Reclaiming Dookie

I knew I had truly become a doctor when I stopped being fazed by the concept or even the smell of feces. When I operate on the bowel now, I no longer hold my breath or skirt contamination of the surgical field by blocking my nose with my glove. Instead, I have become acclimated to the scent of that much maligned body product just as Eskimos have gotten used to snow. In English, we have not quite a hundred words for feces: stool, bowel movement, excrement, crap, manure, guano, jakes, turd, detritus, ca-ca, poopie, dookie, doo-doo.

Word choice aside, I build igloos of clinical knowledge from poop, noting its color, its frequency, its volume, its texture and yes, sometimes even
its odor. When one actually stops and smells the manure, separates it from its social standing and disdained reputation, one can sometimes find that it is a smell no “worse” than a dozen other “accepted” smells. The burn of freshly chopped garlic. The metallic flora of badly applied cheap perfume. Could it be that excrement’s bark is worse than its bite, that feces will forever be associated with a kind of visceral-psychological Bearnaise sauce syndrome, in which the body reacts to the thought of an smell rather than the smell itself? Is excrement taboo because it is so intense, so floridly odorous, the heavy metal music of smells, in your face, blatant? Or is it because we perceive it as waste, as dirty, as undesirable?

In medicine we use the phrases “stool,” or “bowel movement” – cleansing the word of connotation, because we know that excrement is biological waste, but medical gold. I now smile when my surgical patients pass gas, and rejoice when they produce feces from new colostomies. I peek anxiously into toilets to judge whether a bowel movement is well formed or bloody. Thus I have become resistant to the vulgarity of guano. Tolerant of bodily function. Free of judgment, of wrinkling noses. I have realized the value of continence, the diagnostic value of ones bowel habits, and the mechanical genius of the anorectal sling.

In some ways, during this internship year, using the bathroom is the only time of the day when I am free from guilt, at peace. Sometimes sitting on the toilet is the only time of the day I can get off my feet. It is only then that I am free to be myself, not having to answer to anyone else, not needing to answer a page - only the needs of my body. It’s a release. A
relief.

In general, though, Americans show a particularly Victorian disdain for excrement. I have friends who have never farted in front of their significant others. “Doug doesn’t know that I urinate or defecate,” my friend Subarna says half jokingly. But is it healthy to willfully deny the existence of a fundamental bodily function? Could it be that we Americans are missing out on a vital facet of the human condition?

Literature shows that people in other countries have a much more enlightened view of their colonic function. A 1980 British Medical Journal editorial posited that “from infancy, the British are brought up to regard a daily bowel action as almost a religious necessity and to believe in autointoxication from the cesspool of the unemptied colon.”

When my mother visited me from Taiwan last summer, she exhorted me with a similar alarmist view of the necessities of defecation. My boyfriend and I found that our diet tripled in roughage when she began cooking for us.

“Ooh, it is very good that Joe is a vegetarian,” she would exclaim during her hour-long lectures on the importance of dietary fiber. “Ai-yah. When I eat at Peter’s mother’s house, it is all meat. And when I go to the bathroom, it’s all tiny, tiny. Like goat poop.” She thrust out her pinky and pointed with her thumb at the half-inch length that approximated her stool caliber. “You must drink much water and eat lots of veg-e-table. When I went to Big Sister’s house, she’s vegetarian, and my stools were so long. Neme tsang.” She drew out her fingers as if she were pulling taffy, outlining the contours of her prodigious poop.

“You must go to bathroom once a day. Get rid of body waste.” She gestured outward as if shooing away pesky children.

“I know, mom,” I said. “I’m a doctor. You don’t have to convince me that it’s important to have good bowel movements. I know that constipation causes diverticulosis and colon cancer.” But she would not be convinced of my compliance. One morning a few days later I heard her shouting from the bathroom.

“Ilene, come here!” I ran in, wondering if she needed more shampoo, or dental floss. Instead, she gestured toward the toilet bowl.

“What’s wrong? Is it clogged?” I looked at her. She gestured again at the bowl, this time proudly.

“You see how long it is? Healthy.” After a prolonged period of groaning, I agreed that it was an above average sample. Then I quietly went along my way.

A funny thing happened, though, when my mother left. My boyfriend and I started talking about poop all the time. At first we did it for the laughs, and to fondly reminisce about my kooky mother. Then it became another thing we could share – open bathroom doors, blow-by-blows, satisfaction when we delivered a noteworthy specimen. Finally one day my friend Subarna remarked, “You know, it’s great that you and Joe can talk about these things. I think it’s a good sign.”

And I knew that without a doubt she was right. After all, shit does bring people together.