A little different from my usual, but true and universal


I was covering on Christmas Eve and took my first call in the late afternoon. Except for a rare emergency, the day is normally quiet. So, when called, I was prepared to leave for the emergency room. I returned a call to a patient.

“This is Dr. Iannuccilli.”

“Yes doctor, I am a patient of Dr. __. I am worried.”

“Is this an emergency? It’s Christmas Eve, you know.”

“I know. I think it’s an emergency, and I am sorry to bother you.”

She did not sound sick, no wheeze, no shortness of breath, no grunts or gasps of pain. I was formal, somewhat annoyed.

“How can I help?”

“ I am worried about my hemmorhoids.”

She had to be kidding! Hemmorhoids, on Christmas! What a present!

“You’re calling about hemmorhoids?”

“Yes.”

“Why? Why tonight?”

“Because I have to sing in the church choir this evening. It is our biggest concert of the year. Midnight Mass, you know.”

“Yes, I know. So what do hemmorhoids have to do with a concert?”

“I have to sing.”

“I heard you.”

“ I am a soprano.”

“Wonderful. What has that to do with hemmorhoids”?

“How will I hit a high note?”

“Hit a high note? What do you mean?”

“What if I strain while singing and my hemmorhoids pop? What will I do in church if there is blood all over my clothing, and on my backside at that? I must sing. We have been practicing all year. I cannot miss it.”

A Valsalva maneuver while singing? My annoyance was replaced by quiet, laughing, as silently as possible, like holding back a burp at a dinner party. I was unaware that reaching an E above C, even if she could do so (she had an elderly lilt to her voice) created enough pressure ‘there’ to cause a break in the plumbing. I never heard of such an occurrence. I paused, composed myself, and thought for a moment. I needed to reassure this lady that she and her concert would be a success, but how. Sit when you sing? While everyone else was standing? No, that wouldn’t work. She would be hidden from her audience. Pack the area with gauze or some other absorbent? Tissues? Three pair of underwear? Maybe. Slather the area with preparation H, Desitin, or Balmex? Probably not. Not enough muscle.

Suppositories? Out of the question. I had a vision of a bullet shaped missile flying through the air during the high note of ‘Panis Angelicus’. How might any of those remedies stem a tide? I thought a moment longer. Nothing extraordinary was necessary. Simple reassurance was enough. That was the approach. That was it.

“Hemorrhoids don’t burst on a high note,” I said with confidence (is it true?). “But, so that you feel confident, why not place some padding there, something like Depends. Really, don’t worry, you will be fine. And do not fear standing and singing through the entire performance. Position has nothing to do with hemmorhoids (a white lie here).”

“Thank you so much, doctor. And thank you for taking the call. I am sure you would much rather be with your family, so I very much appreciate your time. Merry Christmas.”

Merry Christmas.” I hung up, a smile on my face.

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