well, folks, it seems that my true colors are being revealed. when i started this blog, doctor obsessed with bathroom humor was not the image i was hoping to portray. but (butt) ever since i wrote that hemorrhoid post, my mind has become stuck in that particular realm of our anatomy and physiology. i wrote an as yet unpublished fart post, but i'm trying to suppress it. (everyone knows you can only suppress a fart for so long.) but this particular story must see the light of day. i call it my christening. if you are weak in constitution read no further, i promise to rise above the waistline soon.
i was a third year student on my general surgery rotation. it really doesn't get much lower on the totem pole than that. my intern, whom i followed around like an unloved puppy, (he himself being the unloved puppy of his resident and so on and so on) was sort of odd. he would grab my shoulders at random times, pinning me with a crazy-eyed look, and say - knowledge is power! well, his mantra must have served him well because he later became chief resident of surgery. i digress. dipping into the swamp of my medical training past does that sometimes.
so we get called to the ER to see an unfortunate gentleman with a most delicate problem. we pull aside the curtain and there stands a big burly man, bushy blond hair, red face, giant belly. he is standing on one foot with just the toe of his other foot touching the ground and his hip on that same side jutting out at an unnatural angle. he looks uncomfortable. it seems that he has had some discomfort in the rectal area for several days now, just today reaching the point of complete unbearability. you guessed it. he has a giant angry brooding perirectal abscess. and hence our first lesson on the most fundamental principal in the management of pus - it must be drained.
this is no ordinary perirectal abscess, no bedside I&D abscess (incision and drainage). This particular beast must be tamed in the OR. we need General Anesthesia (i picture a stern figure in military garb). so we get him into the OR. there he comes to rest, jackknifed on the table, a sterile green mountain with just a small square of space left open at the apex to reveal his backside. we too are fully garbed - scrubs, gowns, masks and face shields. we approach the battleground. the intern is on one side, scalpel in hand. i am on the other side with our attending. the attending takes a step back. i follow suit. the attending takes two more steps back, mumbling something about being careful with pus under pressure. i stick close to his side. the intern glances up at us before pressing the blade into this poor man's backside. looking back i think he was aiming. a jet of tannish foul pus comes soaring out of the abscess arcing three or four feet above the patient and pouring down on me. and our attending. mental note to self, i will not pursue a career in general surgery. knowledge is power.