Don’t sneeze while performing a rectal…..


BMJ 18 November 2004. Cite this as: BMJ 2004;329:1245

“I don’t really know what to say, doctor,” said Joe.

I closed my eyes in resignation; could he be any more ambiguous?

One of the skills in general practice is defining the problem. Anything, just anything, can walk though that surgery door. Tragic, comic, or unremittingly trivial—it’s our job to reduce it to some form of manageable problem. But in terms of vagueness and sheer unhelpfulness it’s hard to beat that opening gambit.

Country practice, though, has its advantages, and I already had an important clue. That same network of family, friends, and neighbours that lends such support in times of crisis has a dark side: in the Valley of the Squinting Windows nothing is missed, and at a recent football match Joe had been reported as walking funny.

A few questions further defined the problem. We men are simple creatures; we hate to lose face, and Joe claimed to have haemorrhoids the shape and size of the Mountains of the Moon—not usually the kind of thing one boasts about, even to one’s best mates. He’d looked it up on Google, said Joe, and it suggested he had haemorrhoids.

Pity Google can’t do the rectal as well, I thought, if it is so smart, but the privilege of our ancient profession carries with it responsibility. There are things that need protecting and sometimes that includes unlovely things like Joe’s haemorrhoids. Someone had to do something. And I was the only one around.

But as I delved deeply, trying to paint a (particularly revolting) mental picture of the bodily cavity I was palpating (don’t we all do that?), nothing in my long years of medical experience had prepared me for the horror that lay ahead; I felt a GUBU coming on—a big, big sneeze.

What with my hands being both occupied and repulsive, there was no way to hold my nose or grab a hanky. I tried wrinkling my nose, tried supratentorial over-ride (it works for hiccups, as also, curiously and  co-incidentally, does digital rectal massage); I begged the gods for succour, but the gods are capricious and envy doctors because people trust us and we are a big hit with the girls.

“Wazoo,” I screamed, catarrh exploding across the room. The elemental force of the blast was stunning, almost like an orgasm but without the emotional commitment, and left me in awe of my body’s musculature: such power, such elegance, such coordination. It is the small details I still remember of that climactic moment: the beat of opalescent body fluids on pearly white Irish buttocks that haven’t seen much sunshine and have therefore remained commendably youthful and free of wrinkles (no need for collagen injections there, I thought, my clinical instincts always alert), Joe’s squeal of protest as an already uncomfortable experience became suddenly a disturbing one, the attending nurse’s face pale with fright, her auburn hair wafting in the gale, reminding me of those Woody Allen comedies about autumn in New York, still crazy after all these years.

“I don’t really know what to say,” I said.

“Sure hope that was just a sneeze, doc,” said Joe.


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