Bad smells are good

BMJ 02 March 2002) Cite this as: BMJ 2002;324:553

I’m pretty hardy, and not overly sensitive to bad smells; delicacy is not a virtue in this job. Humans can apparently distinguish up to 10 000 different scents, which is useful for doctors, as every body fluid has its own distinct aroma, and when these have been percolating for a few weeks or more they can become a heady brew.

Smegma, the stuff from infected sebaceous cysts, really stale urine, drug reps marinating in cologne, navel fluff that has been there for a generation, dead bodies, steatorrhoea, purulent phlegm, bad teeth—eight or nine pungent patients during an afternoon surgery on a warm day and the room becomes quite unforgettable.

Not all strong smells are unpleasant, of course. Horse manure (or is it cow dung—can anyone tell the difference?) can be quite invigorating, a good honest reek, like going for a tramp across the fields, a whisper of the countryside to sweeten even the darkest and most bitter surgery.

Smells should indeed be our friends; open your arms and welcome them in. They are such a valuable form of non-verbal communication, such as, “You are only the doctor and not worth getting cleaned up for.” They are also an intrinsic part of the diagnostic process, as with the patient who smelled as if he had been marinated overnight in cat’s widdle.

“Do you have a cat?” I asked shrewdly, sending off the toxoplasma titre.

“How did you know?” he gasped.

“Just a wild guess,” I said, nodding sagely, like Sherlock Holmes patronising well-meaning but bumbly Dr Watson.

Watson was no role model for me, I preferred Doc Holliday, lean, hungry, doomed, decadent, and cynical though he was, he had that touch of fatal glamour. I bet he smelled of whisky and cigars and sulphur; and danger.

Smell is more tenacious than the other senses; get it on your skin and even if you scrub and scrub and scrub you are not washing it off, merely spreading it around, like Lady Macbeth’s dread spot. It is more resistant to the ravages of time.

When the Catman left the room, though his corporeal body was gone, his presence yet hovered around me like a forlorn and stinky little ghost; the song was over but the memory lingered on, a gift to soften my regret at our parting, also to be savoured by other patients, who probably thought that I was the one with the cat problem. And if some of them did happen to gag, it certainly made them forget the complaint they came in with.

Which is practically the same thing as a cure, isn’t it?



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