A Pain in the Anus
Thursday, July 13, 2006
I'm rotating through surgery at the moment. Surgeons consider themselves only slightly superior to God. You see, whilst God created everything from the mouth to the anus, the surgeons fix everything from the mouth to the anus. Hence: superior.
Anyhow, the three men clutching their bums. After taking a quick history ('Eish, it started hurting. I can't wipe.' X3), spreading the cheeks and then sticking a KY'd finger up each of their rectums (I changed gloves in between), I realised I had an emergency room filled with a perianal haematoma (like external haemarrhoids), a perianal abscess (like a huge zit), and a perianal sebaceous cyst (like... um, nothing. I'd never seen anything like this before.) The chance that all three of these men should have presented at the same time, to the same hospital, with the exact same symptoms, is minute, but it happened. Doctor-in-chief (my registrar) declared that there were no beds, and that all three of them would be dealt with in casualties. I fetched three suture packs.
Now, all three men had different pathology, but the management was essentially the same. Anaesthetise, cut, squeeze. Yee-ha.
The first problem is patient positioning. Whilst all three patients assumed the fetal position without difficulty, they struggled to remain that way. The anus under seige tries to hide. They clenched their buttocks against our hands that furiously tried to spread them, they thrust their pelvises forward whilst we tried to get as close to the back door as possible, they straightened their knees while we begged them to bend.
The second problem is that that area is really sensitive. Like, really. Also, the guy who went first seemed intent on terrifying the guy who went second (and so forth) and screamed like a girl as soon as I stuck the needle in his ass. As the surgeon sliced open his haematoma and squeezed out the clots, he howled 'Maweeeeeeeeh!' (The 'weeeeeeeh' part must be pronounced with vibrato. 'Mawe-e-e-e-e-e-eh'. I'd previously only heard this word muttered forlornly by women passing live children through their vaginal canals. It apparently means 'mother'). He muttered 'Eish, eish, eish, my bra' through the cubicle curtain to the man with the giant perianal zit on the other side.
Abscess man was second, and I had the honour of cutting. Now, people, admit it. You love the feeling of a zit well squeezed. And this was zit-squeezer's heaven. After numbing the area, I made the tiniest incision over the abscess ('Eina, fok!') and whoosh, was rewarded by a little river of pus. That kind of thing makes surgery worthwhile.
We did the man with the cyst last, and I have to give him credit. His procedure really was the worst (he was the only patient to require stitches) and he made the least fuss. The cyst looked a bit like an extra scrotum attached perianally (as I was about to start cutting the surgeon even said 'Crap, where are his balls?' Luckily they were safely tucked away). I hacked away at the skin, gouged out the cyst, and was left with something that resembled a tunnel. So I cut the extra skin away, and then started stitching. This was not so easy, because the wound was on the upper buttock, and hence turned away from me (as a second year anatomy lecturer of mine would have said: 'Orienteer nou jouself'). Thus, in order to stitch, I virtually had to turn myself upside down (picture: hair hanging in squeezed-out cyst contents. Euwee.) The wound looked really good at the end though, even if I say so myself.
In spite of the fact that I caused three men considerable pain, they all hobbled out of the emergency room looking relieved and more comfortable. They even said thank you, and told me they were looking forward to sitting down again.
See, I know it sounds incomparably gross, barbaric and filthy, but there really is nothing in the world as satisfying as medicine. I love it a lot.
posted by Karen Little @ 11:36 PM,
93 Comments:
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At 5:08 AM,
~d (tilde) said...
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OOOhhhhhh GOODY! I was SO hoping it'd be like popping a big ole zit! SERIOUS! Heh heh heh...SQUEEZE!
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At 6:38 PM,
Zen Wizard said...
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If I ever have a hemorrhoid in South Africa, it is comforting to know you are there.
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At 6:54 PM,
winters said...
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That was delicate work, beautifully described. I'm glad I had my dinner before reading it though...
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At 2:30 AM,
Vesper said...
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that was actually quite the amazing story. your blog has officially made it to my links. ;)
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At 9:06 AM,
arcadia said...
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karen, that's brilliant! "eina, fok!" lol lol
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At 12:52 PM,
michael said...
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Holy cow.
Well, I'm glad you find it satisfying. Different strokes for different folks, I guess... :P -
At 3:37 PM,
Lexi said...
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ummm........seems like you found your calling........this post is proof positive that not anyone could be a doctor :)
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At 11:52 PM,
Viking054 said...
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Wow, I never thought anal trauma could make such good reading :)
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At 10:40 AM,
The Electric Orchid Hunter said...
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"The anus under seige tries to hide."
Please can we make a bumper sticker out of this? -
At 6:44 PM,
Karen Little said...
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~d - greetings, fellow zit-lover!
zen - it would be a shame for me to remember your anus more clearly than your face, should we ever meet, though?
winters - thanks for the kind words! Hope that dinner didn't come back.
vesper - thank you! Glad you liked the post... I was worried it would be a bit.. too much.
arc - hehe, thanks :) I think there's a lot in this post that only South Africans will get.
mike - you're right, we do all have to like different things, because there are definitely not enough anal zits to go around.
lexi - I think most people could do it if they got introduced gently. Really.
viking - thanks man! Anal trauma is one of the most entertaining things that can happen to a person, I must say. Penile trauma is also fun.
EOH - yes, I give you permission. May I have a free one? -
At 2:10 PM,
Wendy said...
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Your blog is the reason I am happy that I am not a doctor.
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At 12:09 AM,
Dr John Crippen said...
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Karen
Brilliant.
Had me in stitches, so to speak. I have just linked you to NHS BOG DOCTOR in the UK, and given you a very big plug, which should get you a lot of hits from the UK
Great stuff
John
http://nhsblogdoc.blogspot.com/2006/07/pain-in-ass.html -
At 12:58 AM,
said...
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Great blog!
Could you consider your older readers and make it plain old black type, white background? These cutsey colour schemes are rather difficult for those of us with imperfect eyesight. Thanks. -
At 1:23 AM,
theinjuredcyclist said...
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I've just thrown up......
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At 4:53 AM,
Ex Utero said...
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Brilliant. Truly. I do hope you were wearing a face sheild. The thought of all that blood, puss and serous fluid spraying towards your eyes is really more than one can bear.
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At 2:26 PM,
Karen Little said...
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Thank you so much, Cr Crippen! My stat counter is struggling to cope with all the visitors you've sent my way ;)
anon - I am aware of the problem with my current template, and am working on a new one right now, which is far more reader friendly. It should be up in a few hours.
injuredcyclist - ew, puke!
ex utero - I must admit... I wasn't. You know how opportunistic students are: had I taken a moment to go hunt for goggles, some nasty little scavenger would've gotten her scalpel in there before me. So I just decided to keep my mouth closed. -
At 3:16 AM,
Aubrey Blumsohn said...
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Great blog - thanks
www.scientific-misconduct.blogspot.com -
At 6:58 PM,
said...
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The wife wants me to eat my dinner now..........
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At 4:26 PM,
rose said...
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Oh man! I have just stumbled across your blog... I am working in the UK at the moment, but your stories make me want to come back home to SA... nothing beats South African patients! Keep going girl-friend - its the humour that gets you through!
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