He was the best colorectal surgeon in the hospital, a brilliant doctor and an impressive man, with sympathetic eyes and graying temples and a sincere bedside manner that was marvelous to behold. In his 30-plus years in the operating room he had drained perirectal abscesses, irrigated abdomens full of bowel-perforation stool, and otherwise dug his hands into the living guts of thousands of people. I was standing next to him at the operating table when a piece of bloody fat tissue accidentally flung out of the patient's belly and smacked him on the forehead. He didn't so much as flinch.
Yet one time on routine morning rounds, the presenting medical student mentioned that a patient's great toe was starting to turn black and that she was concerned about gangrene. I could see the brilliant senior surgeon's mouth tense up.
The student reached for the patient's bandaged foot. "No, that's OK -- you don't need to unwrap it," the surgeon said. "Just call vascular. They'll look at it." Then he turned toward the door.
"I hate feet," he muttered.
That was the day that I realized that no matter how long you have been in medicine, no matter how carefully trained you have been, you still have an "icky." Everybody's got an icky -- that one thing that sends professionalism out the window and makes each of them squirm. We doctors all know what our own personal icky is, though we are seldom forthcoming about it.
I'm a forensic pathologist. I've done somewhere north of 3,000 autopsies. I can't have an icky, right? Wrong. More on that later.
One guy from my medical school class loved surgery and would run into every messy trauma he could find. Yet when he did his obstetrics rotation he could barely tolerate delivering a squirming, slick baby. Perfectly normal childbirth filled him with horror. I once worked alongside a veteran morgue technician who could handle decomposed and burned cadavers but refused to assist in any case when the body had ants on it. Maggots, sure -- but not ants.
The paramedic who taught me CPR in medical school knew he had an icky. It was puke. When you perform CPR, it isn't uncommon for patients to vomit. He taught us how to deal with it: turn the patient's head to the side, sweep the mouth, look away to breathe. He had a strategy, but he was also honest about his visceral reaction. "Listen, this is the one thing that I can't stand. If they puke on me, I will puke on them. I can't help it."
As a forensic pathologist, I have learned to tolerate the fetid ascites fluid that gushes out of a decomposing corpse when you cut into its belly. I have worked up human bodies that have been scavenged, burned, marinated in swamp water, and literally torn limb from limb. I deal with a lot of horror-story situations.
So what's my icky?
Knowing I am a doctor, I'll get the distant relative coming over to show me her eczema, the good friend asking me to look at her son's neck on the playground to figure out if a bug bite is infected -- strangers shake their warts at me! I hold my breath and try to look professional. It takes all my self-control not to yelp, "Cooties! Eww -- get that away from me!" If I'm going to be looking at skin it better be on a dead guy in the morgue, and I better have gloves and a mask and a full PPE gown on.
Can you overcome your icky? Maybe -- but it takes persistence and dedication to a course of exposure therapy. When I first started in the morgue, I couldn't stand the smell of decomposed bodies. But I always found myself drawn back into the autopsy suite, because I was curious and because I loved everything else about the job. After years of working in this field, my brain seems to have shut off its sensory receptors for the stench of rotting human flesh. I barely even smell it anymore.
So acknowledge your own reflex to revulsion. Recognize what strategies you use to deal with it, and be forthcoming with your colleagues so they can step in and support you when you start to get overwhelmed. Be a good role model to the medical students and residents who are having second thoughts about medicine because of their own visceral reactions to whatever secretly make them squirm. Reassure them that they can find their niche in medicine despite those impulses. Teach them: Embrace the icky!
Judy Melinek, MD, is a forensic pathologist and CEO of PathologyExpert Inc. Her New York Times bestselling memoir, co-authored with her husband, writer T.J. Mitchell, is Working Stiff: Two Years, 262 Bodies, and the Making of a Medical Examiner. First Cut, the first novel in their medical-examiner detective series, will be published by HarperCollins in 2019.
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