Can't Smell This

"Good afternoon!  Is this Jimmy?  Hi, I'm Dr. Duh.  Let me wash my hands first and then we'll talk, OK?"

As I greeted the shy pre-teen boy and his mother, I took a whiff and knew exactly why Jimmy was referred to see me for the pediatric gastroenterology appointment.  The closed examination room was filled with an instantly recognizable stench of flatulence and soft feces mixed with sweat in the child's underwear.  It was an odor that I unfortunately had smelled thousands of times before at work.  After I washed my hands and resigned myself to being stuck in the room for the next half hour, I opened the patient's medical records in the computer, and the referral information confirmed my suspicions:

"Child with encopresis for 2 years, not responding to treatment.  Parents very frustrated.  Please evaluate and treat."

Encopresis is a fancy medical word that describes the condition of being unable to control one's bowels, and this usually leads to a smelly mess in the underwear.  Kids with this problem usually start out with a history of constipation and not wanting to use the toilet when nature calls (particularly during school hours), and as the large intestine fills up with feces, the child eventually gets to the point of losing control and not knowing when small amounts of stool leaks into the underwear.  Jimmy's mother was understandably frustrated as she described how the child would spend hours with the feculent smell on himself and not even be bothered by it.  Jimmy would ignore his family's advice to change his underwear, use the toilet, or take a shower after having accidents, and his friends have started to nickname him "Stinky".  Jimmy somehow had lost the ability to know when he dirtied his underwear, and also seemingly could not even smell himself.

After hearing the mother's account, and after briefly examining the child, I explained to the mother that Jimmy's apparent inability to detect his own soiling via smell and sensation is a very common phenomenon, as our nerves have a way of becoming "habituated" over time to a constant level of stimulation.  In other words, if you smell yourself all the time, you will eventually not smell yourself anymore.  It's the same reason why some people wear thick layers of perfume and not realize how overpowering their scents are, and why other people are better than us at detecting our own bad breath or offensive body odor.

In the same way, we are often better at recognizing others' shortcomings and offenses than we are of our own.  We tend to judge and point fingers at another person without realizing that we are similarly guilty.  Jesus' Sermon on the Mount includes the following exhortation:

"Do not judge, or you too will be judged.  For in the same way you judge others, you will be judged, and with the measure you use, it will be measured to you.

"Why do you look at the speck of sawdust in your brother's eye and pay no attention to the plank in your own eye?  How can you say to your brother, 'Let me take the speck out of your eye,' when all the time there is a plank in your own eye?  You hypocrite, first take the plank out of your own eye, and then you will see clearly to remove the speck from your brother's eye.  (Matthew 7:1-5)

It is always good to give ourselves an honest "whiff" when we feel the urge to pass judgment on others, lest we are the ones with the stink.