Digital Rectal Exam; a fancy name for the act of sticking your index finger - preferably gloved - as far up a patient's rectum as it goes and feeling your way around in there. It serves three purposes. First, in men, it allows you to check the prostate and make sure it feels all nice and smooth, indicating it's healthy. Second, it allows you to check for any polyps or masses that may be lurking there. Last, but not least, it is a way of checking to see if there is blood in the stool. Once you take your "digit" out, it is covered with fecal material that you spread on a strip which changes color in the presence of blood; obviously, you're hoping for no color change as you do this.
Quite useful it is, the DRE. I despised doing it. I've always been about establishing rapport with a patient and helping them feel comfortable, so they would feel at ease while talking to me. Somehow the rapport changes once you've stuck your finger up someone's ass. The DRE is, however, a right of passage for everyone who is on the journey to call themselves a doctor. We had a classmate named Taylor McArthy whose team somehow convinced him to do two DRE exams on the same patient within a matter of hours on the same day. I don't think that was fair to the patient, but for the rest of med school, Taylor was known to us all as Taylor Double Rectal McArthy.
Obviously, this is an exam that we performed quite often and I have lost count of all the rectums that my fingers have met, but there is one that stands out above all else, and remains etched in my memory. This was the case of Mr. Sanchez.
Mr. Sanchez was what we refer to in our professional language as "a train wreck." He was in his early 60's but looked more like he was in his late 90's. He was skin and bones, and there was something wrong with every organ in his body, except for his gastro-intestinal system. He had been a long time heroin user, and the fact that he wasn't getting any heroin in the hospital made him quite nasty and grumpy.
During residency we switched or 'rotated' departments every month. In each rotation, we would be assigned to a group with one senior resident (2nd year or above), two or three interns (1st year residents), and two or three medical students. The patients which belonged to the group prior to us would all be transferred under our care.
I inherited Mr. Sanchez when I started one of my internal medicine rotations during my internship year. I was warned that he was going to be a tough case. Usually we covered patients with medical students, who helped out, but this one was too complicated to assign to a medical student, so I had him all to myself.
I'm a big believer in involving the family in the patient's care. It was not easy for me to find any of his family members. He had some contacts listed, and I called them all; sisters, brothers, cousins, aunts and uncles. None of then wanted anything to have to do with him. His long history of drug abuse had alienated him from his entire family. They explained to me that they were at the end of their ropes, and at this point were hoping he would die so his suffering would end. I didn't judge the family. I can only imagine how hard it must be to deal with a loved one's addiction.
I did feel sorry for Mr. Sanchez. He didn't have a friend in the world, and the nurses and all the other doctors hated him because he was so grumpy and yelled at everyone (when he could muster up the energy). I made it a point to be nice to him. Every morning when I visited him I was super cheerful and joked around with him. He would try to be his grumpy self with me, but a couple of times I got a smile out of him. When I did, I would call him out on it and tell him he's not as mean as he tries to make himself out to be. He would yell and tell me to get out of his room, and I would skip out laughing and telling him I saw him smile. In a few days he opened up more to me. Now I'm not saying I performed any miracles, it's just that he didn't yell at me, actually complied with my physical exam every morning, and answered my questions, his smiles became more frequent too.
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