touchy operations

[gmcsierra]

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are some poeple born with the ability to do touchy operations like sigmoidoscopies and pap smears like it ain't no thang, or is it something you have to work at and toughen yourself around the edges? i am still questioning whether i could handle doing some of these things. blood and such doesn't bother me.

 

[Winged Scapula]

I'm sure some are born with a stronger constitution than the rest of us, but for the most part, it simply becomes a situation of desensitization.

That said, even with the most hardened, seasoned veteran, situations will arise which will essentially gross them out too.

 

[maxheadroom]

Pap smears and sigmoidoscopies are touchy operations? Good to know that I'm a smooth operator.

 

[Doc Ivy]

To those who are well-seasoned and appropriately desensitized: what still grosses you out? Are there things that still surprise/shock you?

 

[Scrubbs]

My personal gross outs (and I'm in Emergency Med):

1. Vitreous fluid! Ugh! Globe rupture is just nasty...
2. Certain ortho things... like external fixation pins (can't explain it)
3. Chylous exudate... so-oo very nasty!
4. Maggot infested diabetic ulcers - nuf said.

 

[Fah-Q]

The things I really hate to see/smell:
tracheostomies
butt pus
the slimy film that covers that skin of huge fat rolls you see on the morbidly obese or under really large breasts
anything in obstetrics

 

[Doc Ivy]

Maggot infested diabetic ulcers - nuf said.

That's just disgusting.
I haven't started medical school yet-- But just to see someone being extubated on TV with all the associated phlegm makes me want to gag.

 

[ecpiii]

My most disgusting/still grosses me out:
#1. I agree w/ scrubbs: certain ortho things like multiple doll-like compound limb fractures and fixation
#2. A really smelly vaginal ooze at parturition
#3. The secret goodies you find under a really big pannus during an abdominal exam

 

[ecpiii]

Re: touchy operations, when getting ready for them/doing them, from my limited experience:
#1 CHECK YOUR OWN PULSE
#2 use the field to steady your hands
#3 EXPOSURE, EXPOSURE, EXPOSURE. Don't be afraid to ask for free hands/another instrument to help.

If you feel confident, you will have a better chance of succeeding in touchy situations. Confidence is built from some natural ability to stay calm AND some ability to stay calm built out of reading/seeing/doing it. I also believe you have to be willing to be in those situations to have a chance. I think that is what the last two years of medical school is really about: does this field I am currently rotating through have situations I dig being in. My limited experience 2 cents in...

 

[Su4n2]

i have a question. during the vaginal exams w/like std's and stuff, can u wear a mask?
i have two things that i can't tolerate- eyes and vaginas. i have to work on that during the next 2 years. i don't know why, i have never been to look art an eys to open or bloody, etc. i can't even wear contacts. same thing with vaginas- and i am a girl!

 

[Winged Scapula]

More mundane things kinda gross me out - usually vomit and loose stool, lots of it.

Blood doesn't trouble me, I rather like pus (especially if I get to squeeze it out 😉 ) and open fractures, and am not too terribly troubled by sputum. While pannuses (panni?) aren't great, especially when they have open wounds, I've been desensitized as often its the femorals I have to head for when placing a central line and just as often (in central Pennsylvania) meet with a large pannus in my way.

 

[ecpiii]

I think the pannus goo gets me because I project into the patients mind, trying to comprehend how one could let an external surface (hidden, but still washable) get so disgusting...

 

[Su4n2]

what's a pannus?

 

[Doc Ivy]

a pannus is the really large overhang of abdominal flesh that you typically see in grossly overweight individuals

 

[DrQuinn]

Pannus-ANYTHING gross me out. I think the worst was when I was a third year in my FP rotation, when a woman asked me to examine a bump on her thigh. She said "Hold up my pannus and I'll show you."

OKAY, GROSS because:

A) I was holding up her pannus while sitting on a stool
and
B) She knew what a pannus was, and referred to it as "my pannus"

I agree wtih Scrubbsy-
global ruptures are down right nasty

I don't mind vaginas, in fact I'm rather fond of them.

Butt abscesses don't really get to me either... once you make it a sterile field and cover it up so all you see is the abscess, it looks like a knee! 🙂

Diabetic ulcers, especially Charcot foot, are dang disgusting. Fresh semen in a bum's underwear as you do a rectal is rather repulsive as well.

Q, DO

 

[Scrubbs]

Originally posted by Kimberli Cox
Blood doesn't trouble me, I rather like pus (especially if I get to squeeze it out 😉 )

We were just talking about this at work the other night... isn't pus strangely satisfying? I actually get sort of excited when I pick up a chart and it says abscess... one of those, "I can fix that!" kind of patients

 

[dumbest premed]

Originally posted by QuinnNSU
Pannus-ANYTHING gross me out. I think the worst was when I was a third year in my FP rotation, when a woman asked me to examine a bump on her thigh. She said "Hold up my pannus and I'll show you."

OKAY, GROSS because:

A) I was holding up her pannus while sitting on a stool
and
B) She knew what a pannus was, and referred to it as "my pannus"

Q, DO

It's even worse when there are "surprises" hidden under it....like 3 day old cheese doodles after someone's been in bed for a week😱 . Ahh the joys of being an emt.

Fresh semen in a bum's underwear as you do a rectal is rather repulsive as well.

I almost stopped breathing when I read that one. I'm glad that I never had to do that "thorough" of an exam . Definitely something I'm not looking forward to😱 .

And the worst thing that I've ever seen that truly grossed me out was an elderly man who accidently "sat down hard on his sacka marbles." 😱 He claimed that he fell backward onto a hard bench and sat down on them with all his weight a few days earlier. He was hoping it would heal by itself, but called ems that morning when he woke up and had an "irritation." It turned out that the poor guy's left testicle was completely shattered. His scrotum was almost the size of a cantaloupe😱 . In 2 years of working as an emt that was the only time that I truly became light-headed😱 .

 

[Winged Scapula]

Originally posted by Scrubbs
We were just talking about this at work the other night... isn't pus strangely satisfying? I actually get sort of excited when I pick up a chart and it says abscess... one of those, "I can fix that!" kind of patients

Thanks for understanding. Most everyone else looks at me queerly when I speak of my shameful love for pus.

There's nothing like incising a tense abscess, having it shoot across the room and relieving the patient of his pain. Did a nice one today and the Cracker Jack prize was a 38-caliber bullet!! Of course, in this day and age of disposable supplies in the ED, I had to toss the FB into a plastic cup (to turn over to the police) which doesn't have the satisfying "ping" of metal against metal.

Oh well...there was pus at least!

 

[ecpiii]

Although this is somthing medstudents would never do, I just watched my MFM attending try (unsuccessfully this time) what may be one of the touchiest procedures around: percutaneous umbilical blood sampling (aka PUBS). You have to try to subdue uterine contractions and fetal movement with uterine/placental curare and maternal IV terbutiline. Then you have to hit an inevitably still-twitching target umbilical cord (which is soft like a piece of aldente macaroni) through the placenta via abdominal US with an 20 guage needle. Finally, you need umbilical blood and only blood (no amniotic fluid, no fluid/blood mixes), so you must hit one of the three tiny vessels (about the size of the 20 guage needle) which may light up vaguely with Doppler. The patient is awake and watching the doc and the US screen, adding to the pressure factor, all the while not hiting the fetus or causing cord lacerations or excessive cord bleeding. Whew

 

[Winged Scapula]

PUBS: "touchy" yes, gross no (at least not in the category of pus, pannus, or other bodily excretions).

 

[shag]

"I ain't got no f*cking 'discharge'. What I got is funky smelling green s*it dripping of my d*ck and crusting up my underwears"

nuff said...

 

[drvlad2004]

Ob/Gyn simply grosses me out. Many clinician say that delivering a baby is a joyful experience but not in my case. Bloody operations don't bother but vaginal discharge during delivery, yuck! Oh, after reading the definition of pannus, that grosses me out. It's astonishing how someone can let themself become so obese😱

This is quite an interesting thread.

 

[triathlete411]

A little known fact, but pannus actually refers to the articular cartilages in rheumatoid arthritis. Panniculus is the correct term for the layer of adipose tissue that is more commonly known as a beer belly.

 

[Winged Scapula]

Originally posted by triathlete411
A little known fact, but pannus actually refers to the articular cartilages in rheumatoid arthritis. Panniculus is the correct term for the layer of adipose tissue that is more commonly known as a beer belly.

Not so little known...and correct. However, has anyone ever heard the beer belly referred to as panniculus? Even all my attendings have always called it a pannus (since it is evident we aren't talking about their joints).

 

[shag]

At 3:00 am on trauma call, it is so much easier to say pannus than panniculus when asking someone (or being asked) to retract the pannus when puting in a femoral line.

I can see it now: "Hey medical student! Retract the pannicou-, pannicuel, pannacuoulolo,... Just hold back the darned fat roll!" 🙂