Lessons Learned

(a tribute to all the new interns and the patients who educate them)

There is always an exception to a rule. Even a wise and inviolable rule such as “the only reasons not to do a digital rectal exam is if you don’t have fingers or the patient does not have an anus.” I learned this lesson and many others like it the hard way during my memorable year as a medical intern.

Late one on-call night, a middle aged man rolls into the coronary care unit on a gurney.

“Our chest pain admission is here. You’re up,” My senior resident orders curtly.

Dutifully, I grab my stethoscope and my 5x7 note cards to meet the new patient and get his story. As the nurses help the patient transfer from the gurney to his hospital bed, I glance at him quickly to get a general impression. He is just under six feet tall, has a full head of black curly hair, a prominent nose and an athlete’s built. In addition, there is an air of familiarity about him. Perhaps it is his face or his demeanor. However, I just can’t quite put my finger on it so I pass it off as early delusions from my growing fatigue.

I interview the patient, asking him the obligatory what, where, when and how’s of his chest pain.

“Well, you see doc, I was watching TV when...” As he talks, his voice and face prick at my memory.

He is someone famous, I am sure of it! I thought to myself, But who is he? An athlete? An actor? My mind is racing. I hear only every other word he is saying.

“the...radiates...shoulder...pressure...sweaty...nausea...resting...”

Thirty minutes later, I emerge from his room having asked every question twice with only a vague idea of what his chest pain is like, yet my memory block of the identity of that familiar face troubles me the most. I sit down in the workroom to review my medical findings with my senior resident.

“You know, his story is quite suspicious for unstable angina,” My senior resident asserts, “we should put him on a heparin drip just in case.”

“Okay,” I reply, taking his words as a mere simple directive.

“You know what that means, right?” He says with a slight grin.

I don’t quite know what he means. I am slow at making connections this particular night.

“You will need to do a rectal exam.”

“What?” I mutter dumbly, failing to make yet another connection, this time between rectal exams and famous people.

“Make sure he is not bleeding out of his ass before you put him on that blood thinner,” he answers with some annoyance.

“Oh, right,” I head out of our work room to look for gloves, lubricant and stool cards.

After rounding up my supplies, I explain to my famous patient what I need to do and why I need to do it. He agrees. The procedure occurs uneventfully. He has no blood in his stool. As I am washing my hands, I muster up enough courage to ask him the question that torments me, “do I know you from somewhere?”

He looks a little surprised, which is saying something since he just had a rectal exam from a rookie doctor, “um, no, I don’t think so.”

We trade a few questions back and forth, then it hits me, “church, do you attend the Amazing Grace church?”

He nods. I smile. He smiles and then there is a long moment of awkward silence as we both realize the deeper significance of our new found insight. That night, I learn the importance of proper timing and that there IS an exception to the rectal exam rule.

- intern #24601


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