Why I REALLY became an anethesiologist

[epidural man]

I remember in med school, to do certain tasks (like breast exams), the school would hire someone to let us practice on.

I remember the rectal exam day well. I was in the last group of the day and I was one of the last to go. It seemed strange to me then, and still does today, that we were practicing on a volunteer, but also, we would watch everyone else do it. Anyway, I got to see this guy's anus before it was my turn, and I had not up to that point seen a lot of male anuses before - but I knew something was wrong with this one. It was bright red, swollen, an looked very painful. Anyway, when it was my turn, as I was putting my gloves on, and placing the gel - the man walked over, watched me gel up, and said "your going to need a lot more than that."

That experience is very funny to me now, but had a large impact on me then. After that, I said to myself that I never want to do another rectal exam again - and I decided I would choose a specialty that did not do them - but at the time, I had no idea which one that would be.

I asked a friend who had always seemed to know a lot about that stuff "I know family practice does rectals, but what about OB/GYN? " He told me "Yeah they do. They do that funny two finger wave thing - you know what I mean?" I had no idea what he was talking about but said that I did because I didn't want to look silly. I then inquired about pathology, and he reminded me that they do them on dead guys - which may be better for some but that seemed way to creepy for me. "How about surgery? They don't really do physical exams do they?" He reminded me that surgeons LOVE the rectal exam. They pratice on each other in fact, and probably even practice on themselves. That was NOT for me. I thought I was onto something with neurology but my friend told me that they not only do rectals, they try to get the anus to wink at you and they do all sorts of tickling down there. No way was I going to do that. Urology was of course out of the question. So I eventually heard about anesthesiology and every anesthesiologist I asked said "Hell no! Internship was my last one!" I was sold. I then came up with a BS story like "I love pharmacology and physiology. I love procedures and am good with my hands, bla bla bla."

The truth is, I haven't done that thing since I started residency and I am so happy for my choice. I made the correct one and for the right reasons. I am, however, a lot closer sometimes then I want to be when doing caudal epidurals. 🙂

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[nightowl]

thank you for sharing

I, too, hate rectals. Maybe you are onto something. Honestly, out of everything I've heard about the field of anesthesiology, that might be the thing that wins me over 😉

 

[cdcd67]

Good reason..Lol..I never knew even neurologists did rectal exams...what about cardiologists...do they also do rectals?

 

[rsgillmd]

Good reason..Lol..I never knew even neurologists did rectal exams...what about cardiologists...do they also do rectals?

Don't know for a definite, but I would guess yes -- before they start any thrombolytics. But I doubt thrombolytics are given commonly these days anyway in the suburban/urban areas. It is probably also the ER guy that does the rectal.

 

[Planktonmd]

I remember in med school, to do certain tasks (like breast exams), the school would hire someone to let us practice on.

I remember the rectal exam day well. I was in the last group of the day and I was one of the last to go. It seemed strange to me then, and still does today, that we were practicing on a volunteer, but also, we would watch everyone else do it. Anyway, I got to see this guy's anus before it was my turn, and I had not up to that point seen a lot of male anuses before - but I knew something was wrong with this one. It was bright red, swollen, an looked very painful. Anyway, when it was my turn, as I was putting my gloves on, and placing the gel - the man walked over, watched me gel up, and said "your going to need a lot more than that."

That experience is very funny to me now, but had a large impact on me then. After that, I said to myself that I never want to do another rectal exam again - and I decided I would choose a specialty that did not do them - but at the time, I had no idea which one that would be.

I asked a friend who had always seemed to know a lot about that stuff "I know family practice does rectals, but what about OB/GYN? " He told me "Yeah they do. They do that funny two finger wave thing - you know what I mean?" I had no idea what he was talking about but said that I did because I didn't want to look silly. I then inquired about pathology, and he reminded me that they do them on dead guys - which may be better for some but that seemed way to creepy for me. "How about surgery? They don't really do physical exams do they?" He reminded me that surgeons LOVE the rectal exam. They pratice on each other in fact, and probably even practice on themselves. That was NOT for me. I thought I was onto something with neurology but my friend told me that they not only do rectals, they try to get the anus to wink at you and they do all sorts of tickling down there. No way was I going to do that. Urology was of course out of the question. So I eventually heard about anesthesiology and every anesthesiologist I asked said "Hell no! Internship was my last one!" I was sold. I then came up with a BS story like "I love pharmacology and physiology. I love procedures and am good with my hands, bla bla bla."

The truth is, I haven't done that thing since I started residency and I am so happy for my choice. I made the correct one and for the right reasons. I am, however, a lot closer sometimes then I want to be when doing caudal epidurals. 🙂

You should have become a Radiologist.

 

[veetz]

During my IM intern year, I had an HIV + homosexual man try to persuade me he needed a rectal exam....and then he asked for a viagra rx immediately after he told me he was not sexually active 😱

 

[seamonkey]

since I have not gotten there yet, just curious how you can avoid a rectal when on your ICU rotations? Seems a rectal is extremely necessary when working up a new admit to the unit? If you can explain how you get out of this it may be of great use to me in the next few years!

 

[ncdoc1974]

I too am guilty of choosing anesthesia mainly based on the fact that I would not have to do rectal exams...No rounds and no clinic also factored into my decision...Radiology was a thought, but I was afraid interventional radiology might inflict some risk of rectals...

 

[Koil Gugliemi]

You should have become a Radiologist.

Sadly, even in rads there is the rectal - prior to what we refer to as "tipping" a patient for a barium enema or CT with rectal contrast...

Sometimes the techs might do it for you, but it's still a (albeit rare) possibility....

 

[Hockeyguy]

since I have not gotten there yet, just curious how you can avoid a rectal when on your ICU rotations? Seems a rectal is extremely necessary when working up a new admit to the unit? If you can explain how you get out of this it may be of great use to me in the next few years!

I have done 6 months total ICU time during my residency - never have done on rectal in the ICU. Have been asked to but have always weaseled out-of-it. Ussually some gung -ho surgery intern around happy to do it.

The one time I really got yelled was by an ICU fellow when I refused to do a disimpaction. I just said "I don't think he needs it" but we both knew it was because I didn't want to do it. The fellow was so pissed at me his lips were quivering as he yelled at me - I just shrugged my shoulders and walked away saying no way man. He ended up doing himself. He still hates me.

 

[bogatyr]

Sadly, even in rads there is the rectal - prior to what we refer to as "tipping" a patient for a barium enema or CT with rectal contrast...

Sometimes the techs might do it for you, but it's still a (albeit rare) possibility....

Don't forget defecography.

 

[AK_MD2BE]

You could have went into Psych/Derm/Radiation Oncology...😀

 

[epidural man]

i saw a patient the other day with levator ani spasm. I probably should have done a complete exam......wouldn't change my managment though.

 

[desflurane]

i see your rectal and raise you a pelvic exam.

 

[amyl]

i hate pelvics and rectals. while their avoidance is not the reason why i chose anesthesia its certainly a great fringe benefit.

 

[Nuriko]

You could have went into Psych/Derm/Radiation Oncology...😀

1. Id rather do a rectal than have a pt. defecate on me. 😉
2. Perianal warts/gluteal melanoma
3. Butt cancer