I offer examples like this one to encourage my residents to follow procedural checklists to the point that safety is an ingrained
behavior rather than solely an externalized concept. I also want to remind them that judgement errors can happen to any of us.
In a slightly different vein, I share an experience from my own intern year with my trainees in the hope that it illustrates the highs and lows of what it
means to be a medical intern. The hazing, the ignorance, the patient care - and, above all, induction into the cult of "doctor-hood."
My first day on the wards, I took over the care of a patient I'll call Mrs. Manganelli. She was an unfortunate woman in her mid-fifties, afflicted with
severe multiple sclerosis. MS wreaks havoc on the connections between nerves, and between nerves and muscles, making things we take for granted --
swallowing, walking, breathing -- very difficult. It also affects "toileting."
Mrs. Manganelli had been admitted to the hospital specifically for the purpose of severe constipation. Her MS had made her intestines barely able to move
food and the resultant waste products along their course. An x-ray confirmed that her colon was entirely full of stool.
My supervising resident and the patient's nurse gave me a strange look, with big eyes and a smile I mistrusted, telling me that "disimpacting" was the
intern's job. I was scared to admit that I didn't know what disimpacting was, but their looks told me it wasn't pleasant. To hide my ignorance, I asked
what "tools" I'd need for the job. The resident pointed his finger at me, and the nurse handed me a chux, those ubiquitous blue pads that are all over
hospitals to place under patients and clean up messes.
Then I understood: I was going to be making and cleaning up a mess from poor Mrs. Manganelli.
"I don't want to be a doctor," I thought to myself, in response to what I perceived as a form of hazing. "This is going to be a long and awful year."
Mrs. Manganelli was apparently used to having disimpactions performed because of her illness. She rolled onto her side (with help) and assumed the
position. Using a gloved finger and lubricant, I found what we would technically call "copious amounts of soft brown stool in her rectal vault." Her
disease meant she had nearly no sphincter tone, so once I was able to initiate the flow of poop out of her bottom, it started coming out on its own. Lots
I tell that story only to the point of illustrating the importance of the lesson it taught me.
Mrs. Manganelli felt about a million times better after being disimpacted. It was remarkable, not just seeing how dramatic her improvement was, but knowing
that it was the direct result of my work. The initial feeling of grossness felt immediately petty.
When my family wanted to hear about my first day of internship, I proudly related what I'd been through. Their visceral reactions to the details told me
that I'd crossed a line. From then on, even with the people closest to me, I would feel unable to share the unfiltered details from my medical world. So
now, for better and worse, my interns and I live behind a magic curtain of people's expectations and perceptions.