When you go to medical school the first two years are spent in the books, going to classes and taking tests, at least that’s what my school was like. In the final two years you’re sent out into different rotations to discover your “likes/dislikes” and ultimately figure out what you want to do in medicine (or maybe it’s to do all the crap jobs the residents don’t want to do… probably both). So the beginning of my third year found me in family medicine, my first real rotation. I was nervous but in the days leading up to it my wife tried her best to assuage my fears; yet she did have one warning. According to her, there was this one “old doc” who she had the misfortune to disagree with on a clinical matter. The old doc’s reply to her clinical challenge was basically, “I’m smarter than you so why don’t you let me do the doctoring here.” If you know my wife, she’s a little stubborn and doesn’t take kindly to being brushed aside, besides she was actually right concerning this matter (we looked it up). It didn’t make her feel any better. It actually only served to fuel her anger towards this man who dismissed her so nonchalantly. On my first day she dutifully reminded me again to steer clear of him. I nervously threw on my white coat and was out the door while saying a mental prayer that all would go well.
As my luck would have it, the very first day in clinic I happened to be working under the supervision of “old doc”. Surprisingly, I didn’t find myself petrified of this guy. I had imagined a vicious, muscled up pit bull that says everything with a terrifying intensity, dogs you at every turn and has one of those evil looking mustaches, but that wasn’t him. “Old doc” didn’t really match any of my preconceptions. He actually looked very similar to Santa Clause, with a bushy white beard, pop-belly, and just far enough into his 60’s that he carried this distinguished air about him. I thought he might be a friendly guy. So without too much trepidation, I introduced myself to him and he very nicely sent me in to see my first patient.
The patient was a 56 year old man who was a farmer and as such was hard on himself and never quit working. As a result, today this man was complaining of abdominal and back pain that had been bothering him over the course of the previous week. Being a fresh off the press medical student, I did the best medical interview I could and took a history of the illness. I was extra thorough taking at least 30 minutes; I wanted to do a really good job. When I came out I thought I knew exactly how to present this case and was feeling pretty confident. I walked back into the lounge where students and attendings hang out between patients. Four other medical students and one attending along with “old doc” were waiting on me. I was nervous as I began my presentation in front of all these people but “old doc” was so unassuming and nice that he put me at ease. I did what I thought was a bang up job, highlighting the points of how the patient hurt his back previously while picking up a heavy object and continued to put stress on it without much rest. Basically I came to the conclusion that this was a musculoskeletal injury of some sort, which looking back seems ridiculously obvious. (Sort of like, “Ah, ha! I’ve deduced the exact amount of fingers on my right hand! I’m a genius!”) I started to get the feeling old doc’s eyes were boring into me. His facial features made me a bit skittish suddenly and he was putting off that “this kid is clueless” vibe. He reminded me of a shark tasting blood in the water. This Santa of a shark started to circle this wounded med student seal. His attack was well planned, his first move a simple, “and what do you plan to do about it?”
“Great”, I thought to myself, “why didn’t I think about a plan for my patient’s treatment?” Instead I panicked and impulsively blurted out, “get an MRI or uhhh….an x-ray first?” That’s when “old doc” went in for the kill. In front of everybody he slowly and methodically took me through my poorly formed logic, all the way from my shoddy history taking skills to my ridiculously expensive and useless workup. He then asked what I would do with the MRI results in deciding treatment. My answer was of course wrong and way to Grey’s Anatomy. Smoothly, without yelling or screaming at me he instead offered a very conservative, common sense approach. Somehow his friendly condescension in front of my friends sucked much, much worse. When “old doc” was done asserting his vast superiority he decided to have mercy on me with a quick, “Let’s go see this patient.” At which point I hurriedly got out from the sight of my peers….way to go on my first day.
We walked into the patient’s room where “old doc” quickly swept back through the history like a pro, elucidating all the important things I had missed. After which he recommended a simple plan for recovery and wrote out a few instructions which I don’t really remember (kind of like you don’t remember the first few moments before getting hit with a bat in the head). I do remember the next part with amazing clarity though, as he suddenly realized the patient needed a DRE. “Hey John, I see here that it looks like you’re overdue for a prostrate exam.”
DRE means Digital Rectal Exam, which is performed on males older than 50 to screen for prostrate cancer. If you’re wondering how we perform this exam, a quick hint: “digital” in DRE is not the electronic kind.
Speaking with a casualness I would have never imagined any man able to command in such a situation, the patient compliantly agreed, “Welp, I guess we better get it done then.”
To myself I’m thinking that I’ve seen DRE’s done before and even had to perform one in our student lab on a paid patient, but still….why am I so nervous? “Old doc” gloves up his right hand. I fidget nervously looking for something to do; I need to be busy right now. Am I seriously supposed to stand here? Any distraction would have been great but I’m in a small room with nothing to do except watch….should I be watching this? The patient unbuckles his belt and drops his pants. The poor guy assumes the position, turned away from us, bent over the exam table with his arms bracing him up….this is so wrong… and he is way too comfortable with this! What the heck should I do? Maybe I should step outside…this is so awkward! It would be better if I had a task. Trying to be helpful I squeezed the lube onto old doc’s fingers and as he stooped over to perform the deed I saw the roller stool behind him. It looked in his way so I quickly moved it towards the back of the small cramped room with my foot so he wouldn’t get tripped up while doing the exam…that would make this situation more awkward. But then, to my absolute horror (time began to move in slow motion) he continued on from his stooping into a slow sitting motion. I tried to say something, to stop him, but my brain had disengaged from my mouth.
When you are this “jolly” of a Santa, it’s not a quiet fall. It was of the “TIMBER!!!” quality and his landing shook the room and the wall he bounced against. I stood there for what seemed like an hour, my mouth open, gaping in shock. OH, MY GOD, I”VE KILLED HIM!!! He began thrashing his legs and arms about trying desperately to get up but in this small cramped space with his size and shape he was like a turtle that couldn’t get off his back. In shock, I stood there for a moment longer than I should have, likely beat red, before I realized that I needed to help him up. Flustered, but slowly recovering I grabbed “old doc” under his arms and hoisted him up off the ground onto his feet. This whole time the patient is still facing away from us with his pants down. Still in the position, he shyly spits out a nervous high pitched question, “Everything ok back there?”
“Old doc” quickly finished the exam, finished writing up the scripts for the patient and exited the room. Still dazed I sat down with him in the lounge where luckily all of my fellow students were off seeing patients. I waited quietly for my tongue lashing. In tortuous silence, “old doc”, with his big white beard, stared at his computer. I stared at the ground; eyes wide open like a child expecting a beating. Slowly he turned to me and as I looked up he said, “If you were my brother, I’d punch you in the face.”
If you are wondering how the rest of the rotation turned out, to my amazement I did well. I think I got a B by evaluation from that very same “old doc”. I kept this harrowing experience to myself for the longest time out of embarrassment and mortification but finally decided to let my wife in on it. She laughed until she cried. I think she felt better about her run in with “old doc”…mine was way worse. As for me, it took a long time to find this experience humorous. I suppose it wasn’t the best way to start off my clinical career but on the bright side it did put me at ease, after all, it could only get better from here.
Newbie Doc
* A special thanks to a good friend who helped me edit and tweak this - Thanks P.G. : )
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