“And are you feeling sick or nauseous?” the student asks.

“Sometimes,” I say. “Usually I have cramps. Or I don’t have much of an appetite.”

The student nods. She says: “How’s your digestion?”

My face crumples. “Uh, well…” I don’t want to answer this question. Not my character. I actually don’t want to answer this question. I, Robert Isenberg, Simulated Patient, have a special aversion to this question. Because “digestion” is a euphemism, a careful buzzword, and what she really means is: How’s the restroom treating you?

“It’s been better,” I say.

“How’s so?”


Just say it! Say it! SAY IT!

“I’ve been experiencing bouts of, uh…” I take a deep breath, then exhale very slowly, in the hopes that the faculty moderator will interrupt and this conversation will end. But the faculty moderator doesn’t say anything. Everyone stares at me, and now I have to get the word out, quickly, because I shouldn’t “feel discomfort” when “discussing” my “bowels.”

“Diarrhea,” I say. “I’ve been having issues with that.”

“Oh, okay,” says the student, making a mental note. And we move on.

Well, she moves on.

- - -

I absolutely hate talking about defecation. Totally fucking hate it.

Blood? No problem. Brain surgery? Show me the pictures. I could discuss open sores and bursting pustules all day. Flesh-eating bacteria fascinates me. The birthing process strikes me as part of the Miracle of Life, no matter how much amniotic fluid gushes out of a freakishly stretched vagina. I can deal with almost any kind of sex reference, sex joke, sexual preference or sex act. Bring on the lesions and lacerations and varicose veins and compound fractures. No fucking problem. I dissected a fetal pig, for crying out loud.

Don’t get me wrong. All these things are unsettling, even disgusting. But I can adapt. Frankly, when you work in a hospital, you have to adapt. Not accustomed to seeing pins sticking into the pale legs of wheezing old women with no hair? Well, get used to it. It’s worse for them.

But please, for God’s sakes, keep me away from the BM. Even cleaning the cats’ litter box makes me want to hurl—whose resulting vomitous streak I would gladly clean up before using that goddamned slatted scoop.

“You don’t like shit humor?” my girlfriend asked me, amusedly, on one of our early dates. “I love poop jokes. But I come from a medical family. It kinda comes with the territory.”

Well, I come from a Socratic, New England, German-American family, and “poop jokes” absolutely do not come with the territory. Actually, the very word “poop” makes me queasy. Even the most clinical alias, like “product” or “leavings” or “stool,” fills me with hate. And never mind the vivid phrases like “bake a loaf” or “trouser chili” or “blowing mud.”

Actually, “blowing mud” is kind of funny. But that’s it.

My friends are always shocked by this. After all, I have worked as a professional comedian, and I’ve enjoyed my share of off-color humor. But feeling grossed out by Number Two is a very serious handicap, in almost any circumstance. You would never imagine how much everyday conversation revolves around colons, diapers, recta and bathrooms. That is, until the very thought of defecation makes you shiver with revulsion.

And farting? Don’t even get me started. Hilarity never ensues.

My violent reaction has no origin story. I was never locked in an outhouse or molested by a Cleveland Steamer. Restrooms are not, by nature, horrifying places, and the “business” that’s done there is, of course, perfectly natural, especially my own business. I have no qualms with urine at all, just as long as it’s called urine and not “pee.” I feel no personal shame or degradation, no discomfort while the act occurs. And yes, every child should read Everyone Poops, that oft-criticized book by Taro Gomi, just as long as I never have to say the title aloud.

Yet my disgust has been lifelong. Picking my nose was a happy kindergarten pastime, but the faintest glimpse of “doo” made me recoil. Just the word “doo” is perhaps the most heinous phoneme in the English language, beaten only by “doo-doo.”

I can think of only one explanation. For my first 17 years, I lived in Vermont, where winter is nearly endless. As soon as the snow melts and the ground finally thaws, farmers start to spread fertilizer. Entire fields are covered in oceans of cow manure, whose methane-infused steam pervades everything, even airtight grade school classrooms. After months of bone-chilling cold, the air is suddenly smoggy with the scent of liquefied bovine excrement. Most Vermonters grow accustomed to the putrid smell, and motorized manure-spreaders—firing jets of dark brown sewage into the air—are a workaday sight. Bottom line: There’s no escaping the cow pies. Even paved roads are smeared with their leavings.

That’s just a theory. Even I’m not totally convinced.

But this disgust is a major hindrance during SP sessions. Defecation is all part of the human cycle, and when somebody asks how I’m “digesting” these days, they notice when I freeze and stare at the floor.

“Um…” I say.

They lean in, thinking they’re onto something.

God, I think. I hate this shit.