* * Anonymous Doc

Friday, January 7, 2011

Some of the comments on the previous post surprised me.

Yes, maybe I am a little squeamish when it comes to bodily fluids. But it seems like it would be different if it were my own kids. Who, hopefully, wouldn't be harboring the kinds of infections that many of my patients are.

If my child threw up on me, I would feel icky, sure.

But if a patient threw up on me, I would feel like running into a decontamination shower, and would probably throw up too.

And so would you. I think.

Even if you're used to what comes out of your pets and your children, I think it's different when it's a homeless guy with scabies and bedbugs and the plague. Maybe that sounds bad, I don't know. Maybe it makes me a terrible person to not want to touch my patients who have open sores all over their bodies, or to go near my patients who smell like sewage.

My hair touched a patient's arm the other day, just barely grazed me, did not make any real contact. And I couldn't stop thinking about it for the rest of the day, and the first thing I did when I walked into my apartment is take a shower.

The first thing I do every day when I walk into my apartment is take a shower. I smell. After a day of work, I smell like hospital patients. I don't want to smell like hospital patients.

I signed up for this, sure. I absolutely signed up for this. And I don't blame the patients for whatever they come to the hospital with. We're here to treat them, it's our job, I totally understand that. It does not make my patients bad people if they have body lice, or if they haven't showered in six weeks, or if they have pink eye. I will treat them. I will do what I can for them.

But it doesn't mean I want to give them a hug, and it doesn't mean I'm not putting on gloves whenever I'm anywhere near them.

Look, some of the things I'm talking about-- smells, urine, vomit-- probably aren't going to actually make me ill, they're just unpleasant.

But I have no interest in bringing home bedbugs or scabies, or catching any illness I don't have to catch.

And then there are the real dangers. I know two residents who've had needle sticks when dealing with patients with HIV, and they've had to take six weeks of HIV post-exposure prophylaxis drugs-- which has side effects-- diarrhea, headaches, fatigue. Not fun. A risk I signed up for, but I don't want it.

Patients scare me. They have things I don't want. This should not be controversial. We're still people, who are still icked out by whatever we were icked out by before we became doctors.


  1. I don't think you're alone in this. I'm only a second year medical student, but I'm rather like you. First thing I do when I get home from the hospital is shower. I don't hesitate about touching patients while I'm in the hospital, but I don't want to bring the hospital home with me.

  2. I can not count the number of times my children have barfed on me. My first thought is always "damage control". Keep the barf to a limited area, so I don't have to clean up all carpets in the entire apartment, etc. That is - lift child to a position where barf can easily be cleaned later. Myself? I can clean myself later. It's not a big deal.

    I perfectly understand how you don't want to catch anything. You are, after all, in a "sick house" - the place where people are put when they get sick. (Or emergencies - the loss of a limb or two isn't exactly an illness, and these people should probably stay away from ill people, but they are still transferred to the "sick house" where they can catch all kinds of nasty things through the large open wounds where their limbs used to be attached. But I digress.)

    So while barf and poo are potential hazards, I think my first question would be - how hazardous is this specific patient to me? What does he/she have? And then quickly grab a clove of garlic. I don't care what others say about me stinking garlic, it's the medicine for 90-something percent of all illnesses described in Ayurveda, and it's still one of the main medicines in the culture of many regions in the world. There is a reason for this. Then I would count on my own immune system. And support my immune system every day through proper food - which I already do.

    As for urine - that's pretty much sterile anyway.

    My urge to barf when the stinking gets real bad? Ventilation! Fresh air! It's weird how we build buildings to put sick people in in order to treat them, and then we don't push enough fresh air through!

  3. I don't blame you at all. You know only too well the hazards of what you are dealing with. I can see why someone in the medical field would be somewhat germophobic.

  4. Vomit is my kryptonite, so even if it's my own special snowflake puking, I am beyond grossed out. Poop doesn't bother me unless the dog has horked up a load they thought was food.

    The dogs in fact, have left sneak attack puddles (of various bodily fluids) for me at 2am that I have walked across barefoot. Wash, rinse, repeat, move on.

    So I understand what you are saying and I am not saying you are wrong to feel as you do.I am squeamish myself, but you do what you gotta do.

    Hindsight squeamishness does seem like wasted energy to me.


  5. my son had a partially developed valve between the stomach and esophogus ..automatic reflux! And pyloric spasm! not a good combination! Add in a sensory issue that caused him to throw up every single day, several times a day till age 11 (still throws up a few times a month) ... and I NEVER adjusted to it! My husband had to clean up every single incident of the chld (19 years)life because otherwise, he'd be cleaning up TWO messes.

    However, my child's pediatrician and GI doctor were quite gracious when he threw up ON them ... and quite helpful in keeping me from repeating his behavior ;o) but that was, in their best intrest! ;o)

  6. I totally agree with you. I can clean up my dog's diarrhea and vomit with no problem but the thought of a less innocent being's excretions/secretions on me makes my skin more than crawl. I also am haunted for the rest of the day when I encounter an event that does not meet my standards for sanitary behavior.

    It's a bit of a cliché, but sometimes I wonder if mysophobia is a worse disease than any of those caused by the germs themselves. It's hard to compare mental and physical ailments, but mental disorders always seem to be the most crippling.

  7. I've gotten better since I started my in-hospital rotations, but you're totally right: the things that gross you out before you start don't not gross you out once you're there. I have such a problem with foot wounds. At this point, I've seen enough foot ulcers/wounds that I can treat those patients without (I hope) being visibly grossed out, but that doesn't mean I enjoy that kind of procedural work.

  8. I can't handle my own snot without wanting to vomit. Kudos to those who have strong stomachs -- you're better (wo)men than I am.

  9. The really awesome thing is that you don't have to do clean-up. That is the nurse's job, at least according to the docs at my hospital. The lower GI bleed that has filled the bed... again. The clogged suprapubic catheter that flooded the bed while the MD was changing it (it seriously looked like a geyzer. Must have been clogged for a while). The ICP insertion that bleeds all over the bedding. And that doesn't even touch on diarrhea, vomit, puss, nasty crusty flaky skin, C-Diff, and god only knows what else I drag home on my scrubs. I'm a nurse and I get to clean up every kind of mess that has come out of or off of man. Please be kind to the nurses!

    1. Seriously. We nurses clean all this stuff up all the time, and I for one am not particularly freaked out by it.

  10. Damn, I feel ya. I am a nurse too, and I have to say sometimes I feel so disgusted, but then guilt follows that. The worst for me is the dusky, flaky skin that peels right off; usually from kidney disease..... ohhh god.