Doctor Diaries: The one with the penis.
Picture the scene: a large teaching hospital, me - a doctor, just qualified and in her first job Urology about 2 months in so I understand the layout of the hospital, generally know what is expected of me. I am very much still learning and will make a lot of unimportant mistakes.
For the uninitiated, urology is the discipline that mainly covers surgical aspects of the urinary system with a few extras. In the majority it ends up being about the penis, testicles, bladder and prostate with the occasional kidney and the tubes funnelling various fluids thrown in.
Tonight’s surgical shift had me covering the urological patients on the ward as well as emergency admissions to the surgical assessment unit. In my first year out of medical school I rarely get to go to theatre and mostly have to hold the fort on the wards during nights whilst the senior doctors in the team are holed up in surgery just coming out between cases to make sure i am not up to my elbows in it, so to speak.
My bleep goes off the 15th time in the last 10 minutes, I answer and talk to the nurse on the Surgical Admissions Unit (SAU)
Nurse: John Smith has arrived…
Me (baffled): John Smith?
Nurse: yes Professor Gint’s circumcision patient
Me (wondering what on earth this is about): Nope still have no idea..
Nurse (huge sigh and likely eye roll): just come up to the unit he needs to be seen.
And she hangs up the phone.
I look at my list of jobs, it is now 1am and I am definitely slowing down, I am not a night owl, I trundle on up to SAU. I have always found nights harder than days, i think it's because things are generally dark and quiet. I also find it really hard to sleep during the daytime. It was much easier when we did 7 nights in a row as my brain got into the sequence but the first two nights were always rough. This was the first night, which might explain my choices.
I arrive at SAU which at the front has 6 curtained bays a bit like ED and there is a man in his early 30’s sitting in one. Nurse approaches and tells me this 34 year old man had a circumcision 48 hours ago and was now concerned that he had an infection, all of his observations (blood pressure, heart rate, temp etc) are normal.
I go towards him and introduce myself whilst pulling the curtains and begin by asking him what he is concerned about. John drops his trousers and underwear (bit premature but ok) and tells me about the surgery for a tight foreskin and how he is now worried as there seems to be a discharge in the area of the sutures.
This is where I make my mistake, we agree that I am going to have to examine him, he is ok with that. I put on some surgical gloves and I kneel down in front of him…..I kneel down in front of a man who is standing naked from the waist down….I kneel down in front of him! And proceed to examine his testicles and penis explaining as I go. We get to the discharge….there is a small amount of foreskin that has been left and it seems a bit of smegma (cock cheese) has built up under this small ring of foreskin. I am explaining this when he grabs the back of my head (as I am holding his penis) holding me in place and says ‘wouldn’t it be funny if the nurse walked in now?’ No John, no it wouldn’t.
Ever polite I get up off of the floor, explain he has to keep it clean under that little bit of skin and he can go home now, he has the number for SAU if there are any further issues. John spends the next five minutes whilst I rush off his paperwork, trying various ways to give me his number. ‘You may feel like a night out’ ‘I’d be really happy if you checked up on me’ ‘you might want someone to go to the pub with’ ‘you might need to call once you have talked with Professor Gint’ ‘oh come on you don’t know when you might need it’. I am not proud to say that I took John’s number to get rid of him with a smile plastered on my face ‘Yes John that would be absolutely wonderful, we can go out on a date and afterwards I can suck off your smegma for you, wouldn’t want you to have the hassle of cleaning yourself, looking forward to it…(big grin)’ I said in my head as he left the ward.
What I did learn is never to kneel in front of a man who is naked from the waist down when you are about to examine his penis. What reminded me of this episode is I did just that with a patient yesterday, some things I will never remember at the appropriate time. Equally, yesterday’s patient was polite and thankful that I sorted out his issue.