Ew

(This post is not for the faint-hearted or easily-offended)

People are often telling me that they could never do medicine. They cite many reasons, but the one that comes up most commonly is that it's 'just too gross'. It amazes me just how truly squeamish people can be: I have a father and an uncle who need to breathe into a brown paper bag at the mention of something so mild as a skin incision, a boyfriend who shudders in disgust if I so much as breathe the word 'pus' near him, and a brother who becomes indignantly repulsed if if he has to witness any scenes from Extreme Makeover, no matter how brief. I always tell people that they would be able to deal with these things if they were introduced to them gradually, as is done over the course of a medical degree. We make acquaintance with the various nasties of the human body at a pace that is gentle and unjarring - we're not just tossed into a vat of diarrhoea and amniotic fluid at the beginning of first year and then told to deal deal with it.

That being said, we're not immune to unpleasant things, and although we certainly don't enjoy being up very close and personal with something that smells, looks and feels hideous, we love talking about it afterwards. There are protracted discussions in the tea room on a daily to weekly basis that revolve around the most revolting things we've ever seen.

Currently doing the rounds is a story about something that was seen a few weeks ago. Patients at the hospital I work at are first seen by a casualty officer, who then decides if they're going to medicine, surgery, or home. Once the decision has been made to send them to surgery, the casualty officer writes the patient's name in a big book on our desk, and alongside that the presenting complaint. Now, I could blab on for hours about how truly unglamorous medicine is (contrary to popular TV-series belief), but I knew we'd hit a new low in the anti-glamour stakes the day a casualty officer wrote in our book: 'Mrs X; Maggots in Anus'. What awaited the surgeon-on-call was an elderly lady with advanced rectal carcinoma. The tumour had grown so large that it was protruding from her anus, and sure enough, there were several small, shiny maggots crawling about in its necrotic centre. (This particular case begs our favourite question here in this country: 'Why did you wait so long?')

Another nasty that we're exposed to on a daily basis at the hospital that I work at is diabetic foot. Now, dear readers, I know that many of you hail from civilised places like America and Europe, where the term 'diabetic foot' refers to a bit of a fungal infection between the toes, or a small ulcer or two. But, as Leonardo DiCaprio recently said, 'TIA, baby', and in Africa we mostly don't have to choose between antibiotics and minor debridement, but between below- and above-knee amputation. My first exposure to diabetic foot on the African scale was as a fourth year student, when I was required to hold the leg up while the scrub sister cleaned it in preparation for surgery. I'm short. The foot came very close to my face. Everything went fuzzy for a moment, and I had flashbacks to the time I went on holiday with my family for two weeks, and the electricity cut out back home, and we came back to a freezer full of rotten meat. The distinctive smell of a diabetic foot fills up any room quite quickly, and if you know it, you know that if you follow your nose you'll happen upon some dejected looking individual hunched up in a wheelchair, with one foot wrapped messily in a long bandage which is soggy and black with necrotic ooze. (It's not uncommon to find maggots underneath these bandages, either.)

And for those of you still with me: one last paragraph of yuk. If I thought I'd hit rock-bottom when I saw anal maggots, my friend Iwan felt he was there a few weeks ago after he had to spend the day with a rectangular stain made up of blood, mucous and genital wart-juice on the front of his shirt - placed there by a patient who had slapped him on the belly with her sanitary pad (it was apparently an accident, but still...). 'Foul-smelling vaginal discharge' is the presenting complaint of thousands and thousands of South African women every day, and it is usually caused by either pelvic inflammatory disease, or by foreign bodies in the vagina - another favourite tea-time topic. People put weird things up there. As a student I once saw an old lady whose family brought her in when they just couldn't take the smell anymore. We found a bottle of paracetemol wedged up near her cervix. A gynae once told me about the finger of a latex glove he extracted from someone's posterior fornix: whether it was left there by a careless doctor or someone who was trying to use it as a condom-substitute is a mystery to this day. A friend of Iwan's recently saw a woman who had for several weeks been trying to manage her discharge on her own. The son of a cardiothoracic surgeon, I imagine this friend had been exposed to human innards at an early age, and is actually quite strong of stomach, but when he inserted his speculum and started pulling out wads of soggy, green, stinky tissue from the patient's vaginal canal, he just couldn't take it anymore: he turned and vomited into the basin behind him.

I could go on forever: the smelly abcesses, the fallen-off penises, the bum troubles, the tum troubles. But I think you get the idea. What's the most horrid thing you've ever seen?