Blood? Vomit? How to deal with the disgusting

It is widely accepted that, as a doctor, your disgust threshold will be different from other people’s. “How do you cope with blood and vomit all day?” people ask. “I couldn’t stand it.”(In an ordinary day you’re more likely to be coping with a shortage of Biros, but you needn’t point this out – it’s nice when people see your life as exciting.) Everyone has a different answer, and there is no doubt that doctors themselves vary in their tolerance, to an extent that may dictate their choice of career. Colorectal surgeons, for example, may be blasé to the point of breeziness about the things that come and go from what the rest of us delicately refer to as “the tail end”.

On my first job, I met a surgical registrar whose mobile was full of photographs of items he’d extracted from patients. At the end of each operation he’d have himself photographed, posing like a proud father with whatever he’d retrieved: remote controls, vibrators, plumbing accessories. “Where do you think I found this?” he’d ask, flashing a shot of himself in operating blues cradling an aubergine. “Eurgh, Mr S, MUST you?” the new doctors would squeak. “You’re not NORMAL!”

Gloating over sex accidents probably isn’t normal, but all doctors, even those with a more evolved sense of humour, have to overcome instinct and programming in order to be able to deal with the things that society and culture find revolting.

Humour is a part of this – remaking an awkward situation into one that is at least a little bit funny. The joke is usually on the doctor. A colleague told me about a consultation in which he’d asked a patient about his bowels. The patient took a handkerchief out of his pocket and put it on the desk between them. He unfolded it carefully. “I don’t know why, but for some reason I thought he was getting out his lunch,” my colleague said. A fresh stool perched between them. “I brought you a sample, to show you,” said the patient. “I didn’t know what to say. So I just said: ‘Thank you, that’s helpful!’” said my colleague. “But the worst bit was, before I’d had a chance to bin it for him, he’d folded it all up and put it back in his pocket.”

Sadly, most repulsive things aren’t funny, and then it is down to context and repetition to diminish any reflex disgust. It’s different because you’re at work; and it’s different because you’ve seen it a hundred times before. And it’s different because all the accidents of the body are either asking you a question – “What is wrong here?” – or sending you a command – “You need to do something NOW!”

The pain or distress the patient is experiencing becomes far more compelling than any dirt or smells that may result. This became obvious to me the first time I was called to see a man who was vomiting blood. Haematemesis is a relatively common hospital emergency, which doesn’t lessen its impact on a first encounter.

It is a horrible event: an awful smell and a terrible mess (as you get more experienced, you learn to pause for long enough to put on a plastic apron before you approach the patient, but the first time, in your panic, you inevitably lean in a pool of coagulating bloody vomit).

None of this impresses you as much as the patient’s fear. Their terror is mirrored by yours: all you want to do is fix it, make it stop. For haematemesis that means getting two big cannulae inserted; sorting out intravenous fluids and blood and medication; and arranging for an immediate endoscopy. When you’re in the middle of it, that is all that matters.

Sophie Harrison is a hospital doctor in South Yorkshire. Some details have been changed to protect identity

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