92. Quick, Boil Water

Remember those movies with an impending birth and a subsequent command to "boil water?" Most of us thought that had something to do with sterile technique. And that's the answer given in most Google responses to the question (either that or as an excuse to send away a nervous father to be)

But the practice existed long before germ theory. Hot compresses accelerate the normal labor processes in which the skin becomes more elastic, which makes deliveries faster and easier for both baby and mom.

Recent research concluded that "the use of warm compresses on the perineum duiring the second stage of labor [the "pushing" stage] is associated with a decreased incidence of perineal trauma," which of course confirms what midwives have been doing for eons.

But in classic "unintended consequences" fashion, the sinks in our delivery rooms don't have bacteria-laden hot/cold controls, it's all motion activated, so never has a chance to warm up. We'd have to go down the hall, around the corner, to get hot water (which is not that hot anyway, again for safety reasons), so evidence and tradition notwithstanding, one rarely sees hot compresses used.

91. Confession

An abnormal Pap smear prompts further evaluation, which often includes a cervical biopsy. Most women experience some anxiety during the 3-4 day wait for biopsy results but few as much as sixty-year old Marlene.  She called in tears after several days had passed without hearing anything (her doctor was out of town and had failed to contact her before leaving).  As the on-call doc, I was asked to talk with her.

We talked about the result of the biopsy, which confirmed the Pap smear--abnormal but a low level that requires monitoring but no immediate intervention.  And we talked about the cause of abnormal Paps: the sexually-transmitted human papillomavirus (HPV).  This again brought Marlene to tears as she confessed that she recently had a brief affair (her 80+ year old husband cannot meet her needs she said in so many words). I'll never do that again, she promised and then asked if she should tell either her husband or her ex-lover about the diagnosis of an STD.

Under the guidance of the "keep it simple, stupid" doctrine, I just said no.  A difference answer for chlamydia or other STDs, but for the ubiquitous, untreatable and mainly female-problematic HPV, no need to stir up trouble. Just don't ask me how I would feel if the ex's next sexual partner ends up with cervical cancer

90. Scent of a Man

"When you've been married 40 years," explained Marley, "you know what he smells like, so I knew something was wrong, even before he was diagnosed with prostate cancer.  Now after radiation therapy he just smells like char."

I'm not too sure how we got on this subject during an annual exam, but I did find it enlightening.