Confessions.
Unless we live in a community with people from different backgrounds, we’ll never know how much “common knowledge” is, in fact, uncommon.
Every patient comes into the emergency room with a short description of why they came. It’s called their chief complaint, and is usually a few words. The funniest ones are from patients who do the darndest things — “doesn’t she have common sense?” the staff exclaim amid uproarious laughter. Examples: “ate pigeon poop,” “uncontrollable urge to dig out eyeball,” “got [random household object] stuck in [hole],” “hair stuck in lawnmower.” Or cryptic ones that tell you something but also tell you nothing. “Sweating,” “bugs,” “hurting.”
Sometimes the differences in common knowledge are dangerous. I’ve seen a whole family with carbon monoxide poisoning — they had tried running a gas generator indoors. A kid who tried to bleach his hair with laundry bleach. Another who tried pedaling his bike with his hands.
It’s easy to judge people for not knowing. It’s also easy to think everybody has always known what they know now. But after about 22 years of school, I still learn things that I definitely “should have known” a long time ago.
(Content warning: butts) Last fall, I was supposed to perform a digital rectal exam (I stick a finger into someone’s butt) on a patient. I had done at least ten before, on standardized patients and on moms shortly after giving birth. I’ve seen tons of butts. I even worked as an anatomy TA. But after faking confidence and getting the patient in position, I couldn’t find the anus. I spent a few sweaty moments rummaging up and down the buttcrack — no luck. With each second we were quickly slipping from “She obviously knows what she’s doing” to “Is there something wrong?” So to preserve the illusion that I did indeed know where butt holes were meant to be, I saw a promising dark dimple in the patient’s buttcrack and stuck my gloved finger in… and met resistance. Strike one. “That’s not my [butt]hole!” The patient protested. “Sorry, sir!” But the longer I looked, the more that dimple gave me the illusion of depth. Could the patient have an anal fistula?! So I stuck my finger in it again, harder. “If you don’t cut it out, right now — ” “Sorry, sir! There really is something here. Have you ever been told whether you had a fistula?” “A WHAT?”
Finally, the resident who had been standing behind me on his phone looked over and pointed out where the anus was. I was looking in entirely the wrong region.
I have absolutely no reason for this belief, but I always thought that the anus was somewhere nestled exactly halfway along the crescent of the buttcrack, facing directly backwards rather than downwards. Somehow this belief persisted even after seeing many butts, and even dissecting a few.
On the social skills side, I learned in my first awkward month of clerkships that I was an enormous pain in the butt. I don’t know what I thought clinical rotations were for, but I knew 50% of my grade was based on faculty evaluations. Translation: my attendings have to know I’m smart. I also had heard that attendings loved to test students by asking them questions on obscure medical facts, a practice known as pimping. I called up my superstar friend, three years ahead of me, top of his class, and asked, “Hey, do you remember what questions you got pimped on? How did you learn what you needed to know for them? Would you recommend any books or review material?” He laughed (at this point he was grinding away at a crazy rigorous residency program), saying, “Why are you worrying about pimping? That stuff doesn’t matter. Don’t worry about it. But if you really want to prepare, you can look up commonly pimped questions online.” Then he launched into real tips. “What you really gotta do on rotations is be a good person. Attendings usually pimp the most senior person first, then they go down the list. If your attending asks a question that someone else doesn’t know, help them. Make them look smart. Then when it’s your turn, they’ll help you.”
Of course, I forgot all of that by the time clinical rotations started. My attendings did ask us questions, both in lectures and on the floors, and I was (in retrospect) terribly overeager to answer. A friend of mine told me later that classmates complained about me behind my back. After a few weeks, however, I realized that the attendings never even really kept track of who answered which question, and it didn’t matter whether the answer was right or wrong. They were more interested in pimping in order to deliver an important learning point. They didn’t even remember my name half the time—I was mistaken for another asian female student so often that first month that even my final evaluations included comments intended for her. What people did remember, though, was how I treated my fellow students and the residents on my team. For all the times my mentors told me just to relax and be a good person, you’d think I would have caught on a bit sooner.
Another thing I should have known maybe a decade ago: I was caught flat-footed asking patients about drugs. Patients would list the things they took regularly by their street names — K2, dog food, Malcom X. For medical purposes, I’d have to ask how much they took, how often, and in what method, and my early questions were cringe city. “So how much heroin do you… *fumbles for word* do in a week?” Now I know the question should flow like, “How many bags of heroin do you use in a day?” Now I know crack is smoked (I was under the impression it was snorted, like cocaine) and shrooms are painstakingly measured in micrograms (for some reason, I imagined they were mushrooms eaten whole, like in Alice in Wonderland). Patients and other med students have laughed at me for not knowing something that the average high schooler could tell you, and I laughed along.
But then in the hallways and workstations of the hospital, that paradigm is turned on its head. Nurses and doctors laugh at patients who didn’t know that pills could be swallowed (he had been taking them rectally his whole life), or who mixed up their superglue and their glaucoma eye-drops (the bottles are the same shape and folks with glaucoma don’t see well), or who mistranslated the instructions on a condom box and put strawberry jam on it instead of spermicidal jelly (a month later, two words: fungus. ball.).
That turns into deriding patients for coming in for minor complaints. “He comes in thinking he’s dying. Hasn’t he ever heard of heartburn?” “The ER isn’t the place to go for pregnancy checks, girl.” “Nope, definitely not a tumor, just a third nipple.” Immersed as we are in the language and knowledge of health, of normal and abnormal, we’ve lost track of the fact that no knowledge is really “normal”. There’s no universal ledger to which all minds subscribe. And that’s why medical professionals are an important sector of society—they’re meant to be the educators and keepers of health literacy. But too often I feel our attitudes are less public-library and more private-art-gallery.
That’s why I like to celebrate the little things I goof on. The little confessions. I’ve spelled ophthalmology incorrectly until last year. I secretly googled “How to shower correctly” for fear that I wasn’t doing it right. I thought it was pronounced AN-ti-FA (like an auntie named Fa) but I never said it out loud just in case I was wrong. (Also what kind of psychopath makes it rhyme with Latifah?) In 2017, when I graduated Bible school and returned to full-time internet use, I thought Brexit was the name of a controversial newly elected British prime minister. God only knows what (or who) I thought Benghazi was.
I also like to surround myself with people who non-judgmentally encourage learning and new experiences. A friend introduced me to flower arranging last year, and no matter how stilted my compositions are next to hers, she always encourages my excitement about the art. I’m always trying to figure out how to cook heretofore unconquered ingredients from the grocery store (beets, spaghetti squash, plantains, escarole), and R gamely tries (and compliments) whatever cockamamie recipe I’m leveling at him. I’m currently reading up on personal finance and public health legislation, and the hardest part is calling up people to ask what my first steps should be. It seems I have a good grasp of the concepts and jargon when I read, but as soon as I have to have a conversation about it, I constantly pause and second-guess my phrasing.
There are still things I find it hard to do, for fear of judgment. I sometimes enjoy running, but I haven’t run with anyone for four years (not even my husband, who valiantly pursued the idea) for fear of falling behind. I turned down free voice lessons from a very accomplished operatic singer friend. I had no idea where my voice stood on the quality scale, and I’d rather pay to learn from a stranger than see my friend react in real-time. I often text R in Spanish (which he doesn’t understand) for the troll factor, but as soon as anybody starts actually speaking Spanish, I clam up. But I hope as I learn to give grace to others for not knowing things or not doing everything well, I’ll give myself the grace to do the same. So that’s what these confessions are for. In case I give off a learnéd persona, or I start to believe my own professional façade, I’ll think about all the new things I have yet to learn, and all the people I have yet to learn from.
