Saturday, March 04, 2006


My family medicine rotation began today, and I was about to see my first patient. I assumed I had all the skills necessary to carry out the entire patient encounter ... after all, I had completed medicine, surgery, and pediatrics (but not ob/gyn, so I hoped it wasn’t a female patient) and thus I felt prepared to handle whatever was needed for this routine check-up.

Walking into the exam room, I glanced over the sheet stating what parts of the history and physical I needed to perform and quickly reviewed how to perform them: heart exam (check), lungs (check), ears (check), and then my eyes fell upon the one exam I did not want to see…the didgital rectal exam. The exam I most hated. The exam I most feared. My nemesis. Precisely why I felt this way about the rectal exam I don’t know, but I do know that I’d rather perform any other component of the physical, including the genital exam, the breast exam, or hell, even the pelvic exam in which I’ve never been trained. Actually, it was probably because I’ve had the least experience with this exam, and the last -- and only -- time I’d performed one was at the end of second year in an artificial, evening workshop when all-to-eager volunteers lent us their rectums for educational purposes.

However I felt, when the time came, I had to do it. I tried hard to recall the instructions from that evening workshop one year ago, the first of which involved putting on two gloves. I then positioned my poor patient (I don’t know if I felt more sorry for him or myself) and regurgitated the only line I remembered from the workshop: “take a deep breath and then exhale”, with the intent of sending in my digit during his exhale.

He breathed in, and as he exhaled I took a quick survey of the terrain ... only to realize I didn’t see no rectum. Uh oh. Trying to buy myself some time, I asked him to breathe in again but still couldn’t find the right hole. I asked him yet again to inhale -- promising him it’d be the last time -- and I shoved in my finger like I was poking dough. I was inside, or so I thought. After some wiggling, I was quite disappointed to realize I had shoved my finger not into his rectum, but merely in between his thighs. Pathetic.

After several more iterations of “OK breathe in, now breathe out”, I finally did get my finger into his elusive rectum and took care of medical business. We were both relieved as he pulled up his pants, and I walked out feeling similar to how I had felt on my first day of third year, fresh out of the classroom and new to the wards. And while I can’t say there was a moral to be learned from this encounter, at least I can place one more mark on my rectal exam belt.