Monday, November 13, 2006

the perianal absess connection

recently i read a blog by a doctor who complained about people asking questions like what's the worst thing you've ever seen. reading the comments i realised that it seems to be universally agreed that this is an inappropriate question. i was also quickly placed under the impression that most people working with human suffering and especially trauma seemed to have some level of post traumatic stress disorder. (this is obviously somewhat of a generalisation) one person spoke about crying on the way home every day after work. there was also a comment that these sort of questions are like asking a cop if he's ever shot anyone. i also thought back to my motivation to start this blog. (it was based on the blog of a depressed suicidal medical student who according to himself has almost been destroyed by the trauma of studying medicine)

all this spawned many thoughts in me. firstly i began wondering if there was maybe something wrong with me because i'm not falling apart. on the contrary i enjoy a good old fashioned gunshot abdomen. i initially felt the abovementioned medical student should never have studied medicine. it simply is not for him. but now i began to wonder if i'm the one who's a bit odd. if i enjoy a gunshot as i say i do, does that mean that i have borderline psychopathic tendencies???

then i was reminded of an arguement i once had with medical students who were not entirely surgically inclined but rotating through surgery at the time. it all revolved around the perianal absess. most doctors reading this now will probably cringe at the mention of this condition. people who trained in pretoria, south africa will associate even more negative emotions with it, bearing in mind that, due to pressure on theater time, they are always drained in the early morning hours. (see previous postings to better understand this madness) for the non medical people reading this, let me explain. a perianal absess is a pus collection very near your anus due to the infection and blockage of one of the glands in the anal canal. the treatment is to take the patient to theater and open the absess up, draining all the puss and leaving it open to heal on it's own. most normal people don't exactly associate this with the glamour of surgery portrayed by any number of television shows.
anyway, the students were basically saying that to study surgery was insane, in part due to the fact that you condemned yourself to a lifetime of cutting these absesses open. i explained that my view was completely different, i.e. most people don't want to even be aware of the fact that they have an anus. yes we must perform our daily ablutions but this is fairly universally seen as a necessary evil. no normal person in everyday conversation discusses his last stool and the experience of passing it. no, we rather see it as something that infringes on other activities that define us as human and not simply biological (this may become a reccurring theme in my writings, i realise now). we would rather just forget the whole experience and that is in fact what we do.
but when you are unfortunate enough to get a perianal absess, that part of your body that we all want to ignore becomes the center of your existance. the pain reminds you constantly of the presence of that specific section of your anatomy. you can no longer stop and smell the roses on the path of life because of the bloody pain in your rear. that which makes us human is put on hold and must move to a position of less importance to that part of the body that always occupies the position of least importance. if you see the perianal absess in this light, to drain it is to return the patient's humanity to him. and if you see it as such, what a priveledge i have to be the one to perform this task. the perianal absess is a reason to study surgery, rather than a deterrant.

now i hear many sceptics saying that this is hardly a traumatic experience for the doctor and doesn't apply to the arguements i read on the blog site previously mentioned. let me recall another incident that happened to me that was and is traumatic. (this one i mentioned in passing on the site) when i was doing my internship (year directly after medical school) i was working in a peripheral hospital in one of the former so called homelands. someone brought a 4 month old girl in who had been sodomised by her uncle. i was the most junior doctor on duty. my senior, a paediatrician of about 15 years experience, heard the story and literally fell apart. she could not bring herself to go behind the curtains to examine the baby. she finally told me that i would have to do it (let me remind you that i was young and green behind the ears. or wet behind the ears and green everywhere else). i had no choice. i examined the child. there was no distinction between the vagina and the rectum. it was all torn open and there was feces and blood everywhere. the child wasn't screaming as one would expect, but emitted a constant eery moaning sound. i did the best i could as the doctor, which due to my inexperience and state of shock was not much. what i did do, though is i held the baby's hand. i made human contact in a situation that is so far removed from what should be the human experience. maybe it meant nothing, but it definitely meant more than my senior doctor meant to the child because of the fact that she selfishly fell apart. yes i say selfish. she put her own emotional wellbeing before even the physical wellbeing, not to mention the emotional wellbeing of the patient.
i don't hold it against her really. she's just not made for that type of work. and that's why i wonder if some people are not meant to do this job.

as with all things in life there are no absolutes and there must be balance. yes we all go through stages when it all becomes too much and, yes sometimes we need to 'debrief', but if one is in a constant state of a low level of shock at doing what we do, something must be wrong.

in conclusion, no i don't think i have psychopathic tendencies. on the contrary, i do what i do to fix the biology so the patient can return to the wonder of life.

hope these thoughts weren't too incoherent.


Anonymous said...

Thank you for this post!

I will go to work tonight with a renewed committment to return my patients to the "wonder of life."

Anonymous said...

I am not a medical student and have only the same knowledge of the human body that you would expect of any other "man on the street", all except for my perianal absess. I have been dealing with mine for about 3 1/2 months now. I have been through diagnosis and antibiotics, (which did not work), then whilst being moved to a ward after my second admission to hospital, it popped. This was the best part of the whole experience. Once the absess is drained, there is no more pain. I have had 2 of these things and I adore the surgeon that is able to look at my bottom and clean out all the "stuff" that we would rather not mention or aknowledge the existence of. I am sat typing this after having woken up to find that my absess, after feeling the pain return earlier, has been leaking huge amounts of blood so I will be spending tomorrow at my doctors surgery and probably once again, at the hospital where a surgeon will once again get the pleasure of loking at my bottom and doing whatever is necessary to sort it out. Not my idea of fun but believe me, if you ever suffer the pain of having an absess, especially where mine is, you will understand what is meant by having the "wonder of life" returned to you. I commend any one who dedicates their life to this noble profession. I am sure I would not be able to do it. Please also understand that to lance and clean an infected absess is as imprtant as asy other surgery, especially to those that are suffering.

Bongi said...

slpritchard, thank you. however i find it a tad disturbing that your perianal abscess was treated with antibiotics and left to pop on its own. antibiotics do not work as you have discovered first hand. also these things should be opened up with a blade before they pop to limit the spread in those where they chose not to burst out.

just for interest sake, what country do you come from?

Anonymous said...

Oh gosh... I decided to read the whole blog. And I came across the same baby:(
I can still remember the first child rape victim I saw in ER not too long ago.