She Wiped Her Nose, Then Prepped My Biopsy. Still, It's Hard To Ask The Nurse To Wash Her Hands

Hand washing before and after touching a patient is mandatory. And before and after walking into a patient’s room or touching medical equipment. (Arlington County/Flickr)

Hand washing before and after touching a patient is mandatory. And before and after walking into a patient’s room or touching medical equipment. (Arlington County/Flickr)

I was lying on my back on a gurney, getting my abdomen washed by the nurse.

She dipped Q-tip-like sticks into the brown antiseptic and then swirled them on my skin where the physician would make his incision. He would penetrate layers of skin and muscle to get into my liver and extract cells. He would send the cells to the laboratory to assess what kind of cancer I had. Eight days earlier, I had learned I had masses in my abdomen and chest. Three days earlier, I had learned the masses were cancer. That day I was on the gurney getting prepped for a liver biopsy, to find out what kind of cancer it was.

While one nurse washed my incision site, another nurse prepared the room. She was adjusting the lights, surgical equipment and my gown. And she rubbed her nose with her hand. Everyone rubs their nose. Humans unconsciously touch their nose or mouth more than 3.6 times per hour.

When we do this, we spread germs into our body from whatever we were touching before and spread germs from our body onto whatever we touch next.

I laid there and wondered if I should say something to her.

In medical school in the early ’90s, I had learned about the risk of normal nose bacteria infecting surgical sites. While on the gurney that day, I remembered a story about a patient with a massive infection in his surgical wound site. The hospital searched for the source of his Staph aureus. They found it in the surgeon’s nose. This story was told to us to remind us of the dangers of what we were seeing on the wards in medical school — which was still full of old-school clinicians who drew blood without gloves and washed their hands only intermittently.

Today things are supposed to be different. Hand washing before and after touching a patient is mandatory. And before and after walking into a patient’s room or touching medical equipment. The compulsory annual online classes for all clinicians include specific directions on how to wash your hands. There are signs on the walls and screen savers on the hospital computers reminding us to wash our hands.

But there I was, flat on my back, wondering if I should say something to the nurse. I was afraid she’d be upset with me if I said something — I was all but naked, lying on my back and pretty much in her hands. The hands that had just wiped her nose. I didn’t say anything. I tried to get my courage up to say something — but couldn’t. A few minutes passed. I decided it was too late to say anything. But I told myself if she did it again, I would say something to her.

And then she did. She rubbed her nose with her hand and then reached for the equipment table with that same hand. The equipment that would be in my liver in a few minutes.

I called her on it. Continue reading

Why To Exercise Today: Your Gym Mates Can’t Be This Bad


Rarely do I break out laughing and exclaim “Bleah! Gross! No!” at the same time, but that’s the effect of this hilarious and mildly horrifying piece by NBC’s Health on Today: You Won’t Believe These Gym Gross-Outs.

It begins:

Gym rats: beware of gym rats, as well as gym cockroaches. Also, you’d best avoid that dried vomit coating the stationary bike, the blood swirling in the whirlpool, and that old man in the locker room who is dutifully airing out his genitals with the hand-held hair dryer.
These are merely five of the nearly 2,000 gnarly sights, smells and sounds reported by fitness center patrons in a new Harris Interactive survey commissioned by the Cintas Corporation. Exercise buffs were asked last month, via an online poll, to list “the dirtiest object or behavior” they’ve ever seen in an athletic facility. They were urged to “please be as descriptive as possible.” Oh, and the people obliged – just in time for the January surge of membership deals from your local gyms.
“Body builder farted as I was inhaling about to bench press,” wrote a 49-year-old man.
“A woman soiled herself while weight lifting,” added a 76-year-old man.
And we certainly cannot forget the super-parched guy who, for some reason, decided to start “licking the drinking fountain.”

The rest of the piece is virtually bursting with all sorts of bodily fluids — mainly sweat, of course. And the comments host a lively debate between disgusted gym-goers and points like this one: “People do all these things everywhere, not just at the gym. It’s called being human.”

My favorite came from a microbiologist who suggested wearing gloves while lifting weights but also notes: “Sweat isn’t a problem. It’s sterile when secreted, and as it ferments it produces ammonia, which kills bacteria. The bacteria that live off sweat won’t harm you.”

Readers, I’m almost afraid to ask: Any gym reports of your own to rival these?

Why You Really, Truly Should Not Put Q-Tips Into Your Ears

Notice the warning. (Carey Goldberg/WBUR)

Notice the warning. (Carey Goldberg/WBUR)

Brilliant. Just brilliant. Do you think I may qualify for one of those Darwin awards? Here’s my sorry tale:

Many a morning, my ears are still wet from my shampoo when I insert my phone’s earpieces into them. One recent morning, a little light bulb lit up over my head: “Hey! I’ll lightly swab the water out with Q-tips to speed the drying process! Sure, there’s some advice I’m vaguely aware of that it’s really not healthy to insert Q-tips — or anything smaller than your elbow — into your ear, but just look at the little cotton domeheads on sticks! They’re so clearly engineered to enter an earhole, aren’t they?”

The swabbing felt good, and seemed to work. Just one small problem: Within days, I was experiencing occasional bouts of what I can only describe as indescribable weirdness. It was a sort of dislocating reality shift. A sudden sense that the world was off, and then righted itself again. Something like the feeling you get when you’re on a stationary train and don’t notice when it starts moving, then look out the window and see the landscape sliding by: a displacement, a minor sensory shock, a brief vertigo.

Dr. Jennifer Smullen (Courtesy of Mass. Eye and Ear)

With my few remaining brain cells, I made the wise decision to stop using the Q-tips, and the sensation abated a few days later. And in hopes that others may learn from my mistakes, I spoke today with Dr. Jennifer Smullen, an otologist and neurotologist (a specialist in surgery of the ear and nerves to the ear) at Massachusetts Eye and Ear. She was kind enough first to treat my sheepishness, and then to share wisdom that I hope spreads far and wide. Our conversation, lightly edited:

I am feeling very stupid at the moment…

Don’t feel stupid. This comes up over and over. I do not have a day that goes by that I do not address this issue.

Sigh. I’m feeling a little better. So why should I not have done what I did?

Number one, you would like to have some wax in your ears. The ear canal makes wax for a purpose. The wax in your ear waterproofs the ear canal and keeps water from going in and getting stuck, sort of like wax on your car. If you clean your ear with a Q-tip, that strips the wax and lets the water stay in.

So my trying to remove water with a Q-tip actually created a vicious cycle?

Exactly. So number one, you should leave the wax in your ears because it waterproofs them. It’s also a natural antibiotic. It’s naturally acidic and it prevents infection in your ear. So if you take away the wax, you’re more likely to get a swimmer’s ear infection. Third reason why you shouldn’t remove the wax with a Q-tip in particular is that at the end of the ear canal is the ear drum, and the ear drum is much closer to the outside than you might think. If you put a Q-tip in your ear so the entire cotton has gone in, you’re probably touching your ear drum. People always say they didn’t go in that far, and they always do.

And what’s the problem with reaching the ear drum?

The ear drum is very delicate, so you can puncture it with a Q-tip, and I’ve seen that many times. Continue reading

Even Maureen Dowd, Who Calls Out Presidents, Did Not Confront Doctors

New York Times columnist Maureen Dowd

Darn that new New York Times paywall. If you’re past your 20-story limit and don’t subscribe, you won’t be able to get to today’s Maureen Dowd column, which I, personally, would headline “Nerviest Woman In American Newspapers Says Even She Is Intimidated By Doctors.”

Taking off from recent news about new efforts to stem hospital infections, she describes an encounter with a young doctor who was wearing a tie while he attended to her brother, Michael, who had been hospitalized for pneumonia. Why, she asked, had Michael contracted four additional infections in the hospital?

“It could be anything,” he said. “It could be my tie spreading germs.”

I was dumbfounded. “Then why do you wear a tie?” I asked. He shrugged and left for rounds.

Michael died in that I.C.U. A couple years later, I read reports about how neckties and lab coats worn by doctors and clinical workers were suspected as carriers of deadly germs. Infections kill 100,000 patients in hospitals and other clinics in the U.S. every year.

Love her or hate her, Maureen Dowd is a towering and verbally fearless columnist who has called out president after president. Yet, she writes:

I saw infractions of the rules in the I.C.U. where Michael died, but I never called out anyone. I was too busy trying to ingratiate myself with the doctors, nurses and orderlies, irrationally hoping that they’d treat my brother better if they liked us.

Maureen asks Elizabeth Cohen of CNN, author of “The Empowered Patient,” how best to confront health care providers, and Elizabeth says we have to get over “the ‘waiter spitting in your soup scenario,’ that the medical professionals will somehow avenge themselves, by giving less attention, if you insult them.”

Easier said than done. But the stakes are so high. Long ago when you could smoke in hospitals, a friend of mine once picked up an emergency room ashtray — you know, the waist-high metal cylinder kind? — and bashed it against a wall when he felt his loved one was not receiving proper attention. I appreciate his passion, but you can’t help a patient much from a jail cell.

Perhaps we need inspiration from examples. I wish Maureen had ended her column with an example of how she now actively questions doctors. Instead, she describes practicing assertive tactics on taxi drivers.

Readers, have you ever stood up to a health care provider on behalf of a loved one? Please share. Here’s the voice of experience from a commenter on the Times column, the mother of a medically fragile child:

i also learned very quickly to question doctors — not in a nasty confrontational, in-your-face way, but firmly, with courtesy. in the end, it’s the life of your loved one that you are protecting, if not your own. and i’d like to think that docs know full well that hospitals are havens of disease — and that it’s part of their job to keep people safe. a simple, “oh, would you mind purelling again? we’re really struggling with his condition today” is not something a doc can really so “no” to.

Truth Squad: NYT Story On Unwashed Masses Stinks

You gotta love Jack Shafer, who trashes the latest New York Times Style section trend story about people who don’t wash as “bogus.”

Granted, the definition of “trend” is somewhat nebulous in journalism: we learned if you could get a mere three examples, that constituted a “trend.” But even under that generous definition, says Shafer writing in Slate, The Times story, “The Great Unwashed,” fails to deliver what it promises when it asserts: “Some people have all but abandoned the idea of soap, shampoo or deodorant and yet still manage to have friends, relationships and office jobs.”

Indeed, the story brims with accounts of its subjects’ washing and deodorizing strategies. The only thing remotely unusual about the story’s subjects is that they don’t wash as often as some other people.

Jenefer Palmer, the story’s first subject, showers three times a week or less. Todd Felix showers daily, but with an unscented body wash. Bethany Hoffmann Becker reports on her Facebook page that she uses wipes after running but showers before getting into bed. Blake Johnson bathes every other day. Tara Freymoyer shampoos with Herbal Essences. And Alice Feiring bathes four times a week. Not a single subject of the story claims to have completely abandoned washing…One of the story’s subjects uses a “natural deodorant” and another uses a “sliced lemon” on her armpits. In my book, anything you rub into your underarms—be it mothballs or gunpowder—to smother smell qualifies as deodorant. If you’re a user, you don’t belong in a story about nonusers.

Unwashed Nation: Study Finds Dirty Hands Abound

At Grand Central, Penn Station and other public venues, many bathroom users still don't wash their hands

I tell my kids to wash their hands about a dozen times a day. So do their teachers, and the large, bold-face signs in every public bathroom. Yet, for some reason, these ubiquitous messages don’t seem to penetrate, or maybe it’s just the grownups who aren’t listening.

According to a report by the American Society of Microbiology and the American Cleaning Institute (the cleansing product lobby), hot dog handlers, baseball fans and bathroom users in a variety of public places simply aren’t washing their hands. The New York Times reports the news from a microbiology conference in Boston:

Some subjects were asked about their washing habits in telephone interviews; others were watched by undercover observers in public restrooms. Some of what the sink spectators witnessed was, well, filthy. Consider: 20 percent of people using the restrooms at Pennsylvania Station and Grand Central Terminal in New York did not wash their hands.