Two penis anecdotes from the hallowed halls

Today, Beth wrote about her new doctor, who sounds like my kinda gal (professionally speaking). I considered blogging on my philosophy of patient care, but then I thought, Naaaw. I'm gonna tell two dick stories. Both tales come from a year I revisit in nightmares: internship.

The Punitive Foley

Foley catheters are inserted up a patient's urethra and into his bladder to drain urine. For lengthy operations, Foleys are necessary to prevent bladder distension. They're useful in critically ill patients, too, since they allow the doctor to closely monitor a patient's renal urinary output. Foleys have lots of worthwhile uses. Hell, I used one the other day to try to stop a nosebleed. In the wrong hands, Foleys are dangerous weapons. On my urology rotation, my second-year resident got paged to one of our hospital's most dreaded medical wards: a ward that catered exclusively to drunks and drug addicts in withdrawal. "Patient bleeding from his penis," my R2 told me. "Bad Foley. Wanna come along?" Bleeding? Bad Foley? WTF -- was it barbed, fer cryin' out loud? Of course I wanted to come along. Once we hit the ward, the story spooled out faster than Hemingway's fishing line. A nurse caught one of the drunks peeing off the side of his bed. She called a medical intern, asked for and received an order to place a Foley catheter. She inserted it, then inflated the balloon a wee bit prematurely. (Um . . . you're supposed to inflate the balloon when the end of the catheter is inside the bladder, not the prostate gland.) I heard most of this secondhand from my R2, cuz when I got to the ward and saw this guy moaning and bleeding from his penis, my gorge overcame my curiosity. Sorry, but I have no followup on either the patient or the nurse.

The Lame Excuse

As an ENT intern, my best and worst rotation was on the ENT service. On the one hand, the call was one night in four, and the patient loads were in the single digits. On the other hand, if I made a mistake on my own service, it could dog me for the rest of my training. The attending physicians, those guys and gals who would one day write my letters of recommendation, were ever watchful. One day, my chief resident called me onto the carpet. "Did you place Mr. 04yt-n's Foley?" She was a blonde frosty enough to do justice to any Hitchcock film. I could tell from her voice that the correct answer was No, but I answered truthfully. After all, Mr. 04yt-n hadn't screamed when I'd inflated the balloon, and he hadn't bled from his penis, either. What could be wrong? "Um . . . yes?" "You gave him a paraphimosis," she said, only without the benefit of hyperlinkage. That link, by the way, is safe to follow, rather educational, and will probably not induce nightmares. Unlike this link. "Which is what, exactly?" "You've done your urology rotation." "Well, yeah --" "You should know what it is." My R2 took pity on me. "Mr. 04yt-n isn't circumcised, right?" By then, I was so baffled by this exchange that I probably shrugged. "No. He isn't circumscised," said my chief, biting every word. "What are you supposed to do when you place a Foley in a circumscised penis?" "Roll back the foreskin." "NO. What do you do AFTER you place the Foley?" "Um . . . " Wash my hands? Kiss the patient on the cheek and say, Call me? Come on, Hoffman. Think! Or at least keep your mouth shut. "You're supposed to roll the foreskin back down," said my kindly R2. "If you don't, the foreskin constricts the glans, and it swells. Badly." Cool waves of relief washed over me. I grinned ear-to-ear and said, "Hey, I'm a nice Jewish boy. What do I know from foreskins?" My chief, still biting her words: "You're also a doctor, aren't you?" Zing. This story began and ended with my team -- I think. If my bosses were snickering about me, they were kind enough to do so behind my back. By the way: the patient did fine, no thanks to me. D.