When I was a surgical intern, I remember I was assigned to report on appendicitis. I remember being called to do the report when I hadn't finished making my slides. I remember the usual symptoms -- right lower quadrant pain, anorexia -- and I remember the signs to watch out for during the physical examination.
I don't remember ever thinking it could happen to me or any of my loved ones.
Which is silly, because people do get appendicitis, and why shouldn't those people be people I know?
Like...I don't know...Aivan.
Fresh from thanksgiving parties given by his fellow board-passers, Aivan complained of pain in the right lower corner of his abdomen the other night. No fever, no loss of appetite (clearly!), no other problems really. "
Obserbari lang," I said.
Yesterday morning, the pain was still there and was worse during urination. I explained the possibilities to Aivan. "Of course, the first thing we think of is appendicitis," I said, and proceeded to mention ureteral colic and abdominal colic.
"And it hurts when I cough," Aivan interrupted.
Oh.
He wanted to wait until I got off work at 5 PM so I could personally examine him. I told him it might be better if he had himself examined by my uncle, a surgeon whose clinic was a couple of stone-throws away from where Aivan lived.
"Maybe after lunch," Aivan said. Both of us, I think, were still clinging to if-we-don't-do-anything-maybe-it-will-go-away. But by 2 PM, my uncle had elicited direct tenderness, rebound tenderness and Rovsing's sign. By 3 PM, the med tech had extracted blood for CBC. By 4 PM, Aivan's white blood cell count had risen to 14,000. By 6 PM, we were at the Emergency Room, being admitted.
By 7 PM, we were laughing about it. The good thing about having appendicitis
now, I tried to persuade Aivan, was that you won't have to worry about having it ever again. Which was small comfort for him when the doctor on duty asked him to prepare for a rectal exam.
Aivan was horrified. I acidly pointed out that at least he was the one being examined, as opposed to being the one who rectal-ed someone else. "You mean you've done rectal exams on other people?" he exclaimed. "I'm never holding your hand again!"
(Yeah, right.)
It is a mortal sin not to do a rectal exam on a patient who complained of abdominal pain. As our seniors loved to say, there were only 2 acceptable reasons for not poking your finger into the patient's butt:
1. if you didn't have fingers
2. if the patient's butt had no hole.
(Sorry. I hope no one's actually eating while reading this.)
Pila ra ma'y istorya, Aivan's appendix is now resting in peace inside a specimen bottle on top of his bedside table.
I remember we also once did a report on a guy who got impaled on the stern of a rowboat. Now
that's scary.