by Jacob Freedman, UMMS 2009
Student Finalist for the 2006 Gerald F. Berlin Creative Writing Award
I am now six weeks into medical school and tomorrow I will make the joke that I am approximately one-sixteenth of a doctor. My knowledge is limited to the Krebs Cycle, the anatomy of the thorax, and the genetics of Hemachromatosis. I have been participating in a program where first-years are paired up with mentor doctors who are supposed to teach us the tricks of the trade. I go to Dr. P’s office almost every week and he gives me the free pens that the drug reps give him and lets me see his patients.
It’s Tuesday afternoon and I am sitting with Dr. P in his office. He tells me about how when he was in medical school in San Francisco his anatomy lab was on the seventh story overlooking the Golden Gate Bridge. I tell him about how our anatomy labs are in the basement and how the ventilation isn’t very good and that’s why I had to trim my beard because it was starting to smell like embalming fluid. He says that’s ok because he used to get distracted in lab looking over the bay area and therefore being in a windowless basement probably isn’t so bad because at least I’ll get the chance to focus. I tell him about how there is major construction with all sorts of sledgehammer-banging right outside the labs. He says that’s ok because he never learned anything in lab anyways and that seeing patients is the best way to learn about being a doctor and why don’t I go see the next patient on my own and then report back to him.
I walk into the examination room and introduce myself to the forty year-old man sitting across from me. He is completely bald, wearing a yellow raincoat, and has been having trouble urinating. I stick out my hand and say, “Hello Sir, My name is Jacob Freedman and I am a medical student working with Dr. P. Do you mind if I ask you a few questions?” The bald man in the yellow raincoat shakes my hand and says, “Sir? You don’t have to call me ‘Sir,’” and then I say, “Well I picked it up in the South and it’s stuck with me ever since.” He says, “Oh,” and then I tell him that I went to college in Virginia and that even though I miss the weather, I never got to watch any Red Sox games down there so its good to be home. The bald man in the yellow raincoat says, “I love the Sox and I just bought a shirt that says ‘Big Papi for President!’” I tell him that back in 2004 I voted for David Ortiz as a write-in candidate and the bald man in the yellow raincoat laughs.
He seems comfortable enough with me and I decide that it is time to make the transition away from our obligatory introductory chat. I ask him about his trouble urinating, “Can you tell me a little bit about this problem you’ve been having Sir?” It’s been going on for the past two months and it didn’t use to hurt so badly but these past few days it’s really hurting something awful. His stream of urine is not consistent. Sometimes it goes to the left or to the right. Sometimes it is ninety-degrees to one side or even more. He can’t control the stream and sometimes he pees on his leg and he ruined a good pair of shoes so he’s been sitting on the toilet seat to pee for the past few weeks. Sometimes there are two or three streams. The urine is heavy he thinks. It hurts a lot worse in the morning. He’s not sure if he’s been urinating more frequently over the past few weeks but he thinks that he probably has. Nothing seems to help alleviate the pain. And he ruined a good pair of shoes; did he forget to mention that?
I take a deep breath. I ask him if he has any idea what might be the cause of this problem. He doesn’t. I ask him if anything like this has ever happened to him before. It hasn’t. I ask him if he’s noticed anything different about his penis since the problem began. He wants to know what I mean. I ask him if he’s noticed any discoloration, any lumps, or anything else abnormal. He says no. I ask him if he’s had any pain in his back associated with this problem. He asks where. I think for a moment and wonder how he will react if I say, “in your kidneys and ureters.” I decide that this isn’t the best course of action and say, “in your mid-or-lower back.” He says no. I think that I’ve ruled out kidney stones for now but I’m not sure because we haven’t studied abdominal anatomy yet.
I take a deep breath. I wonder what the best way to ask him about his sexual behavior is and ask him, “Do you practice safe sex Sir?” He tells me that he’s been married for nearly twenty years so not really.
I take a deep breath and I tell him that I’m going to get Dr. P. Dr. P is sitting at his desk and looking over the results from the urine sample that the bald man in the yellow raincoat gave the nurse. It’s negative for proteins and ketones and Dr. P tells me I’ll learn all about this when I take physiology of the kidneys and chuckles which means that physiology of the kidneys is either very funny or very difficult. I tell Dr. P that the bald man in the yellow raincoat has been having all sorts of problems urinating. I tell him about the multiple streams and the pain and the shoes and how there aren’t any other associated symptoms. Dr. P asks me if I have any idea as to what sort of ailment can cause these problems. I tell him that if I remember anything from that pamphlets we got back in college it’s that STDs are one cause of the bald man in the yellow raincoat’s symptoms. Dr. P twists his moustache and gets up out of his chair and I follow him into the examination room.
Dr. P says hello to the bald man who has taken off his yellow raincoat and hung it over a chair in the corner underneath a framed photograph of fireworks that Dr. P took a few years ago. They shake hands and the bald man makes a funny inappropriate joke. This probably means that he and Dr. P have a good relationship because patients who don’t usually make boring tasteful jokes or just talk about the weather. Dr. P asks the bald man about his medications and his diet and about the bald man’s golf game and then takes his otoscope and peers into the bald man’s various orifices. Dr. P asks the bald man to take off his shirt and places his stethoscope on the shirtless bald man’s back and listens to it. Dr. P places his middle finger on the shirtless bald man’s back and taps it twice and says to me, “This is how your percuss the patient; now you try.” I tap my middle finger twice and Dr. P says, “Congratulations, you know how to percuss,” and now in addition to knowing the Krebs Cycle I know how to percuss and this makes me feel like more of a doctor.
Dr. P puts on a pair of latex gloves and tells the shirtless bald man to take off his pants so that his penis can be examined. The shirtless bald man takes off his pants and his penis is approximately three feet away from my face. Dr. P looks at me and says, “Have you ever seen anything like this before?” I shake my head as I’ve only been in med school six weeks and I have no prior experience examining patients or penises. The tip of the naked bald man’s penis is covered with a pale, scabby crustiness that looks unpleasant. Dr. P looks up at the naked bald man and says, “This is probably what has been causing your discomfort.” Dr. P asks the naked bald man about his sexual behavior and the naked bald man tells him about how he’s been married to the same woman for nearly twenty years. Dr. P asks him if he practices safe sex and the naked bald man says that he does sometimes but that his wife is on the pill so it isn’t a big deal. At this time I am hoping that the naked bald man will come out with it and say that three months ago he went to Jamaica with his college roommates and had sex with a prostitute. He doesn’t say it. I wait to hear the naked bald man say that he’s been having an affair with his secretary or with his sister-in-law, that he’s been unfaithful even just once so that I don’t have be in the room with Dr. P as he effectively insinuates that the naked bald man’s wife has been cheating on him. The naked bald man remains silent and I try to hide my uneasiness. I have no desire to watch as the naked bald man is forced to conclude that his wife has been having unprotected sex with another man and that’s why he needs to take the gonorrhea and chlamydia test that Dr. P tells me to go get.
I walk down the hall to the laboratory and to get the test that seems to be nothing more than a long q-tip in a vial of clear liquid. I bring the test back to the examination room and Dr. P takes the q-tip out of the packaging and tells the naked bald man to expect a mild level of discomfort. I probably wince even before the naked bald man but he doesn’t notice because his eyes are closed and he is biting his lower lip. Dr. P tells the naked bald man that his meatus will no longer be occluded and that he should expect less pain to accompany his urination. The naked bald man puts his clothes back on and Dr. P tells him to take one 400mg antibiotic pill every morning at breakfast and every night at dinner for the next six days and to call him for a follow up visit. Dr. P also tells the bald man that he should be practicing safe sex because his infection might be contagious. The bald man nods his head and buckles his belt and shakes hands with Dr. P and then with me. He puts on his yellow raincoat as he leaves the examination room and takes a handful of chocolates from of the candy dish at the reception desk on his way out.
The bald man in the yellow raincoat was Dr. P’s last patient of the day. Dr. P and I sit and chat for a little while about the Red Sox and about playing golf in the Fall in New England. He has to dictate and so I take my stethoscope, shake his hand, and tell him that I’ll be back the following Tuesday.
The next morning for breakfast I have a glass of orange juice and a bagel with cream cheese. I joke around with my roommate and tell him, “I am approximately one-sixteenth of a doctor.” He tells me that he isn’t exactly sure what being one-sixteenth of a doctor means. I tell him that I’m not exactly sure what is means either but that I don’t believe it qualifies me to diagnose ailments of the penis and in doing so inform forty year-old bald men that their wives of nearly twenty years have been cheating on them. Perhaps when I am one-eighth of a doctor I will be qualified to do these things.