Category: Practical Medicine

Pap Smears and Tools of the Trade—Dr-Patient Relationship

Subtitle: Blurry Bottoms—Hand Me a Screwdriver (1987)

For two years Maryann, an attractive mid-30s brunette, had been putting off getting a Pap smear because she didn’t particularly like the OB/GYN doctor she had seen in the past—he was somewhat cold and distant—made her feel uncomfortable, so she put off going. Finally, fear and guilt took over, so she asked her friend for a new doctor recommendation.

Over the years, because of my wife’s hypersensitivity (at least from a male’s standpoint) to being over-exposed “in the position” for a pelvic exam, I had become very conscious of and sensitive to the feelings that most women harbor about being “in the position” with a man doing the examining (notwithstanding Jane, my nurse always standing nearby). Because of my kindly and non-patronizing demeanor and my gift to be able to assist women in feeling a bit of security in an uncomfortable situation, I had gained a reputation as a safe, caring gynecologist. However, my personal or family female friends either came to see me BECAUSE I was gentle and sensitive, OR, they would NEVER in a thousand years come to me for a pelvic exam, because they imagined that if I run into them at the store or church, I’d remember what their bottom looked like (in actuality, for medical providers all the bottoms become sort of a blur, anyway).

So, following her friend’s recommendation, Maryann sheepishly presented at our office. Taking a brief new-patient history, Jane showed her into the exam room and handed her a folded paper (“maximum exposure/minimal coverage”) gown with instructions to take off all her clothes, don the gown with the opening in the front and sit on the end of the table. Moments later, I joined them.

I glanced at the history form—Maryann was essentially healthy, although it was apparent that because of “new doctor/Pap smear” complex—she was understandably jittery, so we made some small talk to help her be more comfortable for the assessment, and with Jane holding her hand, I began with a breast exam—all went well.

Then, with my back to them, I slid on my latex gloves while Jane assisted Maryann to lie down and put her legs up in the stirrups. Over the years, I found that if the patient can’t see my face because of the drapes and position, they are less uncomfortable—kinda like “if I can’t see you, you can’t see me” sort of disconnect. I sat on a stool facing the bottom end (no pun intended) of the exam table, where, just in front of my knees, were two instrument drawers storing the exam speculae (the “duckbill exam thingies” as they were known to many female patients). Maryann was fully-positioned ready for the instrument exam. I applied KY gel to her and reached to open the drawer to pull out a sterile speculum. The chrome drawer handle fell off in my hand! I was unable to open the drawer to get the exam instrument!

Then, in one of those moments you’d like to go back and relive so you can phrase something differently, I unconsciously said, “Jane, hand me a screwdriver!”

I’ll never know exactly what went on in Maryann’s mind that moment, but instantaneously she was sitting straight up on the table with one arm covering her breasts and her thighs pressed together—I just barely got out of the way of flying feet as she screeched, “What are you going to do with THAT?”

Too late to rethink my phrasing, I immediately realized that I had done a massive faux pas, worsening an already bad situation.

Jane promptly grasped Maryann’s hand again and patted it as I displayed the errant loose drawer handle, apologizing for my poor choice of wording/timing. After a short, very quiet pause, we all had a hearty laugh—it broke the ice and the remainder of the exam was quickly completed without incident.

Maryann ended up coming back for her Pap smear year-after-year, but each year before she’d lie down on the exam table, she made me prove the drawer handle was functioning and that no screwdriver would be needed.

Dr Carlin Intro

Once a prison inmate presented to my ER with a five-inch “shank” (homemade knife) jammed into his right temple to the hilt—and he lived to tell about it.

That caused me to later reflect: “Carlin, you’ve seen things that almost no-one else in the world has ever seen. Maybe others would be interested in hearing some of the unusual—or even the not-so-unusual—cases, and in relating and sharing some of their own.

So, the idea of this blog was born—a place where an Old Timer like me can relate and share medical “war stories”—mine and others’; a place for posting practical, common-sense remedies, and a source of medical edutainment and humor. A doctor can learn a lot by simply observing and being aware of what is going on—actually examining the patients—including having the “stethoscope in the ears” (hence the title of this blog).

“Doctor Carlin” was a Family Practice doctor (also doing OB) in a medium-sized Arizona community for 15 years, then switched to Emergency Medicine in mostly-rural hospitals all over South Texas for 4 years and afterward continuing in central Arizona until retirement.

A colleague once told me, “Yeah, I wanted to be a doctor from the time I was a little kid.”

Not me. Dr Carlin had not considered becoming a physician.

My Dad was a cattle and sheep rancher. I grew up knowing that he had had a dream and passion for Bridge Engineering and that he’d completed a year and a half of Engineering at a university. Then the Pearl Harbor attack, December 7, 1941. Since his background was farming/ranching, while everyone else was rushing to enlist to return the fight and exact revenge on the perpetrators, Dad was mandated to leave college and go home to the ranch to help raise food for the troops and the rest of the country. He never got back to college. I grew up wanting to go into Engineering, so I could fulfill his dream.

As I neared High School graduation, it seemed that all of my closest friends had college scholarships for one course of study/college or another. But not me. I’d already been accepted to a university—of course into their College of Engineering. But somebody forgot to tell me that if you want a scholarship for college, you have to actually apply for one. I hadn’t—I was without. Then, two days before graduation, I found out that the local Mothers’ March of Dimes organization had offered a scholarship for $150—but it was only for a Pre-Med student who was actually registered in Pre-Med, taking Pre-Med classes and everything!

I thought about it for about three minutes. Then I lied: “Yes, I AM a Pre-Med student.” On the spot, I filled out the application—and since I was the only one applying—they awarded it, handed me a check made out to my college, and the scholarship was announced along with those of my friends on graduation night as I crossed the stage.

Three months later, March Of Dimes check in hand, I went in to officially register in college classes. Now, I had a dilemma—continue with the lie and my Engineering direction, or personal integrity—meaning I’d have to register in Pre-Med and actually take the classes (at least for a quarter, to keep up the façade while spending the tuition scholarship money). I chose the latter, intending to change majors back to Engineering at the beginning of my second quarter. So, in the company of 450 other new Pre-Med students, I began classes in the fall of 1966.

I soon found that the Pre-Med curriculum was challenging! But, notwithstanding my (typical Freshman) immaturity, I was keeping my head above water in my class/labwork. So, I decided to keep plugging away for a 2nd quarter. I began to notice that Pre-Med students were dropping out of the program like flies and switching to other, less demanding, majors. It became a challenge to me—by the end of my first year, I had decided, “I can DO this!” My lean towards engineering became less, then none at all. For the first time in my life, I began entertaining thoughts of actually being a doctor. I stuck it out. By the time I graduated (with a double major—Pre-Med and Journalism) in 1970, there were only 20 of the original Pre-Med students who graduated in Pre-Med—the rest went to other majors. And of those 20, only 5 had been accepted to Medical Schools, anywhere in the world. Of the 15 others, two had been accepted into Dental Schools and the rest graduated with a nearly-useless Pre-Med Zoology B.S. degree (many of them were accepted into advanced-degree programs and may have subsequently re-applied to medical schools). (to be continued)