This question was originally posted on Quora.com and was answered by Sheaffer Williams, MD from University of Nebraska Medical Center (1900) What follows is a candid and uncomfortable reportage on the unknown horrors that await unsuspecting medical students. As is often the case with my posts, they shouldn’t be read by anyone lacking a true hunger for the gritty reality of medical edumacation. “Rectum? Hell, damn near killed him!” —Me, every time I do anesthesia for a rectal procedure. General surgery rotations provide a wealth of what was called “scut” work back when I was a med student and dinosaurs ruled the earth. In addition to histories and physicals, daily rounding and note writing, there were two duties that students competed vigorously to avoid doing. Procedure number one was termed “Expressing prostatic secretions.” AKA “milking the prostate” It answered the important diagnostic question “What bacterial organism is causing Mr. Jones’ chronic prostate infection?” As glamorous as this sounds it was awful. Here is a description of the procedure from Medscape: “Prostatic massage is performed similarly to a digital rectal examination. The patient is asked to lean forward over the examining table. The physician then puts on gloves and applies lubricant to the examining index finger. Next, the physician spreads the patient’s buttocks and advances the index finger into the anus. The prostate is then massaged by stroking it from the periphery toward the midline several times on each side. EPS is then collected from the urethra as it exits the penis.” Hey kids! Doesn’t that sound like the kind of healing opportunity for which you went to med school? When your resident was a woman and the small group of 4 to which you were assigned were women, guess who was allowed to participate in this delightful diagnostic exercise. Result: Humiliation for all concerned and a diagnosis of E. Coli. Procedure number two (pun maliciously intended) was termed “manual dis-impaction.” The game was played like this. Mrs. Smith was the happy and contented denizen of a nursing home. She was demented and had several life threatening diseases. She was admitted because her abdominal x-ray had shown that her abdominal distention was due to an advanced case of constipation known colloquially as FOS (full of $hit.) She had been tried on every stool softener and laxative and enema known to medical and perhaps even veterinary science without relief. Residing in her ancient and venerable rectum was a rock hard ball of poop that she had no hope of passing on her own. She was miserable and perforated colon was imminent. Surgery? Get real. She couldn’t tolerate it at all. Time to provide your med students with some Super High Intensity Training (SHIT)! The lucky med student then gloved up, and, using only their lubricated index fingernail, they picked pieces off the poop ball and extracted them as high up as they could reach. At that time an enema was given causing the mass to come down into rectum where it would be re-dis-impacted until softer stool was achieved and the log jam burst. This allowed the rest of the colon to empty at high velocities powered by the accumulated gas and extensive pharmacological intervention. Again, what a glorious opportunity to ease the suffering of a fellow human being. Even better was the thought that I was paying tens of thousands of dollars a year for the opportunity to rescue demented patients from death by colonic explosion. Not surprisingly I didn’t enter general surgery or urology. I am proud to say I never put my finger up a stranger’s rectum again after med school. Source
