And I STILL got a letter of recommendation out of that guy!

Days left in residency:  7 (if you count today), 4 (if you don’t count today or the weekend), (but who’s counting?)


7:43 PM, Operating Room 3

It’s been one of those days.  The surgeons should be done with their cases for the day but, for reasons that don’t just border but full-on straddle the ridiculous, they are only just starting their second, a laparascopic partial colectomy.  Who starts a lap colon at 8 PM?

La Cubana Gringa, a well-seasoned resident, busies herself with positioning the anesthetized patient and getting things going.  She knows Dr. X is on his last nerve.

Dr. X enters, visibly frustrated.  He’s totally pitted out.  This confuses La Cubana Gringa.

La Cubana Gringa voiceover: WTF?  Did he just do a quick Insanity plyometrics cardio uber-abs work out DVD in between the last case and now?*

Dr. X:  What?

LCG:  What?

Dr. X:  You’re looking at me funny.

LCG:  Sorry.  You just look…frustrated.

Dr. X:  I am.  This is bullshit.  Who starts a lap colon at 8 PM?

He exits the room to go scrub before LCG can come up with an obnoxious comment that lives up to her high personal standards.

Twenty-six minutes later, the ports are in and the case is started.  Dr. X mans the camera.  LCG is dissecting out the vascular pedicle like it’s her job.  Well, it is her job…she just happens to be mind-blowingly good at it.*

Dr. X:  You are mind-blowingly good at this.*

LCG ligates the pedicle and proceeds to dissect posterior to the upper part of the rectum.

LCG (playfully brown-nosing): Well, you know… when you have a good teacher!

Dr. X:  Ass kisser.

LCG:  Ass doctor.

Dr. X is, in fact, a colorectal surgeon.  The two surgeons laugh heartily at the well-timed pun.  The mood lifts somewhat.  Perhaps the glands in Dr. X’s axillae have even slowed production.  The case proceeds along smoothly and conversation drifts to more lighthearted topics.

LCG (while operating):  Ok.  So, what’s the grossest thing you’ve ever had squirted in your eye?

Dr. X:  Hmm. Give me a second to think about it.  How about you?

LCG:  I once had the contents of a sebaceous cyst splatter into my left eye.

LCG recalls the incident as if it were permanently squirted onto her left cornea.  The sebaceous cyst was the largest she’d ever seen, at least 4 CM, on the upper back of an emergency room patient several years back.  She was just sterilizing the overlying skin when the tender, almost transparent flesh that separated her from the cheesy, sebaceous matter inside the cyst ruptured.  She was simultaneously dazzled and flabbergasted by the kinetic energy with which the cyst contents exploded onto her hair, face, and left eye.  It smelled not unlike vomited blue cheese.  It was disgusting.  She should have worn eye protection.

Dr. X:  That’s disgusting.  You totally should have worn eye protection.

LCG:  Yeah, well, you know what they say about hindsight.  Your turn.

Dr. X:  Oh, I don’t know…I vaguely remember something gynecologic ending up in my eyes during med school.  Too long ago though.

LCG:  “Something gyneocologic” ends up in your eye at ANY point in your life and you forget it??  Boo.  You’re boring.

Dr. X:  I know.

Unbeknownst to the surgeons, outside, a thick, foreboding cloud cover rolls in.*  Almost like something ironic and bad is going to happen later.

9:23 PM, Emergency Department

While his chief resident, La Cubana Gringa, is the the OR with Dr. X, the surgical consult resident on call evaluates a patient in the emergency department who he thinks might have a peri-anal abscess.

Surgical Consult Resident (eagerly, proud of his diagnostic prowess):  This guy needs a rectal exam under anesthesia and surgical drainage!

He scuttles up to the OR to schedule the case and wonders, passively, if he remembered to wash his hands.  He sniffs his index finger and seems satisfied with the result.*

11:49 PM, OR 3

The colon case is finished and the peri-anal abscess patient is now on the OR table in the lithotomy position.  It’s a commonly used position; completely utilitarian, albeit comically so.  Though, top points for Most Comedic Position, in La Cubana Gringa’s book, still goes to face down with the butt cheeks taped to the side of the bed so that they are spread open.  It’s a good thing patients are asleep before they get put in these positions or they’d feel violated.  Or aroused, depending on the patient.   LCG ponders this as she raises the OR table to level that’s comfortable for her to proceed.

Dr. X walks in and finds himself eye to eye with the anus in question.

Dr. X (tired):  I should have been a florist.

LCG:  Who needs to smell flowers when you have 24-hour access to the human perineum?

Dr. X chuckles.

LCG dons her gown and gloves, positions herself between the patient’s legs and, with a little lube, does a quick rectal exam.

LCG:  Hmm, I don’t feel an abscess in there.

Dr. X hadn’t expected to have to get involved.  He sighs heavily as he pulls on a gown and gloves and gets in between the patient’s legs to LCG’s right.  Four is a bit of a crowd (what with LCG, Dr. X, the patient’s right testicle, and the patient’s left testicle), but LCG stays where she is.  Dr. X does a rectal exam.  Pauses.  Then sticks a speculum in and looks around.

Dr. X:  I agree.  I don’t feel anything either.  But the patient was in excruciating pain.  So he probably has an intersphincteric abscess. In which case you should just make a small incision with a scalpel right here.

He points to a spot in the patient’s anal canal.  LCG feels the spot with her finger and appreciates the space between the internal and external anal sphincters.  She grabs an 11-blade and makes a small incision.  LCG is instantaneously startled by the feeling of something warm and wet splattering onto her forehead just above her right eyebrow.  She instinctively squeezes her right eye shut; she’s wearing her glasses so she doesn’t think anything got into her eye but one can’t be too sure when butt puss is amongst list of possible projectile liquids.

LCG turns her head to the right to look over at Dr. X, her right eye still clenched shut.  Simultaneously, he turns his head to the left to face her, his left eye clenched shut.  They are mirror images of each other.  Dr. X has butt puss showered fancifully along the left side of his face and all over his left eyelid.  It smells of poo mixed with curdled milk and toe jam.

LCG:  So, back to my question from earlier.  What’s the grossest thing you’ve ever had squirted in your eye?

Dr. X:  I hate you.

LCG:  You totally should have worn eye protection.

* These items may be exaggerated and/or somewhat completely fictional.


2 Responses to “And I STILL got a letter of recommendation out of that guy!”

  1. 1 Rachel July 10, 2010 at 7:45 am

    Hahaha! I’m glad I have a finance degree and didn’t decide to be a doctor! Glad you’re back and writing again.

  2. 2 Brown July 31, 2010 at 11:30 pm

    You’d think that butt doctors would never get near a patient’s ass without protection. I have a feeling that he won’t hesitate the next time someone asks him what the grossest thing he’s ever had squirted in his eye is.

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The madness featured here is mine and mine alone. It does not, in any way, reflect the madness of my employers, colleagues, patients, nutty family, or my colorful friends. The privacy of my employers, colleagues, patients, nutty family and colorful friends is sacred & deeply respected, so no names. All words Copyright © la cubana gringa, no method, just madness 2006-2010. All comments © their authors. Don't steal; it's not nice. (And my Grandfather knows people.)

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