November 17, 2010
MIN Creative Writing Exposition 2010
By: Claire Cronin MD
Since the origin of the loincloth 7,000 years ago, mothers have
been telling their children (husbands implied) to wear clean
underwear when going to see the doctor. The underlying assumption
is that the physician is trained to notice and record the condition
of a patient's undergarments and that there will be a lasting
documentation of it in the medical chart:
Physical Exam
Cardiovascular System: regular rhythm and
rate.
Respiratory System: clear to auscultation.
Abdomen: soft, non tender, no hepatosplenomegaly, no
masses.
Underwear: neglected appearing with abnormal pink
overtones and severe loss of elasticity.
In reality, most physician appointments are elective which
allows a patient the opportunity to discreetly hide their knickers
beneath their pile of clothes when undressing. With the evidence
concealed, doctors rarely have the opportunity to judge the state
of a patient's undergarments. The younger generation avoids
commentary on their under-things by going "commando" and through
the adoption of the thong. The thong, even when worn, provides
precious little material for evaluation.
If on the other hand the visit to the hospital is an emergency,
then usually the underwear is either not present, having been left
behind at the scene of the accident, or already soiled from the
trauma, which makes the clean underwear issue moot on arrival. If
there is any undergarment remaining, it is cut off with shears and
placed in a plastic bag that will be returned to the patient at the
time of discharge.
The necessity of having to wear clean underwear when going out
of the house, just in case you have an accident has gone the way of
waiting 30 minutes after eating to go swimming just in case you get
a cramp. It has been replaced by a new edict that is far more
relevant which is, "Clean your Belly Button!"
This new concern to all is important due to the advent of
laparoscopic surgery. Gynecologists and surgeons are using small
incisions that are guided by a camera placed through the umbilicus,
to perform both elective and emergency surgeries. In order to gain
access to the belly button, the surgeon spends the first few
minutes of the operation cleaning the lint and other concretions
out of the navel. This preparatory step is occasionally accompanied
by gagging noises which is comical coming from professionals who
aren't fazed in the slightest by the two main byproducts of general
surgery, pus and poop. Unlike the underwear situation where very
little judgment occurs, comments such as "..and she seemed like
such a nice girl", are frequently heard in the operating room.
There is a surprising lack of awareness on the public's part as
to what can accumulate in a belly button and therefore what must be
removed. These collections can take the form of a hair ball or a
blackened wax cast of the umbilicus. Lint from clothes can
accumulate just as it does in the dryer. Some entrepreneurial folk
actually save and display their navel lint in jars. Unfortunately,
the volume of material increases as the patient ages and just like
their arteries, can harden. I like to think of it as a cache of a
lifetime of little treasures.
The anatomy of the belly button obviously plays a role in these
matters. This is primarily a disease associated with "innies" but
not exclusively. Some "outies" have folds that can collect a dark
grime in the hard to see areas. Women with belly button rings
usually have extremely clean navels as the purpose of the ring is,
to show off this titillating body part. After pregnancies, when the
piercing is stretched out, along with the rest of the abdominal
wall, the upkeep of the navel is usually abandoned as woman no
longer wish to draw attention to this area.
Most patients have not received adequate instruction on proper
umbilical hygiene. It has not received the same level of attention
that the area behind the ears has. I remember driving in a car as a
child with my parents and in front of us was a sedan with two
children and a plant in the backseat. My parents told my sisters
and me that the plant was coming out of the ears of a third unseen
child who didn't clean her ears properly. I had nightmares for
awhile but that was good parenting. I still search for the
beginnings of potato buds in the shower.
There is a technique to cleaning the belly button. It involves
soap and water and gentle probing. Care must be taken not to
scratch the inside of the skin which can cause infections.
Apparently alcohol should not be used in order to not disturb the
delicate pH balance of the area. Who knew the umbilicus had an
acid-base issue?
I once met a patient who flew from Bermuda to Boston for a
weeping, foul-smelling discharge that was emanating from his
button. He came with computed tomography (CT) scans and other
official reports from all the physicians that he had seen on the
island. The surgeon that I was working with took one look at the
patient's hirsute abdomen, glanced at the films and asked for a
Kelly hemostat. Without uttering a word he plunged it into the
patient's navel and pulled out a wad of old hair and muck that was
wedged deep into the crevice. It was one of the most successful
surgeries that I have ever witnessed.
Another woman who I think of with fondness prior to any
laparoscopic procedure that I am performing, came in as an
emergency patient to my office because she had been cleaning her
belly button with a Q-tip and when she pulled out the stick the
cotton tip was missing. She was attractive but very obese and
clearly very hygienic. I didn't mind one bit fitting her in between
patients to extract the prodigal "Q". She understands what is
important.
So until the next edition of the mother's handbook is released,
do not feel obligated to throw away your favorite pair of old
boxers but do pay attention to the maintenance of your belly
button. It is the window into your abdomen that must be kept free
of clutter in case you need your appendix out. Next time you visit
grandma, bring along some cotton applicators and tweezers and help
her navel out too. Try not to pass judgment if you find that
missing Lego piece from your childhood, as she grew up in the
pre-laparoscopic era. She seems like such a nice lady.
