If one is good, then two is better...

My co-intern and resident were down in the E.R. last night admitting a patient, and I, being caught up on my work, was waiting for them to eat dinner. I realized the cafeteria would be closing some of its lines soon, so I went to the workstation in the E.R. and asked if there was anything I could do to help. Clay told me, "Well, I'm almost done writing orders, but we need a rectal exam with a guaiac test, and a tilt test."

A rectal exam is just what it sounds like, performed with a lubricated gloved finger. It yields information about sphincter tone, the shape and texture of the prostate, and if there's stool in the rectum. A guaiac test is a cheap and inexpensive way to assess for hidden blood in the stool. And finally a tilt test, which takes about 4 minutes, is done by taking the patient's blood pressure and pulse while supine, sitting, and standing. The results of this test give a clue to the patient's blood volume status.

"I'd be happy to do those things," I told Clay, thinking it would mean we'd eat sooner. After seeing the patient, doing the tests, and bringing him a warm blanket, I dropped off the guaiac card at the nurse station and returned to the doctor station to find Clay and my resident. They were gone! While looking around for them, I noticed the patient's door was shut, even though I'd left it cracked open. There was Clay, performing yet another rectal exam on this poor patient!

Clay later told me he thought I was kidding when I volunteered to help.