03 April 2012

Disgust, discussed

Why do some sights and smells disgust us? There appears to be a sound evolutionary basis. For example, when one bites into a fruit and then sees that it is infested with insects, one's visceral reaction is to spit out the food and possibly even vomit. Both of these actions quickly eject the offending agent from the oral cavity and the gastrointestinal system, reducing the risk of harm. Disgust often protects us. Similarly, we find repulsive the smell of feces as well as that associated with decomposing matter. Given that objects that issue these putrid odors often harbor disease, it is sensible and live-preserving that our senses urge us to steer clear.

Medical practice sometimes demands that we suppress this important and innate instinct. While I was shadowing an outpatient pediatrician, the six-month old girl we were examining took the liberty of defecating into her diaper. The pediatrician didn't mind, because it afforded her the chance to glance at the stool and confirm that it looked healthy.

I, on the other hand, found the situation nearly insufferable. The oppressive smell assaulted me. Would it ever stop? My eyes searched the room in desperation, seeking some sort of relief. I inwardly cursed whoever had designed the room to have windows that don't open. Yet I soldiered on, maintaining my blank expression and steadfastly refusing to make known the extent of my despair.

When we finished seeing the patient, I asked the doctor to pinpoint when in her training the smell of feces ceased to faze her. She thought for a long time, and replied matter-of-factly, "It was sometime around the first year of residency."

Many aspects of medical school would seem impossible if not for the knowledge that other people have done it and survived. I don't understand how I will manage the long hours of residency, but I know that I will. I don't understand how I will know about so many diseases, but I know that I will. And so, someday I too will be a physician who is impervious to poop. I don't understand how I shall arrive at this point, but I know that I will. My nose and I will anxiously await that day in the meantime.