What Gets You?

Everyone (and I mean everyone) who works in healthcare has an Achilles heel. Of course anatomically speaking we all have a tendo calcaneus but that is not what I am talking about.

Nope. What I am referring to is the bodily fluid, odor, sight, sound, sensation, taste, texture, illness, task, procedure, or person that you just can't stomach. That 'thing' that 'gets you'. It makes you weak in the knees (in a bad way), causes your vision to go a little red and fuzzy around the edges, your blood pressure to drop, your gag reflex to fire, sweat to bead, and hands to become clammy.

From geriatric lab techs to weather-worn nurses, crusty old doctors to gritty respiratory therapists--they have at least one 'thing'. And if they say they don't, they're lying.

I was having this discussion with a newbie medical student a couple of weeks ago saying how it'll be interesting to watch everyone in our class discover what their medical Achilles heel is. I know what mine is. Well, if I am completely honest I have quite a few Achilles heels. I always thought that over time they would disappear, but even several years of working in emergency departments hasn't numbed me to a few shudder inducing 'things' that still 'get me'.

1) Nails. I mean finger or toe nails. When they are severely deformed or overrun with fungus, shattered, or split I feel a shiver go through me. The last time I almost fainted in the ED was from attempting to overcome this issue by pulling out the shattered bits of finger nail from a crush injury.  My feeble attempt at medical aversion therapy. I'm getting better with them but still don't think I could watch an ingrown toe nail surgery.

2) Crepitus. That is the crunchiness you feel when there is broken bone under the skin (you can also have crepitus for other reasons which do not creep me out so I am not discussing those types). I am talking about bone crepitus.

My 2006 almost-faint-during-procedure was in Whistler where we dealt with countless fractures that required skill at removing ski-boots/snowboard boots/bib-pants/long-underwear etc. Contrary to media portrayal we *do not* cut clothes off people most of the time, especially there when a pair of good ski pants can run you over $500! So you've got to hold on to the crunchy, floppy, limb while a colleague pulls the fabric or boot off. This I am borderline ok with most of the time but sometimes during reductions or casting it makes me get all sweaty and pale. The worst one occurred was while I was holding traction on a 4 year old boy who had broken his leg. I still remember that purple cast and the wave of nausea taking over me as I felt those little bones shift under my fingers."Don't faint! DO NOT FAINT" was my mantra for the entire task.

Bones in general freak me out actually. The feeling of ribs cracking when doing CPR is really unsettling, seeing ribs cut during autopsy also makes me almost hit the floor. Though strangely, compound fractures (i.e the bone sticking out of the skin) don't bother me. There is no rhyme or reason to these aversions.  But I suppose this eliminates 'orthopod' from future residency options.

3) Pseudomonas. Once you smell it you'll remember it for life. The best way that I can describe it is a putrefied, sickly-sweet, heavy, rotten smell. And I swear---with no scientific evidence whatsoever to back this statement---that the odor molecules from this microbe are larger and stickier than any other. Once you breathe it in it seems like the odor attaches itself to your nasal passages for days. Days, people! I am not exaggerating. You're riding your bike or eating dinner or watching a movie, you inhale and BAM!! it's there again, like you're face is right in a giant petri dish of the stuff. When a patient has an infection of this flavor I need to put a little clove oil under my nose to make it through the shift, or a dab of friars balsam on the neck of my scrub top. Trust me, it's bad.

Those are probably my top three shudder-inducers. I always find it interesting to poll my medical colleagues as to what theirs are, and often it is not what you'd think. It's almost never the big things that jump to mind as the offensive bodily fluids. It's almost always bizarre and random phobias. I have co-workers whose 'achilles' is a thing like: knees (they don't want to touch them, especially if there is something wrong with them), or suctioning sputum (spit), touching feet, seeing greasy hair, assessing rashes, etc. Some of them I can understand but others (knees?) are beyond me.

To work in places like the emergency department or an operating theater I suppose it is adaptive that we aren't disturbed by the usual suspects, otherwise we couldn't do our jobs. But it is funny how certain aversions (or phobias) still manage to leak out and remind us that we are not bullet proof to the bodily aspect of the human condition.

What gets you?