The Clinically Indicated Bow Tie

As a naïve second-year medical student, my professor for the Physical Diagnosis course was Dr Dhand. Dr. Dhand was a pulmonologist trained in India whose expertise in diagnosing disease using his eyes, ears and touch was unparalleled. Like any star-struck student, I wanted to impress.

Assigned to perform a complete physical exam on a patient suffering from cirrhosis, I recognized the patient’s ascites (fluid accumulated in the abdomen from liver disease) and realized I had my chance to demonstrate the physical diagnosis exam for ascites called shifting dullness. Armed with rudimentary diagnostic skills, I performed “shifting dullness” by rolling the patient on his side and then froze in horror.

Looking back, I hadn’t learned yet that patients with cirrhosis are often given a medication called lactulose that improves their mental clarity but causes remarkable diarrhea. If I wasn’t such a hopelessly inexperienced rookie, I would’ve turned the patient carefully.

But in my eagerness, I turned him with gusto and watched my long tie sweep forward and stick to the inevitable fecal consequence of lactulose.

Frozen for an eternity, I took great pains to avoid dislodging my tie and reached into the pocket of my short white coat to extract a pair of trauma shears. One clip ‘surgically’ removed the length of my tie and taught me the clinical indication to wear bow ties.

I then snuck out of the hospital because back then, men were required to wear ties or be sent home.

Some parts of an identity are cultivated. Others arrive unexpectedly. My bow tie persona arrived courtesy of shifting dullness, lactulose and the youthful desire to impress.