I walked into one of our big trauma rooms to see a medical patient who had been placed there because of overflow.
After introducing myself to the patient and his very pregnant companion, I asked him what brought him to our ER.
His chief complaint was as big as the room.
"Doctor, I'm dying of colon cancer."
His exact words. And as he spoke, his words were accompanied by his companion's eye-rolling.
I think now is a good time to describe the patient. He was 25. Yes, 25. He looked very nervous but otherwise normal appearing, short brown hair, 6'0", 220 lbs. Pure muscle. I think he ate a side of beef for lunch every day.
"Why do you think that?" I asked, suspicious I might already know. "Do you have a family history of colon cancer?"
"Well, no. I don't think anyone in my family ever had it--until now. But," he hesitated, choking back his emotions, "every time I go to the bathroom, you know, from behind, I see blood in the toilet and on the tissue."
"Bright red?" I asked. "Yeah," he replied.
What twisted human nature compels each of us to look in the toilet when we are done using it? I am reminded, though, of reading that if you put just one ml of blood in a toilet bowl, most people would overestimate how much blood they were actually seeing. I doubt this patient was an exception.
His concern for his health was very real. And although he was not your average demographics for a colon cancer patient, he still warranted a thorough physical exam and blood work.
"So, every time you have a bowel movement, you see blood?"
"Yes, sir, for the last two days."
"Any pain?" I asked.
"Not, really," he replied, "just a little itching and discomfort."
"Have you ever been constipated?"
"Well, yeah, I have," he answered.
"And obviously, you work out a lot. Do you do a lot of sit-ups? Crunches? Core workout?"
"Yeah, how did you know?" Don't give me too much credit--like I said, the patient was pure muscle. A four-pack wasn't a far stretch of the imagination. However, the abdominal strain and pressure from those exercises could be a contributing factor to his problem.
My next question surprised him. "Do you have internet access?"
"What?" he asked, glancing at his companion.
"Well, did you 'Google' your symptoms?" I asked with sincerity.
His female companion jumped in and answered for him. "Yeah, he did. Yesterday. And since then that's all I've heard about--'I'm dying,' 'I'm not gonna see my kid be born,' 'Why me?'."
On a roll, she took a deep breath and continued. "I have to be honest. I'm 37 weeks pregnant and I have to listen to him whine? I don't think so--it should be the other way around, right? Just tell him he's okay, Doctor, and we'll get out of here."
She finished speaking, looked at the patient, and gave him another dismissive eye-roll.
I loved it. I was going to ask her to give me an eye-rolling lesson when we were done. Twenty times a day, easy, I could be using that talent. And who knows, maybe for extra credit, she could teach me to bob my head, hold up my defiant index finger, and drawl out, all with a little attitude, "Mmmm hmmmm". High-pitched, of course.
After finishing the patient's history, we moved on to his exam. I reviewed the patient's vital signs with him--all good. I performed a very thorough physical exam--all good. This included a pain-free abdominal exam. I reviewed the patient's blood work results as ordered from triage--all good. Again, this included a normal CBC (no signs of anemia). I saved the best for last.
"I'm going to need to do a rectal exam to see exactly what's going on."
This was the moment when I knew this patient seriously did think he was dying. He had no objections to a rectal exam. There are very few reasons that a 25 y.o. male wouldn't object to a medical rectal exam. Very few. So his willingness for this exam spoke volumes of how ill he thought he was.
I performed the exam. And, I'm happy to report, it was in his favor--no blood, no pain (a touch of discomfort, at most), and no unusual findings.
Well, except for one. He had two small, inflamed hemorrhoids that were the most likely source of his bleeding.
Ugh! More near-death hemorrhoids! God's joke on the human race, they are.
I explained in detail to this patient what hemorrhoids are. I explained that we treat them with sitz baths, suppositories ("you mean I gotta put one up my ass?"), creams, and stool softeners. If his symptoms continued, I explained, his family doctor may change treatment, order a colonoscopy or CT scan, or have him see a colo-rectal specialist.
"An ass doctor?" he asked. "They really exist?" Oh yes, Virginia, there is a Santa Clause. And to you, buddy, yes--ass doctors do exist. They're the ones wearing heavy cologne along with plastic face shields and cover-up procedure gowns.
During this conversation, out of the corner of my eye, I saw this patient's girlfriend trying to hold back her smile and failing miserably. And yes, she was rolling her eyes at him. Again.
I liked her. And I liked this patient. In all seriousness, his worries could have been any of ours.
Finally, after my best reassurances that he was not dying of colon cancer, the patient finally relaxed and joked a little about "his new little buddies down there." I actually think he was going to name them.
I pulled out a blank sheet of paper and wrote on it. H.E.M.O.R.R.H.O.I.D.S.
I handed it to him.
"What's this?" he asked, taking the note and reading it aloud.
"Your next Google search," I answered, smiling.
His companion laughed out loud and rolled her eyes. Again. Only this time, they were directed at me.
After the recent news report of how people are bypassing their doctors and relying on search engines to make self-diagnoses of their symptoms, I decided to flip that coin. Thanks for reading, as always. Next post will be Wednesday, December 9.