Recently, my registrar and I were doing a ward round at quarter to eight on a tuesday morning and discovered that one of our patients had been complaining of bleeding from the "back passage". While in your average man in the street this inspires nothing more sinister than a snigger at the euphemism, to pretty much every doctor in the land it inspires at best a weary shudder.
Obviously, this is because blood in someone's poo means you have to stick your finger up their arse. In medical parlance this is to "perform a PR", and the chances are you'll find something which stinks even worse than usual thanks to the disgusting smell partly-digested blood produces. Unfortunately for us, it's a really good clinical examination - you find out if they're constipated, if there's obvious blood, if it's likely to come from low down the gut or higher up, whether there are any lumps or bumps suggesting anything from haemorrhoids to cancer, you can feel the prostate in men, and you can use it to localise abdominal pain by applying pressure in various different directions which can, for instance, help you identify an appendicitis.
It's also not something you particularly want to do at the best of times: only the dangerously weird actually enjoy it - but before you've had breakfast on a tuesday morning adds that little bit of top-up misery.
Our patient, thankfully, was fine. As we went to wash our hands I shot the reg a mournful look. He replied simply, "Sometimes I envy those city boys." We carried on.
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