Thursday, October 13, 2005

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.

15 Comments:

Blogger WolfBuckingham said...

Yuck...but interesting.

Hey, I like your blog. Do you want to exchange blog links? I'm at www.billsbitterpills.blogspot.com.

10/14/2005 04:02:00 AM  
Blogger mm said...

Honestly - how is it that someone who can spell orthorhinolapdanceology without blinking an eye doesn't know the difference between right and write?

And more disconcerting:

"What are you supposed to do when you place a Foley in a circumscised penis?"

"Roll back the foreskin."


OUCH!

10/14/2005 04:42:00 AM  
Anonymous Candy said...

That picture of para-whatsis? It made me make assorted noises, most of them along the lines of "Ack! Whoa! Blergh! Gurk! Argh!"

10/14/2005 05:45:00 AM  
Blogger Pat said...

Maureen--I always thought orthorhinolapdanceology was hyphenated.

Doug--Is Mr. 04ty-n related to Ralph 1241C+? A cousin on the 9UU218-B side, mayhaps?

10/14/2005 05:47:00 AM  
Anonymous Eugie Foster said...

Gah! I don't even have a penis and this entry made me cringe. *twitch*

10/14/2005 06:14:00 AM  
Blogger Douglas Hoffman said...

Wolf: I've linked you. I didn't find anything frankly misogynic or racist, which is my main no-way-no-how criterion.

Maureen: if I were an orthorhinolapdanceologist, I suspect I would be so happy in my profession I wouldn't bother to write fiction.

Where did I make the right/write error?

The rest o' ya: now you know how glamorous medicine truly is.

10/14/2005 08:03:00 AM  
Blogger Douglas Hoffman said...

Maureen: found it. Fixed it. Also fixed POV wobble in same paragraph.

Every day, in every way, I am getting better and better.

10/14/2005 08:17:00 AM  
Blogger mm said...

The attending physicians, those guys and gals who would one day right my letters of recommendation...

A joke:

Q:What do you call premeds who can't get accepted into orthorhinolapdanceology?

A: otorhinolaryngologists

or

A: Doug

10/14/2005 08:22:00 AM  
Blogger Gabriele C. said...

Now I really want to know how you stop a nosebleeding with a Foley.

10/14/2005 10:05:00 AM  
Blogger Lilith Saintcrow said...

It is obviously true what my mother said: one does learn something new every day.

I can't wait to send the link to this entry to the DH. It should provide him with amusement as well as a cautionary tale: never piss off the nurse, especially if there is even the faintest of chances that you will be catheterized. This fact is so important I wonder that they don't teach it in school...

I must agree with Eugie. I don't possess male genitalia, but I flinched at that second story. Owie.

10/14/2005 10:31:00 AM  
Blogger Douglas Hoffman said...

Joke: what do you do with the bottom quarter of your medical school class?

Take 'em to the gym. If the student can bench press his own weight, he goes into orthopedic surgery. If he can't, he becomes a gynecologist.

Um -- that part about the orthopedic surgeons? That part isn't true. Orthopedic surgery residencies are competitive as all hell, so they get the cream (same goes for ENT).

As for the gynecologists: muwahahahaha.

10/14/2005 10:44:00 AM  
Anonymous fiveandfour said...

Ouch.

And for some reason I'm imagining the words and hand motions those guys used to describe what happened to them to other people later.

10/14/2005 10:56:00 AM  
Blogger jive said...

u got a great blog...but sometimes the posts are too long and gets difficult to read...try making shorter posts - just a suggestion!

10/14/2005 02:00:00 PM  
Blogger WolfBuckingham said...

Doug:

Thanks...I've added your link to my blog to.

10/15/2005 08:28:00 PM  
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