Sunday, September 9, 2007

Consciousness Raising Exercise #12

When a young woman considering potential career paths stated that "Nursing might actually appeal to me as long as I don't have to deal with any blood, shit, or vomit," she was told to think about other career options. Just as doctors cannot afford to be squeamish about the sight of blood, they cannot afford to hide from the power of language to evoke images and describe things they were taught to fear.
The first "safe sex" brochures (underwritten with funds raised by San Francisco's infamous religious drag troupe, the Sisters of Perpetual Indulgence) featured sexual terms like "sucking," "fucking," "rimming" "fisting," and "cum."

Few, if any of these terms are used by the mainstream media or taught in medical schools. Yet a physician cannot talk about sexually-transmitted diseases without being able to talk freely about sex.

A simple exercise in consciousness raising can help you get past the problem of dealing with sexuality, overtly sexual language, and what that language implies. So why not confront one of the scariest items in the repertoire of human sexuality?

Anal sex is practiced in nearly every culture known to man. Its existence has been documented in many parts of the animal kingdom. Clinically, you already know that:

  • Unprotected anal sex is a known risk factor for transmission of the HIV

  • Unprotected anal sex is a likely cause of anal warts (Condylomata acuminata).

  • Male and female rape victims are often forced to submit to anal sex.

  • The traumatic insertion of foreign bodies into the human rectum (including
    objects as large as a man's arm) can tear the anal sphincter and rectal mucosa, thus making a patient extremely vulnerable to infection.

  • In certain cases, the traumatic insertion of a foreign body into the rectum may require surgical repair.

  • Analingus (rimming) can easily lead to parasites and other gastrointestinal

Scary stuff, huh?

Almost as scary as a grand mal seizure, a crack baby suffering withdrawal symptoms, a battered infant, a patient with delirium tremens, or the unfortunate soul who comes to the Emergency Room with multiple gunshot wounds.

As a doctor, you receive plenty of on-the-job training in how to deal with such patients. And you know how to describe their presentation and treatment when dictating reports.
But some day you may be required to treat a patient whose indulgence in anal sex has necessitated a trip to the Emergency Room, to a City Clinic, or to a proctologist's office. As a doctor, you will not only have to render care to that patient, you will need to candidly and open-mindedly discuss the situation with the patient. After the patient leaves, you will need to describe your findings and treatment with the help of the English language.

So look down at your two hands. If those hands belong to a medical student or a practicing physician, do the following:

  • With the palm facing you, raise your right hand to eye level.

  • Make a fist.

  • Extend the middle (long) finger.

  • Read the following text out loud:

"How many times during the course of my professional career will I be required to insert a gloved finger inside a patient's rectum?
Tens? Hundreds? Thousands of times?"

The bottom line is that if you can do it, you can say it.

And if you can do it, you can also find the proper words to descxibe what you have done. After all, whose finger is that anyway?

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