Hi... Gross Shadowing Experience... HELP ME!

[dfsabryk]

---

Members do not see this ad.

Hi, my name is Dina and I have been interested in podiatry so I decided to shadow a podiatrist in clinic and in surgery to see what I would be getting myself into. I have seen many cases in her clinic from fungal toe infections, calluses, warts, post-surgery check, bunions, plantar fasciitis, etc...

I was okay with everything except....toenail removal surgery. I never had problems with blood or opening things open, however, there was something today about dealing with the toes and nails that really made my stomach very upset. Thankfully, I didn't pass out and I kept a smile the whole time. BUT, I kept wondering... Would I be able to get over this? Would I be able to do the same procedure without feeling so grossed out?

To all the experienced podiatrists, please tell me what your first experience was like and if what I am feeling is normal? would I be able to handle this in the future after training or would I also remain grossed out. I tried to look at lots of pictures after and even viewed a video online of the same procedure to get my eyes and brain used to it...but it still makes me sick. Please HELP!

 

[Podfather]

Hi, my name is Dina and I have been interested in podiatry so I decided to shadow a podiatrist in clinic and in surgery to see what I would be getting myself into. I have seen many cases in her clinic from fungal toe infections, calluses, warts, post-surgery check, bunions, plantar fasciitis, etc...

I was okay with everything except....toenail removal surgery. I never had problems with blood or opening things open, however, there was something today about dealing with the toes and nails that really made my stomach very upset. Thankfully, I didn't pass out and I kept a smile the whole time. BUT, I kept wondering... Would I be able to get over this? Would I be able to do the same procedure without feeling so grossed out?

To all the experienced podiatrists, please tell me what your first experience was like and if what I am feeling is normal? would I be able to handle this in the future after training or would I also remain grossed out. I tried to look at lots of pictures after and even viewed a video online of the same procedure to get my eyes and brain used to it...but it still makes me sick. Please HELP!

First of all don't freak out it may be nothing. Many a MD, DO,DPM student or resident had passed out or become ill doing or seeing certain procedures. It may be a temporary problem and I would suggest doing more shadowing to see if this is temporary. Try to figure what part bothered you. The injection, the cutting of the nail, the blood, the nail removal etc.? Once you get a handle on it you can try to desensitize yourself. But definitely spend more time before deciding on the profession. For the majority of DPMs this is an essential service.

 

[PADPM]

Without getting too graphic, I've actually seen this with students, residents, etc., many times during simple nail surgery. And it usually occurs when separating the nail from the nail bed when using an instrument such as a spatula to lift the nail plate from the bed.

Even though the toe is anesthetized, when you slide the instrument under the nail, it literally looks like a well known torture method. I don't think it's the actual removal of the nail plate or nail border, but it usually seems to occur when an instrument is slipped UNDER the nail plate to separate the plate from the bed.

Hey, I've been in practice for a long time and it still gives me the creeps.😱

 

[G8RB8]

Without getting too graphic, I've actually seen this with students, residents, etc., many times during simple nail surgery. And it usually occurs when separating the nail from the nail bed when using an instrument such as a spatula to lift the nail plate from the bed.

Even though the toe is anesthetized, when you slide the instrument under the nail, it literally looks like a well known torture method. I don't think it's the actual removal of the nail plate or nail border, but it usually seems to occur when an instrument is slipped UNDER the nail plate to separate the plate from the bed.

Hey, I've been in practice for a long time and it still gives me the creeps.😱

Read this while eating...awesome

 

[flyhi]

Read this while eating...awesome

Me too 😱

And cringed

 

[347932]

First year of residency I passed out twice. Once while doing a Charcot Recon and seeing the forefoot hanging on by a thread, and the other while doing a very infected diabetic foot I&D. First incision sprayed pus to the ceiling of the OR and down I went...

 

[Ferocity]

What about smells? How do you deal with extremely foul odors? I'm talking about the type of stench you'd encounter from C. diff colitis or from heavily decaying flesh + infection.

I feel like I'm going to have to stuff Altoids in my nose to get through this kind of stuff. 😳

 

[zane870]

What about smells? How do you deal with extremely foul odors? I'm talking about the type of stench you'd encounter from C. diff colitis or from heavily decaying flesh + infection.

I feel like I'm going to have to stuff Altoids in my nose to get through this kind of stuff. 😳

Before starting pod school, I worked in the CT department of a large regional hospital back home. One day I brought a guy down for a CT guided pelvic abscess drainage. Oh man, I don't know what bacteria were in there but it caused both CT rooms to stink and the control room was almost uninhabitable!! The interventional radiologist and the nurse that were doing the case were turning pale too. The whole corridor was pretty raunchy for the rest of the afternoon!

 

[NatCh]

It usually just takes a little time to desensitize to what you're seeing. I think people have difficulty seeing what they perceive as being a painful stimulus because they empathize with the patient, but know that when the doctor has anesthetized the toe the patient isn't feeling any pain. You ought to watch the procedure a few more times to see if it gets easier for you, because the toenail removal is a pretty core skill to the profession. Perhaps remind yourself when you're shadowing that there's no pain?

When I was an undergrad I worked for some Pathologists as their diener, and since having assisted in hundreds of autopsies I haven't encountered anything makes me lightheaded. The first few post-mortems were a bit weird but after the adjustment it was smooth sailing. I think the toenail removal may be the same for you. You just have to disassociate and get focused on the task at hand.

As for foul odors, they seem to stay in your clothes and nose long after the source is gone. Why is that? I picture little spores taking up residence in my nares. That's gross. In the morgue we had a bottle of oil of wintergreen to rub across the upper lip if anyone wanted to use it.

http://www.amazon.com/Now-Foods-Wintergreen-1-Ounce-pack/dp/B0041U2VIE


Edit: I'm reminded of an article I read in a local newspaper written by a surgeon who got called in to treat a little girl for an accidental gunshot wound to the abdomen. There was pain, crying, panic, and chaos, but he had to get past all that and get to work. He had a great description of the disassociation/focus -- I think he phrased it something like "mentally lowering a veil" but his words were more eloquent. I'm trying to dig up the article for you.

Edit: I found the article. http://www.madraspioneer.com/archives/Story.aspx/14570/doctor-reflects-on-trauma-follow-up

It's not quite the same thing as removing a toenail, but I really enjoyed reading the article and think some of you may also.

"Within moments, my mind let fall the amazing partition that allows me (and most other surgeons) to enter purified chaos with the ability intact to think and to take extreme actions."

 

[PADPM]

Oh, you've just brought back some horrible olfactory memories. When I was a resident in a very busy big city hospital, I had a wicked experience in the ER.

I was instructed to drain an abscess in the ER. The patient was a middle aged transvestite with a huge peri-anal abscess. Just EXACTLY the reason I went into podiatry. When I went to drain the abscess, it literally exploded like a volcano and the pus hit the ceiling and the anaerobic smell was beyond description. I won't go on to give you the rest of the details at the risk of causing severe pscyhological damage to the readers.

I did get in trouble since I performed the procedure in one of the ER "clean" rooms and the area had to be shut down and completely scrubbed, etc. The hospital had special rooms for these cases but I didn't know that at the time.

Regardless, there are some smells in practice you will simply NEVER forget. I won't even mention the woman who came into the ER that same week with a tampon that had been "in there" for 9 months.........

 

[NatCh]

Oh, you've just brought back some horrible olfactory memories. When I was a resident in a very busy big city hospital, I had a wicked experience in the ER.

I was instructed to drain an abscess in the ER. The patient was a middle aged transvestite with a huge peri-anal abscess. Just EXACTLY the reason I went into podiatry. When I went to drain the abscess, it literally exploded like a volcano and the pus hit the ceiling and the anaerobic smell was beyond description. I won't go on to give you the rest of the details at the risk of causing severe pscyhological damage to the readers.

I did get in trouble since I performed the procedure in one of the ER "clean" rooms and the area had to be shut down and completely scrubbed, etc. The hospital had special rooms for these cases but I didn't know that at the time.

Regardless, there are some smells in practice you will simply NEVER forget. I won't even mention the woman who came into the ER that same week with a tampon that had been "in there" for 9 months.........

Sick x 2!

One of the more common podiatric odors that I don't love is that yeasty diabetic smell.

 

[PADPM]

Sick x 2!

One of the more common podiatric odors that I don't love is that yeasty diabetic smell.

Are you KIDDING???? Doesn't it remind you of fresh bread or a really "hoppy" beer😱

 

[NatCh]

Are you KIDDING???? Doesn't it remind you of fresh bread or a really "hoppy" beer😱

Maybe that's why I can't stomach an IPA…

 

[dropfoot]

Sick x 2!

One of the more common podiatric odors that I don't love is that yeasty diabetic smell.

Yeah, that's good stuff. Smells like a Holiday.

 

[flyhi]

Oh, you've just brought back some horrible olfactory memories. When I was a resident in a very busy big city hospital, I had a wicked experience in the ER.

I was instructed to drain an abscess in the ER. The patient was a middle aged transvestite with a huge peri-anal abscess. Just EXACTLY the reason I went into podiatry. When I went to drain the abscess, it literally exploded like a volcano and the pus hit the ceiling and the anaerobic smell was beyond description. I won't go on to give you the rest of the details at the risk of causing severe pscyhological damage to the readers.

I did get in trouble since I performed the procedure in one of the ER "clean" rooms and the area had to be shut down and completely scrubbed, etc. The hospital had special rooms for these cases but I didn't know that at the time.

Regardless, there are some smells in practice you will simply NEVER forget. I won't even mention the woman who came into the ER that same week with a tampon that had been "in there" for 9 months.........

I am officially traumatized. Happy to just stick with feet.

btw, where has the barf emoticon gone?? Really could use it right about now.

 

[javajava]

I am officially traumatized. Happy to just stick with feet.

btw, where has the barf emoticon gone?? Really could use it right about now.

Oh my oh my this thread needs more of these stories

Found them

 

[flyhi]

Oh my oh my this thread needs more of these stories

Found them

THERE they ARE!! I don't know why I couldn't find them

The stories are great, but I'm afraid the bursting peri-anal abscess will haunt me for a bit.

 

[PADPM]

THERE they ARE!! I don't know why I couldn't find them

The stories are great, but I'm afraid the bursting peri-anal abscess will haunt me for a bit.

And I didn't even get into the details!!!

Actually, I always wanted to be a proctologist, but there weren't enough openings.😀

 

[Ntran1986]

And I didn't even get into the details!!!

Actually, I always wanted to be a proctologist, but there weren't enough openings.😀

HAHA this really gave me a good laugh. I love a good pun 😀

 

[AZ25]

Hi, my name is Dina and I have been interested in podiatry so I decided to shadow a podiatrist in clinic and in surgery to see what I would be getting myself into. I have seen many cases in her clinic from fungal toe infections, calluses, warts, post-surgery check, bunions, plantar fasciitis, etc...

I was okay with everything except....toenail removal surgery. I never had problems with blood or opening things open, however, there was something today about dealing with the toes and nails that really made my stomach very upset. Thankfully, I didn't pass out and I kept a smile the whole time. BUT, I kept wondering... Would I be able to get over this? Would I be able to do the same procedure without feeling so grossed out?

To all the experienced podiatrists, please tell me what your first experience was like and if what I am feeling is normal? would I be able to handle this in the future after training or would I also remain grossed out. I tried to look at lots of pictures after and even viewed a video online of the same procedure to get my eyes and brain used to it...but it still makes me sick. Please HELP!

I've seen several of my classmates have negative reactionsto toenail avulsions. It seems pretty common and it seems like everyonegenerally gets over it after seeing one or two or five of them done or actually doing one. It's pretty nasty looking thefirst time you see it though and the room you're in is always small andthere's 3 or 4 people in the room and then you start to feel warm and you'vebeen standing all day and you probably didn't eat a good breakfast and it'susually smelly in the room too and on and on and on. It's a lot to overcome, soit can be overwhelming at first but you'll be fine.

 

[MaxillofacialMN]

The best/worst thing I've seen is live maggots inside a wound just crawling around. That's gross.

 

[MaxillofacialMN]

Also, at least you didn't fall into the operative field. I've read stories of residents fainting and landing in the field. That would be a terrible experience.

 

[DPMer]

Read this while eating...awesome

Conjures up the SAW movies....without anesthesia. Happy Halloween 2011 folks!

 

[DPMer]

Oh, you've just brought back some horrible olfactory memories. When I was a resident in a very busy big city hospital, I had a wicked experience in the ER.

I was instructed to drain an abscess in the ER. The patient was a middle aged transvestite with a huge peri-anal abscess. Just EXACTLY the reason I went into podiatry. When I went to drain the abscess, it literally exploded like a volcano and the pus hit the ceiling and the anaerobic smell was beyond description. I won't go on to give you the rest of the details at the risk of causing severe pscyhological damage to the readers.

I did get in trouble since I performed the procedure in one of the ER "clean" rooms and the area had to be shut down and completely scrubbed, etc. The hospital had special rooms for these cases but I didn't know that at the time.

Regardless, there are some smells in practice you will simply NEVER forget. I won't even mention the woman who came into the ER that same week with a tampon that had been "in there" for 9 months.........

I had a patient in clinic last month at school whose bilateral, icthyotic blackish looking leg and foot wreaked malodorous so bad that it spread throughout the whole clinic and everyone (Clinicians, residents, and student doctors) had to stop doing their work for a moment and trace the source of the smell. By the time I had the history and physical done, I opened the door and found a crowd of faculty, students, and residents waiting for me to present. I will never forget this. Cranial Nerves 1 and 7 were activated big time that morning among all there!