This is another excerpt from my freshly-overhauled memoir, hopefully coming soon in one published format or another.
My eyes rolled as I surveyed the nurse's note. Paula was in once more to address her bowels. The stool softeners and fibre drinks I gave her two weeks earlier apparently cured her constipation, but now she had gas and cramping. And she felt something "down there". Happy Monday to me.
"Good morning, Paula! The nurse tells me you've got some bowel issues again."
"Always," she sighed in resignation. "What you gave me worked, but I think I feel something down there." Paula was on disability for chronic depression and post-traumatic stress disorder. She was stable on medication but that was about it, probably beyond the point of feeling willing or able to deal with her past.
As a consequence, Paula wasn't terribly interested in the mind-body connection that governed her preposterously irritable bowels, so micromanaging her colon became Paula's de facto full-time job. As the old Yiddish saying goes: when you have nothing to do, shitting is also work.
"You feel something," I said, "like a hard bowel movement that won't come out?"
"No, more like a bump. And it feels like it's on the inside."
I asked Paula all the questions that would point to a serious problem. As she was in my office every other week, the answers remained no. Flipping through her notes, I'd only ever done a manual rectal exam.
"Well, Paula, if you feel something I should probably have a look. I'll use a plastic anoscope. It's uncomfortable, but it'll tell us for sure if you have something minor like a hemorrhoid or something more serious." I fetched a paper drape, and guided her onto the exam table into the fetal position.
Much like the atomic bomb, the plastic anoscope is a contraption I wish we could un-invent. It's a fancy name for a cheap transparent tube, with a removable torpedo-shaped rod running down its center as a guide. It's lubricated then inserted into the patient's back passage. Finally, the guide is removed and you do your best to keep it in place. Some sort of portable light or headlamp is flicked on and voila...three to four inches of anus is visible, give or take. Hemorrhoids, polyps, skin tags, anal warts...just like a Cracker Jack box, you never know what the prize is inside.
I got everything ready including my ultra modern headlamp. Forget those old-school flashlight/mirrors on a headband - this looked like something a Special Forces trooper dons for night missions. Paula exposed her considerable rear end. I lubed up the anoscope and pushed it in without too much discomfort on her part. Out came the guiding rod...
...and out came shit. Nasty, oozing, unformed shit. FUCK ME.
I extracted the anoscope and scrambled to tidy up the evidence. The room would need a serious cleanup and hit of air freshener, but I could mouth-breathe through the rest of the appointment if I made it quick. I gave Paula a blood requisition and planned to bring her back sooner than usual. That should make a somewhat truncated appointment more palatable. The hardest part would be holding my composure, while my inside voice screamed bloody murder.
Shit on the exam table. A metaphor for my career choice if ever there was one. Stay in school, they said. Study medicine, they said. Pinnacle of the professional world, they said. No nobler career, they said...