You're Going to Feel My Finger Now

Dear Friends,

    On December 7th, 1941, a Japanese fighter pilot crash landed on Ni'ihau, the smallest and westernmost Hawaiian island, mistakenly believing it to be uninhabited. The remarkable events that transpired on that tiny island over the next six days have become known as "The Ni'ihau Incident." I'll let Wikipedia tell you the story. Since reading this, I have been obsessed with the idea that this needs to be made into a stage play. I couldn't write a play to save my life, but I can write songs (especially if lives are on the line), so I composed a song about what it would be like if there was a play about the Ni'ihau incident.

The Boggy Man

I was 19 years old and seriously considering medical school, so my dad made arrangements for me to  spend an afternoon shadowing a colleague of his in the family medicine clinic. The first patient we saw was an elderly gentleman presenting for a routine health maintenance examination. Dr. Bower wasted no time introducing me as "Student Doctor London," and announced that I would be assisting him with the rectal exam.

 The misleading title made me a bit uncomfortable, but I loved the idea of "assisting." It implied that a good rectal exam requires teamwork, and I was part of that team!

So here I was, snapping on a latex glove and squirting lube on my right index finger. This is how the first patient encounter of my life would begin.

"Do you feel it?" Dr. Bower asked, "Do you feel the prostate?"

"Maybe," I said, "Actually, I'm not sure."

"You'll know you're there, because it feels just like the tip of your nose."

I carefully brought my ungloved left index finger to my nose and gently rubbed it back and forth. I was surprised to discover that the tip of my nose had a subtle divot that I had never noticed before. 

"Do you feel it now? Just like the tip of your nose, right?"

I was fishing around, but I honestly felt nothing, and repeating the hint just wasn't helping me. I needed another landmark, something akin to, "if you drive past the Wendy's, you've gone to far." No such luck.

"Does it feel like your nose, or is it boggy?" Dr. Bower asked with a slight note of concern.

At this point I should mention that the most enviable perk of a medical career is exclusive access to the world's greatest lexicon. We have delicious words, and we love using them. A rash might be violaceous, meaning that it's purple. On the other hand, it might just be heliotrope, meaning that it's purple. If someone looks sort of mousy, we don't say they have a "mousy face." No, that would be simply pedestrian. We say they have mouse facies. Other patients have Elfin facies or Mongoloid facies. If a child is just odd looking in an indescribable way, he just has facies. 

Boggy, on the other hand, sounds vernacular. It doesn't smack of medical jargon, the way "cloacal septation" or "hemi-albinoism" do, but don't be fooled. In the 15 subsequent years, I've never heard the word "boggy" used to describe anything other than a diseased prostate gland. 

At the time, the word meant nothing to me. I had recently learned what the tip of my nose felt like, but I couldn't remember ever having stuck my finger into a bog.

"No, it's not boggy," the patient chimed in with authority. The doctor seemed to accept that, which left me even more bewildered.

I realized I was still rubbing my own nose, much harder now, hoping that I would feel some sort of new landmark that I had missed, but all I felt was the same subtle divot, and now my arm was getting tired. Pretty soon I was going to need to switch hands.

It was no use. For a moment I entertained the possibility that I was exploring the wrong orifice, but simple visual inspection confirmed that this was not the case. The path was straight, there were no forks in the road, and my finger-length was adequate. I simply did not have the tactile facilities to locate a prostate gland. I would never be a doctor. 

Gradually, my frustration gave way to a sense of horror. What if this man's prostate was perfectly normal, and there was something wrong... with my nose? I had never noticed that divot before. Seriously, there's no way that a divot like that could have been there my whole life without me picking up on it. What if it represented some sort of malignancy or a rare wasting disease? What if it was the first manifestation of a syndrome that would eventually saddle me with disfiguring divots all over my body?

It was time to lie. "Oh there it is. Yes, I've definitely found it," I announced. Now I just needed to act grateful and pull out my finger quickly, but not so quickly as to appear impolite. 

"Just like the tip of your nose, right?" The doctor smiled, clapping me on the shoulder.

"Basically," I said, "Um, are you going to feel it, just to be sure?"

"Of course," he said, squeezing petroleum jelly onto his own gloved finger. He clearly misunderstood my request. I wasn't asking him to repeat the rectal exam. I wanted him, desperately, to palpate my nose and tell me how long I was going to live.

Lying awake that night, I decided that Dr. Bower probably didn't need to feel my nose because he could recognize the problem just by looking at me. I pictured him in the doctor's lounge the next morning, sipping coffee and talking shop with his colleagues.  "The most fascinating thing," he would say, "I had an undergrad shadowing me in clinic yesterday, and he had divot facies."

With warmest regards,

Zach