Sunday, September 9, 2007

Conscious Raising Exercise #22

A website created by emergency physicians entitled Rectal Foreign Bodies (also known as "The Butt Page") can be found on the Internet. Radiologists and Emergency Room physicians routinely swap war stories about patients who seek medical treatment after inserting foreign objects into their rectums. A partial list of such objects includes:

PensCarrotsLight bulbs
PencilsVibratorsSoda bottles
SquashZucchinisBars of soap
GerbilsSteel ballsScrewdrivers

You have been asked to do a postsurgical consultation on a prominent businessman and politician, a so-called "pillar of the community" who socializes with many of the doctors on staff at the hospital. Prior to interviewing the patient, you sit down to read his chart and notice something quite peculiar.

Whereas most doctors, in their dictated reports, rarely use the exact same words to describe a patient's reason for coming to the hospital, each consulting physician (and there have been many on this case) has dictated the same text verbatim:

"The patient is a 36-year old white male who has been in excellent health all along. The patient states that he was up on a ladder, about three or four steps, cleaning the windows, when he lost his balance, fell, and landed on a protruding sprinkler head approximately 0.75 inches wide and 6 inches long, which protruded through his anal orifice, full length. The sprinkler was extracted immediately."

This accident could, by an extreme fluke of fate, have transpired exactly as described above. Indeed, when the patient went to surgery, it was discovered that his anal ring had suffered traumatic tears at 2 o'clock, 4 o'clock, 6 o'clock, 8 o'clock, 10 o'clock, and 12 o'clock.

However, your own personal cynicism warns you that it would require extremely good aim to fall off a ladder and impale yourself on a lawn sprinkler. Furthermore, your personal sexual practices (coupled with your awareness of the patient's sexual practices) make you suspect that the patient's injury was self-inflicted rather than accidental.

Faced with these thoughts, what do you do?

  • Check with the other physicians who treated the patient to see if anyone is attempting to cover up an unpleasant truth that could ruin the patient's political career?

  • Meet with the hospital's chief of staff and risk manager to discuss your ethical dilemma?

  • Dictate the exact same text that was used by the other physicians who treated the patient?

  • In 100 words or less, dictate your "History of the Present Illness" for this patient:

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