Peri-Rectal Abscess cases. 51 year old, diabetic, corpulent, follicularly gifted man comes in to the ER complaining of fever, chills, and excruciating anal pain for the last few days. The ER doc calls a surgical consult. This is where I come in. I examine him. Look at his bloodwork. Look at the CT scan that the ER had obtained of his pelvis. And I determine that this guy needs to go to the OR. He had a peri-rectal abscess. (See Figure 1, the little blob on the right is a much smaller version of what this patient had.) (For those of you who don’t know what abscesses are, they are a localized collection of pus usually with surrounding swelling and inflammation. As for why people get them, that’s a whole chapter in and of itself. This is not that kind of blog.) (It’s a worse-than-that kind of blog, actually.)

Now. Abscesses are gross. They’re gross anywhere. On the arm, face, shoulder. Gross. But near the ass, they’re even grosser. They can track from the skin, up into the tissue planes right alongside the rectum for inches and inches, becoming huge pockets of purulence, sometimes fistulizing with the rectum. AKA connecting with the rectum. Which means…yes, shit meets pus. Now that’s the kind of mingling you don’t want going on at your party. And that’s what this guy had. In his bum. We take him to the OR for an incision and drainage, the treatment for an abscess. I don a face mask, shoe protectors, an impermeable gown, two pairs of sterile gloves. The anesthesiologist places the patient under general anesthesia. Prep. Drape. Scalpel. In one swift movement, I incise the abscess. And proceed to get showered. Bathed, if you will.

With projectile.
Shitty.
Pus.

Or purulent shit. (Depending on how you want to look at it.) Either way, a torrent of frothy, feculent ass frappuccino. (This explains why I don’t drink frappuccinos.) (This also explains why I wear impermeable gowns.) And the smell! Oh the smell! Imagine rotting flesh being eaten by a vulture whose stomach contents are then pumped out, fried in a skillet with a pat of butter, eaten and then shit out the other end. Then multiply what that must smell like by 14.3. (Just a rough estimate of the caliber of stench we’re talkin’ about here.) In an attempt to be helpful, the circulating OR nurse put some peppermint oil on my face mask near my nose. But that only conjured the virtual olfactory equivalent of peppermint flavored ass gum. Which, call me crazy, I don’t think would market well.

Upon finishing my account, I looked up at Mr. KnowItAll. I think he actually gagged at one point. He’d certainly stopped eating long ago. Then, silently, he threw both his hands up in sweet, sweet surrender.

And that’s how I got lots and lots of free sushi all to myself.

Don’t challenge me to a grosser than gross game. Just don’t.

(I warned you.)