“Don’t believe everything you hear about research, even from me.” It was a great line to end an outstanding lecture on evidence based medicine. Everyone laughed and began standing up as the lecturer called for questions. I thought he was going to get a standing ovation. But no one went to the microphone.
I love it when the lecturers say the same thing. “Take a good history…” They act as if we don’t know what questions to ask. Don’t they get it? The right questions are all written out on the template. Sometimes I just don’t know what to do with what the patient tells me. Ever had one like this?
“How was your night?” my wife asked as I trudged into the house. I just wanted to go to bed, but the smell of the coffee beckoned me towards the kitchen. Just one cup, I thought.
“It was good for the patients, but bad for me,” I said, shrugging my shoulders.
Everyone has them. Some won’t admit it, but everyone has a situation or procedure that, even though they’ve done it a thousand times, they avoid as often as they can. You’re supposed to feel comfortable performing these procedures, but you feel just the opposite. For me, and I’m embarrassed to say this, it’s rectal exams.
It was 8 a.m. on July 1 at the Maryland Institute of Emergency Medical Services, or ‘Shock Trauma’ as it was known locally, and the shift was supposed to be over. But I was still finishing up the last few stitches of a semi-open peritoneal lavage on a guy who had run his motorcycle into something very hard. As soon as the other members of the trauma team saw that the returning fluid was clear, they all ran for the door. “Let’s take a picture,” I said. “It’ll be our ‘graduation photo.’ The attendings are already gone. We are the last rats to abandon the ship.” The remaining residents gathered around the patient, using him as a rather grisly backdrop.
The story I’m about to tell you is completely true. But the names have been changed because, well, you’ll see. I’m sure you guys who are now entering the established field of emergency medicine cannot begin to fathom EM prior to 1979, but here’s one for the books.