Private Parts

Possible prostate findings to feel for in the rectum.

Today we learned how to perform the genito-urinary exam. I was thankful that our afternoon began with a perspective-setting commentary from one of our faculty who pointed out that the day you learn to examine someone's penis, vagina, or rectum is one of those profound days in a life of medicine when you realize you are doing something very different than most other people in the world. How to feel a testicle without squeezing it too hard, how to perform a pap smear, how to insert your finger into the rectum to palpate the prostate; these tasks are about as visceral as it gets, and require both intimacy and calm detachment.

Indeed, in learning to handle the private parts of strangers, there seemed to be an interesting mix of emphases. On the one hand, confidence is paramount. One of my favorite quotes is that "it's hard to lead a cavalry charge if you think you look funny on a horse." Likewise, it's hard to examine a vagina or a penis and make the patient comfortable if you are sweating bullets and are visibly horrifically uncomfortable yourself. The patient must believe in you and they can only believe in you if by all appearances you seem to believe in yourself.

On the other hand, this is no time for cocksure behavior. The private parts are no realm for assumptions about your competence or calming presence. It is no time for assuming you know how the patient is feeling or for falsely believing enough perfect grace will extinguish their fear or discomfort. 

Thus, as much as confidence was emphasized, so too was humility. Always finding ways to keep the patient as covered as possible, always working the hands slowly from a place of comfort first before you arrive at a territory of primal sensitivity, always warming your speculum, always checking to see if the patient is doing alright; these imperatives remind you that as much as you try to detach and focus on palpating the private parts before you like it's your job (it is), you are dealing with human beings who feel, fear, love, cry, hope, think and worry as deeply as you do.