It’s graduation time again… I’m reposting this essay about transitions:

Hail, graduates!

After the first day of medical school, my mother called to ask me how it went. Then she threw in a kicker:

“I have a small rash I want you to look at.”

What the heck did she think I learned in one day?

I now know is that she was giving me an early lesson in boundaries:

I had crossed some magical line into MD-land, where I’d be expected to answer any question and have an opinion on all parts of the body and all medications, herbal supplements, chemicals, diets, beauty products, and the latest studies written about in newspaper articles (people read actual newspapers back then).

No matter that I’d had one day of the Krebs cycle, and nothing to show for it. I was now an almost-doctor!

Persnickety guy that I am, I really got frustrated when my Mom sent her friends in my direction, too. “I’m not a doctor, I just play one on TV,” became my go-to line to deflect their unwanted medical questions.

Things changed even more dramatically when I started internship.

My first day on the wards, I took over the care of Mrs. Manganelli, an unfortunate woman in her midfifties afflicted with severe multiple sclerosis (MS). This is a disease that wreaks havoc with the connections between nerves, and nerves to muscles, making things we take for granted like swallowing, walking and breathing very difficult. It also affects “toileting.”

Mrs. Manganelli (not her real name) had been admitted for severe constipation. Her MS had made her intestines barely able to move food and the resultant waste products along their course. An x-ray confirmed that her colon was “FOS” (full of stool, or a less nice word we somtimes use).

My supervising resident and the patient’s nurse gave me a strange look, with big eyes and a smile I mistrusted, telling me that “disimpacting” was the intern’s job.

I was scared to admit that I didn’t know what disimpacting was, but their looks told me it wasn’t pleasant.

To hide my ignorance, I asked what “tools” I’d need for the job. The resident pointed his finger at me, and the nurse handed me a chux, those ubiquitous blue pads that are all over hospitals to place under patients and clean up messes.

Then I understood: I was going to be making and cleaning up a mess from poor Mrs. Manganelli.

“I don’t want to be a doctor,” I thought to myself, in response to this form of hazing. “This is going to be a long and awful year.”

Mrs. Manganelli, apparently used to being disimpacted because of her illness, rolled onto her side (with help) and assumed the position.

Using a gloved finger and lubricant, I found what we would technically call “copious amounts of soft brown stool in her rectal vault.”

Her disease meant she had nearly no sphincter tone, so once I was able to initiate the flow of poop out of her bottom, it started coming out on its own. Lots of it.

A heaping pile.

And as gross as this story is, there are a couple of interesting facts and lessons I took from it.

Mrs. Manganelli felt about a million times better after being disimpacted. It was really remarkable both to see how dramatic her improvement was, and that I’d had a direct hand (so to speak) in making her feel that way.

When my family wanted to hear about my first day of internship, I proudly related some of the details of what I’d been through, thinking they’d find it amusing, or at least fodder for some storytelling.

Their reactions told me that I’d crossed over. Never again would I be able to share unfiltered details from my world. They couldn’t handle the truth.

So now, for better and worse, I live behind a magic curtain of people’s expectations and perceptions.

Like Mr. Gorbachev, I hope to tear down this wall.