A Day In the Orifice

By Hellin Brown

This book is a delightful memoir filled with medical tidbits you never knew and might never need to know. It is an honest and funny portrayal of human frailties intertwined with bits of medical history. It is graphic, descriptive and heartfelt.

It is not intended for the feint of heart, rather for the curious and for those in need of a chuckle. It is one woman’s take on the evolution of medicine over fifty years and her real experiences with the patients in the back office of that idiom.

It is written with unabashed honesty from her memory bank and embellished with her take on the world of medicine and how it has changed over those years she was a part of it.

• Language: English
• Publisher: Lulu Publishing Services
• Release date: Jun 13, 2016
• ISBN: 9781483453002

Book preview

funny.

DEFINITION OF ORIFICE

For those of you wondering what I mean by the orifice, let me shed some light on that…. Just bend over. WAIT! That was meant to be funny. The meaning of orifice is an opening or aperture; thus any external opening in the body of an animal can be considered one. They really are the ins and outs of medicine. Most male humans have a total of nine that you could potentially put something into. We women have one extra. This is generally the rule, but I did go to grammar and middle school with a gal who had two vaginas and two uteruses, and she didn’t know that until she reached puberty and was always having her cycle. There must have been something in the water, because another gal I knew in grade school was born with four kidneys and thus two collecting systems, which included two bladders four ureters and two urethras. I recall that they removed two of her kidneys when we were in grade school and most likely threw them away. This was just before organ transplants became possible. The first successful kidney transplant took place in 1954 between identical twins. For the most part, though, men and women each have two nostrils, two eyes, a mouth, two ear canals, an anus and a urethra. We gals have one more as the vagina is also an orifice. So women have ten major ones and men have only nine. Nipples and sweat glands and even the navel have been considered orifices, as have hair follicles and taste buds. So, in a nut shell, these orifices provide access to an internal cavity through a natural passage called a canal, duct or meatus.

In ears, the auditory canal, or meatus, directs airwaves from the outside to the tympanic membrane (ear drum) where mechanical energy is converted to electrical energy, which is then sent to your brain and allows you to hear. With nares, which are the holes in your nose, the inside surface is wet and collects dust and pollen as you draw air through them. It also helps to warm cold outside air before it reaches the lungs. Nasal meati inside the nose open to the four paired sinus cavities. These also collect inhaled particles and warm the air and perhaps lighten the weight of the skull. (I guess some folks really are airheads). And, of course, without our nose and olfactory nerve we could not detect smells. Our tongue, with its myriad of taste buds, allows us to detect sour, sweet, salt, savory and bitter. We even have receptors on our soft palette and in our esophagus and epiglottis. We each have fifty to one hundred thousand taste buds. The sweet buds are on the tip of our tongue. The very back is bitter, sour is on the sides and on the edges. And we need saliva for any of this to be detected. But we still need to smell in order to detect and identify other tastes. Try biting into a slice of raw onion while breathing only through your mouth and you will be surprised and no doubt convinced, because you might think it is an apple! Blindfold yourself and let a friend test you. You naysayers will be surprised! You really do need to smell to fully taste and recognize what you put into your mouth.

The mouth gives us access to the GI tract and the respiratory system. The urethral meatus is the pathway for urine to reach the outside from your bladder. Your bladder resembles a balloon and when it fills you recognize the urge to urinate. The anus dispels solid waste which is stored in the rectum and the vagina is the gateway to the uterus. Ostomies are holes, but are made surgically to the outside and are not congenital. There lies the difference. For example, if a section of your colon is removed and you are not able to have a bowel movement through your anus, the stool might be redirected to the ostomy hole or the stoma where a bag will collect those wastes, which you will then have to dispose of. These are not orifices as they do not occur naturally. Stoma is the Greek word for opening.

Birds, in contrast, have a cloaca. In Latin this means sewer. This is aptly named as it is a common chamber and outlet into which intestinal and urinary and genital tracts open. Some reptiles and amphibians have these as well. However, no placental mammals have these. There is a siphon in Mollusca, Arthropods and some other animals. I plan to stick with humans for the most part, but will introduce a few animal facts along the way, because we ourselves are part of the animal kingdom.

The Opossum is the only marsupial (pouched) animal in the United States. As far as I know, it is also the only animal with a bifurcated penis. Bifurcated means it is split into two parts or prongs. That is because the female opossum has a cloaca. Thus, the penis of the male has to look whole when entering, and then be able to separate lengthwise to form two halves, so each half can go directly into the fallopian tube and uterus on each side. I imagine the penis looks like a hot dog split lengthwise, but not for the entire length. I have also seen it described as a two pronged fork. Because of the two tines, long ago it used to be believed that the male opossum’s penis went through the female’s nose. This was because nobody ever saw the babies being born and then they just showed up in her pouch. They are merely embryos, when after a very short gestation and they are about the size of a bee, they crawl out through the cloaca and wiggle their way up through the hair on her belly and enter her pouch and attach to a nipple. This happens eleven to thirteen days after fertilization and over twenty babies might be born, even though an average litter consists of eight to nine infants. The mother possum, as it is commonly called, has thirteen nipples. Twelve are arranged in a circle and the thirteenth is in the center, so she can successfully raise a litter of thirteen three times a year in the North American climate. The babies finish their gestation attached to their nipple for about two months. At this time they will crawl out and live on her back or abdomen while clinging to her hair. Another interesting anomaly is that the male opossum sperm heads align and pair inside the male reproductive tract. They are ejaculated in pairs and remain so until just before fertilization. Most humans have one uterus and usually give birth to one offspring. So we are not used to having womb mates. Other mammals like cats and dogs have multiple uteruses and routinely have multiple offspring with double the number of nipples needed to feed their babes. Octomom with her eight live babies in one uterus was a stretch. (Pun intended)

That reminds me of a neighbor of long ago who knew we had a cat and that I worked in a doctor’s office. He knocked on our door one day holding his male cat, BoBo. He was visibly upset and said, Can you help me? BoBo has all these lumps on his stomach. What’s wrong with him? Well, my hubby looked closely, gently felt the cat’s belly, and said, Howard, those are nipples. His indignant reply was, What do you mean they are nipples? He is a boy! My husband asked calmly, Howard, do YOU have nipples? And he looked dumfounded and replied, Yes, spun on his heels and left, no doubt embarrassed. So, even though the number of nipples is indicative of the number of offspring in most cases, you guys don’t need them to feed the young and they are just a remnant. I will explain more about the reason for that later. Even though men do not need their nipples, it was illegal for them to expose them before 1936. Most female humans have two nipples, and if things are left to nature, seldom have more than two babies at a time. I actually have seen extra nipples in women either below the regular ones on the front of the body along the mammary plane or even under the arms where they might contain breast tissue as well. The elephant is the only other mammal I am aware of whose breasts are situated under their front legs, which would anatomically correlate with our armpits. It is thought that most mammals have twice the number of nipples needed for an average sized litter. This ensures survival of the species.

ZEBRAS

When a patient comes into a doctor’s office, usually the person who rooms them and takes their vitals hears their troubles first, before the doctor even sees them. At least that is the way it was when medicine was different. Now you get a quick set of vitals done and are put in a room to wait for your fifteen-minute appointment.

Often, just being able to relate their symptoms and receive a much-needed hug can make folks feel better. Sometimes tears are shed, and often the patients feel healed just by being able to unleash their fears and have someone listen and take them seriously. It goes without saying that survival is our number one basic instinct. It is the human condition to fear for our lives. Long before the internet, Timor Mortis was just as real. Now people come in having researched their symptoms, certain that they have their diagnosis, and are often disappointed when they aren’t sick! In fact, years ago, one doctor said to me, It is much more common to have an uncommon manifestation of a common disease, than it is to actually have that uncommon disease. He was right-on. Patients, and often doctors, look for the worst case scenario when it comes to illness. I just did it the other day when my hubby’s balance was off. I went for a stroke scenario instead of first suspecting his ears.

Medical students are taught several specific principles. They hear about and study so many rare diseases that they tend to expect to see them in their everyday practice. Sometimes, however, they spend way too much time looking for these rare diseases and therefore miss the simpler ones. Doctors sometimes refer to these rare diseases as zebras. Many doctors hear hoof beats and want to think zebra when they should indeed be looking for horses. On the other hand, they really do need to know about those zebras, especially now that there is so much world travel. Another medical aphorism, Occam’s razor, states that when you are faced with a difficult problem, the correct explanation is usually the simplest one, especially if it uses the fewest assumptions and can be proven with known facts. While this is useful advice, doctors are constantly reminded to avoid thinking intuitively which might lead them down the wrong path in trying to make a correct diagnosis. Another medical aphorism deals with decision making, and is known as Sutton’s law. Seems bank robber Willie Sutton claimed he robbed banks because that’s where the money is. This simple assumption suggests that doctors should look for the money when making a diagnosis by ordering tests which most likely will confirm or rule out a disease. The term shot- gunning tests refers to ordering every test in the book and hoping to confirm a diagnosis if they make a hit…kind of like shooting a spray of buckshot. One of the most important aphorisms is When in doubt, ask the patient. One would think this would be the first and best approach. Most patients know what is going on in their bodies and often don’t want to be subjected to a bevy of unnecessary tests. I have gone into offices where the doctor has never laid a hand on me. I find that worrisome in this world of high- tech medicine. One would hope that most doctors reach sensible conclusions using both intuition and clinical exams along with a few initial tests to support their suspicions. Doctors are also expected to honor the Hippocratic Oath, which is swearing to practice medicine ethically; to never cause harm, to never give a lethal drug even if asked, and to keep the patient’s information private, are a few examples. Some of that is changing along with our times. I just read in this morning’s paper that our state is preparing to join several others to allow doctors to assist patients in the dying process. Amen to that, if you ask me.

Currently, about thirty nine percent of family doctors said they communicate with patients