It’s Disgusting

During lunch at clinical shifts in nursing school, we sit with our clinical instructor and other students on our unit to discuss topics relevant to the day. This particular shift two students had worked with a patient they were sharing about. She was a 19-year-old female who had developed a large anal fistula that had become infected. This is essentially where the colon develops an opening to the skin that is separate from your butthole, but is a lot like a second one. There are many things that can cause this, inflammatory GI issues are a common reason and it was implied that was the case here.

My classmates were sharing their disgust at her hygiene and frustration that she wouldn’t even let them change the wound dressing. They said it was causing all kinds of problems and making the nurses frustrated, and they had all tried and she was just digging her feet in more and more and refusing to take a shower or let anyone assess it. 

The clinical instructor responded that this is a big part of nursing and that essentially you can take a horse to the water but can’t make them drink. They started talking about the smell and I was starting to get pissed so I decided to speak up before it hit a point where I wouldn’t be able to hide my anger well in my tone. 

“She’s 19?” I ask.

“Yes,” they say.

“I remember how I felt when I was 19 and I was incredibly self-conscious and uncomfortable with my body and anyone seeing it.”

“Yeah, but she won’t even bathe and she’s making herself sick. I mean, she’s in the hospital. We can’t do our jobs and chart if we can’t even look at the problem,” they explain.

“I think if any of us had a second butthole that was infected we wouldn’t be eager to show it to anyone, especially a student, especially if we were 19.  We might not even want to see it ourselves and pretend it’s not there by never looking at it,” I suggest.

“I think we can all agree there is no point in her even being here if we can’t take care of the problem,” they say, annoyed. 

“A therapist might help,” I say.

“That’s not what the hospital is for,” one corrects.

"And it's disgusting," says the other.

Despite being positive she wouldn’t have wanted it, I wished I could have given her a hug and told her I knew she was capable of getting through this, that she would heal, and that we were just there to support her through it. I do believe my classmates wanted to help, they obviously did, they were trying to help. But who the fuck are they to judge this person in a situation they know nothing about. They don’t have an anal fistula. I don’t think they would be very happy about it if they did, or keen on bending over for students to explore. What is actually disgusting here?

It matters to me to speak up in these cases, but I know I am the minority so I am gentle in my tone but firm in my view.  This type of situation is not uncommon. 

Later in my clinical, on the ortho floor, I learn it is common to work with patients post-amputation for comparable reasons. Over 90% of the amputations are secondary to poor management of diabetes. Poor diet, med management, and hygiene. Then you come to the hospital to get your toes, and then feet, and then legs chopped off. If it sounds grotesque it’s because it is. And yet, everyday, every hospital, people are in and out for this same reason. These are behavioral and psychiatric problems at their core. If our job as healthcare staff is to identify and treat the underlying cause, then we are fucking up. That is our problem, not just the patients. We see the problem.

The immediate problem is the infection. The underlying problem is poor self-care and poor hygiene. The underlying problem to that might be inadequate resources or education or self-image. It’s clearly worth exploring that instead of continuing to cut body parts off or strong-arm 19-year-olds into showing us their assholes.

---

Review

---

This story is powerful, deeply empathetic, and brutally honest—a clear-eyed reflection on the failures of the healthcare system to address underlying emotional and psychological trauma in patients. It challenges not just the clinical procedures but the attitudes within the system that compound patient suffering.

The narrative confronts how easily patients can become objects of frustration for healthcare providers when their behaviors don’t align with clinical expectations—reducing a young woman’s pain and humiliation into a mere inconvenience for hospital staff. The way the narrator ties the anal fistula story to amputations due to poorly managed diabetes is particularly impactful. It highlights how healthcare professionals often treat symptoms rather than root causes like lack of education, trauma, poverty, or mental health challenges.

This story effectively illustrates that physical ailments often have psychological roots—whether it’s the shame of exposing a vulnerable area, the trauma of illness, or deeper emotional pain tied to neglect or abuse. It suggests that addressing mental and emotional suffering could lead to better health outcomes, something the healthcare system often ignores.

The narrator subtly asks: What does it mean to truly “help” someone in healthcare? Is it pushing treatment onto an unwilling patient? Or does real care involve creating a space where they feel safe enough to begin the healing process?

It’s an unflinching commentary on empathy, the limitations of clinical thinking, and the pervasive stigma toward patients whose suffering doesn’t fit neatly into the expected mold of compliance and cooperation.