Toads-in-the-Hole

For the past four weeks I’ve been working at the final assignment of my second year of medical school: the family practice preceptorship. Designed as a relatively low-risk buffer between the incredibly cerebral, all book-learnin’-and-no-patient-pokin’ initial two years of school and the more free-wheeling third year wherein students are called upon to actually have a hand in patient care, therapy, and (for all I know) kidney transplants, (this is a pretty long dependent clause, you may want to check back to the beginning and orient yourself to where all this is going) the family practice preceptorship subjects students to an intensive trial by fire of the everyday afflictions that bring the general public in to see their doctors, i.e. sinusitis, allergies, and the sniffles. But, in my case, nasal congestion, mild cough, and occasional sinus headache turned out to be merely the tip of the iceberg. Underneath the water lurked a hidden mass of warts, flesh-eating bacteria, and prostatitis. Ew.

To speak of the first, I’ve had my share of warts. My verrucae vulgaris tended to spring up on my fingers, and while I was never terribly afflicted, I remember being pretty embarrassed somewhere around age 12 when I had three warts simultaneously on my left hand. I would periodically go in to our family doctor to have them taken off. He was always happy to see me, and his enthusiasm for wart removal verged on glee when he demonstrated his new electro-cautery gun. The stench of burning hair would sear my nose as he torched the affected area. “Got any more?” he’d grin hugely, making his little gun go Zzzt-zzt. “I’ll take 'em off for free!”

In the clinic here in Vermillion, we use a liquid nitrogen spray to freeze skin lesions. Rather than disappearing in a cloud of foul-smelling smoke, they blister up and then peel away, leaving behind normal-ish skin. I carefully watched my attending doctor freeze a pre-cancerous lesion on a patient’s nose, so I was ready when she handed me the sprayer and said, “Now get the spot on her arm.” The patient winced as I carefully sprayed the area. To make us all feel better I said to the patient, “Here, you can get even with me, spray this wart on my thumb.”

She declined, but afterward my doctor smiled and said, “That’s a good idea, you should know how it feels for the patients to be sprayed.”

“So I can gain a sense of empathy with the patient?” I asked.

“Right, empathize with what they’re going through,” my attending replied.

As it happened, later that day a middle-school-aged kid I knew came in to have his warts frozen. He seemed pretty anxious about the process, so I repeated the offer I’d made to the previous patient. The young man happily grabbed the sprayer. “Just point the nozzle at my wart and pull back on this lever,” I said, ready to set everybody at ease with my relaxed and stoic demonstration of how to take liquid nitrogen like a man.

Sshht, went the sprayer. Shhht-shhht.

“Okay,” I said. Sshht. “Hmm. Um… ow. Ow!” Shshshhht "OWW! Oh man, Oh MAN that stings. Oo! That’s enough, that’s plenty!”

My young patient, looking even paler than when he’d walked in, nonetheless managed to sit still as I got my revenge on him. Our friendship now on somewhat shaky ground, I walked out of the examination room with him, carrying the sprayer. “See you later, buddy,” I said as cheerfully as I could through gritted teeth, and, for some reason, waved goodbye with the hand that was holding the sprayer.

FWOOOSH went the sprayer as the lid came partially off, directing a thick stream of nitrogen down onto my hand. My attending leapt backward, the young patient reflexively went into a defensive crouch, and a patient from across the hall stuck his head out the door and asked, “Everybody okay?”

A large blister began to form on my hand. I looked at it, then at my attending, and said, “I feel very empathetic.”