Downtown dani, p.22
Downtown Dani, page 22
“That would be a shame. This guy is a real looker.”
“Sucks for him. He’s gonna be out of commission for a while. Hey, you don’t really believe that he ran into the wall with his penis, do you?”
“Of course not, but I didn’t want to embarrass the poor guy and call him on his story.”
“Is he drunk?”
“He smells like a bar, but he’s coherent enough to answer questions.”
“Okay. I’ll be right down. What room is he in?”
“He’s in room nine. Name’s Johnson.”
“Oh, come on, that can’t be his name. Mr. Johnson with the penis injury? Seriously?”
“Dani, you can’t make this shit up.”
“Alright, I’m on my way.”
Wow, a penile fracture. I haven’t operated on one of those yet. They don’t come in very often. Victor is going to be so jealous that I got such a juicy case on the weekend he traded with me.
I hurry down to the ER and pick up the only paper intake chart sitting in the file folder for awaiting consults. As I continue to skim down the page of the initial assessment information, I walk into room nine. Before I can even look up and introduce myself, I am greeted with, “Oh my god, could this get any fucking worse?”
I stop in my tracks with my eyes glued to the chart in my hands. No, no, no, no, no, no. Dani, you do not recognize that voice, I try to tell myself. My eyes dart back up to the top of the chart and confirm my worst nightmare. Johnson, Adam. Medical record number 265-124-3354. How the fuck is this happening? Why did he come to this hospital for Christ’s sake? Why am I the asshole on call this weekend?
I finally look up and see Adam positioned on a stretcher with the head tilted up. He is lying back against the pillow and his arm is slung over his face. Without making eye contact with me, Adam continues to complain, “Liz told me when I had dinner with her this week that you weren’t on call this weekend. Why are you here?”
“Why am I here? I think the more appropriate question is why are you here?”
Adam finally looks at me with so many emotions coming out of his eyes: fear, embarrassment, despair, mortification. “Dani, I can’t do this. Not with you.”
“Adam, I’m all you’ve got. I’m the only urologist in-house right now. I can’t contact my attending that’s on call this weekend without actually examining you myself.”
“Can’t you ask a different urology resident to come in?”
“It’s 4:30 in the morning. Of course I’m not calling in another resident who has the weekend off.”
“I, I have to go to another hospital, or something.”
“Adam, there’s no point in you leaving to go to another ER and have to wait hours to be seen again. Look, based on what the ER resident told me, I think you may have a penile fracture.”
“A penile fracture! What the fuck is that?”
“Hey, it’s going to be alright. First off, if is it a penile fracture, it is very treatable.”
“Okay, but what the hell is it?”
“It usually occurs when there is a blunt trauma to an erect penis. The structure in the penis that fills with blood during an erection is called the corpus cavernosum. There are two of these that run along the shaft of the penis. They are covered with a strong protective outer layer called the tunica albuginea. If the impact to the erect penis is forceful enough, the tunica albuginea can tear causing the blood to escape the corpus cavernosum into the surrounding penile tissue leading to swelling and bruising.”
“That sounds awful. Am I ever going to be able to get it up again?”
“If it is a penile fracture, then the good news is, yes. Very likely you will be fine with normal erectile function. The bad news is that it has to be surgically repaired. As soon as possible.”
“I have to have surgery? Holy shit! Are you doing it?” Adam asks aghast.
“Again, if you do have a penile fracture, then yes, I will be in the OR, but I will be assisting the attending who is on call this weekend. But let’s not get ahead of ourselves.”
Adam puts his hand over his mouth, closes his eyes, and takes a very long breath while he weighs his options. “Okay. Okay. I guess I don’t have any other choice. So, what do we do?”
It’s not like this is a walk in the park for me either. It’s very weird treating somebody I know, and this isn’t just a sore throat. I know sooner or later he’s going to have to drop trou for me. Not to mention the fact that I’m still pissed at him for calling me a whore last weekend. However, I can put that aside for now since I am empathetic to his very unfortunate situation. I make a concerted effort to put on my professional demeanor. “I’m going to need to ask you some questions first to get a better understanding of what happened tonight.”
“Didn’t I already answer those questions?”
“Yes, but I need to clarify a couple of things,” I say.
“Okay. Go ahead.”
“From what I understand, you ran into a wall with an erect penis when you were trying to get to the bathroom in the dark.”
“Yes.”
“Did you hear a popping sound when your penis hit the wall?”
“Yes.”
“Did it hurt?” I ask.
“Yes, when it first happened. The pain isn’t so bad now though.”
“Okay. Did your penis detumesce when the injury occurred?”
“Did it what?” Adam asks.
“I’m sorry. I mean, did you lose your erection after the impact?”
“Yes.”
“When did this happen?”
“About three hours ago.”
“Have you been able to urinate since this happened?”
“Yes.”
“Was there any blood at the tip of your penis or in your urine?”
“No.”
“At least there are no obvious signs of a urethral injury,” I say.
“That’s good, right?”
“Oh, definitely,” I respond. Then I continue, “Adam, is this really what happened?”
Adam looks away without answering me.
“Come on, Adam, I need you to be honest with me. It’s important for me to know the mechanism of injury. It gives me a better idea of what’s going on with your penis. There are imaging studies that I can get, but at the end of the day, if I know what happened and have a strong suspicion that you do indeed have a penile fracture, then we need to get you to the OR quickly regardless of what an imaging study does or does not show.”
“No.”
“No, what?”
“No, that is not what happened.”
I pause waiting for him to continue, but he doesn’t.
I decide to help him out. “A penile fracture typically occurs when a man is having vigorous sex with the woman on top. The penis slips out of the vagina and as the woman comes back down, the penis hits the woman’s perineum or pubic bone causing the erect penis to buckle.”
Adam sheepishly looks up at me, but does not say a word.
“Am I close?”
Adam slowly nods his head.
“Okay, that’s good that we have that straight.” I jokingly add in, “I guess Gia changed her mind about premarital sex.”
This does not illicit even a half smile from Adam. Instead he says without changing his expression, “Gia and I broke up.”
“Oh,” I say surprised. “What happened?” Not that I’m disappointed.
“Today I was supposed to go downtown to do a deposition for one of the cases I’m working on, but had to go back to the office to get a file I had forgotten. I couldn’t find it on my desk and remembered that I had left it in Gia’s office when we were discussing the case the day before. When I opened the door to her office I found her bent over her desk with our boss behind her riding her like a jockey.”
I cringe, “Ohhh, that’s bad. Wow. I’m really sorry.”
“Yeah, you could say that I was a little taken off guard.”
“I bet next time she’ll remember to lock her office door.”
“That wasn’t exactly the first thought that crossed my mind.”
“Fair enough. So, how did she explain herself?”
“She tried to rationalize to me that it would really help her career in the end, no pun intended, and that she was doing it for us.”
“Na-ah,” I gasp in disbelief.
“The best part was that she claimed she had still maintained her virginity because it wasn’t vaginal sex.”
“Come on. She doesn’t really believe that, does she? That’s ridiculous.”
“Needless to say, her excuses fell on deaf ears and I told her we were over.”
“I’m sorry. That’s not a good way to have things end. Although, I think you can do better if that’s any consolation.”
“It’s not, thank you, but I think I can too.”
A follow up question then dawns on me. “So then, who were you having sex with?”
Adam does not answer. He just looks at me and his expression morphs from anger to shame.
“Someone you met in a bar, perhaps?”
“Don’t worry Dani, the irony is not lost on me,” he responds regretfully.
I’m thrown, not just by what’s happened to Adam, but by the way he’s looking at me, apologetically.
I may be mad at him, but I’m not going to kick a man in the balls when he’s down and also happens to have a broken penis. “Okay, all that doesn’t really matter now. We just need to make sure that we get you fixed up. But that means I’m going to have to examine you now.”
Adam resigns himself to the humiliation and lifts his hands off the sheet covering his lower half so that I can take a look. I put on a pair of rubber gloves and pull down the sheet. I lift his gown and my eyes bug out at the sight, although I thankfully manage to stifle any audible noises of shock from my mouth. I’ve only seen pictures of the eggplant deformity, but in real life it really takes your breath away. Adam’s penis is impressively swollen, purple, and bruised.
I forge ahead and begin my exam. I try very hard not to notice the tremendous size of his penis and tell myself that given his injury it is unclear the true dimensions of his member. Cutter, be professional, dammit! I feel along the entire shaft of his penis, but cannot feel any fracture lines in the tunica albuginea through all the swelling in the penile tissues. His scrotum, testicles, and perineum are normal with no bruising, so Buck’s fascia must still be intact.
“Adam, based on your exam, I do think you have a penile fracture. You need to go to the OR.”
“Is there any other treatment besides surgery? Can we just wait and see if things get better?”
“The best outcomes from this kind of injury are obtained from immediate repair of any tears in the tunica albuginea. The longer you wait, the greater the chance of erectile problems.”
“What do you do in the surgery?”
“We explore the corpus cavernosa and close up any areas where it has torn.”
“That’s it?”
“Yep. You’ll probably stay here for a day or two after the surgery for observation. You can’t have sex for a couple of weeks afterwards, but then everything should be okay.”
“Sounds like this is my only reasonable option,” Adam capitulates.
“Before we take you to the OR, I’m going to have to get a retrograde urethrogram to make sure that there are no injuries to your urethra.”
“What’s that?”
“The urine channel in your penis, that you urinate out of.”
“Okay. Does it hurt?”
“No. I just have to put a small catheter in the very tip of your penis. Then I inject radiopaque contrast into the urethra while an x-ray is taken to look for any tears along the length of the urethra.”
“Sounds like a blast,” Adam says sarcastically.
“All things considered, it’s not so bad.”
“So says the person who is not having it done to them.”
“True,” I agree. “Okay, I’ve got several things I have to take care of to get you on the OR schedule. I’ll have the ER get the pre-op blood work done. I’ll be back in a little bit. Are you okay?”
“Not really.”
I put my hand on his to reassure him. “It’ll be okay, I promise.”
As I head for the door, I hear, “Dani.”
I stop and turn back to Adam. “Yeah?”
Adam looks me straight in the eye and says sincerely, “Thank you.”
“Of course,” I say without hesitation, and then hurry out the door.
I find Marni to let her know that I do think “Mr. Johnson” has a penile fracture and needs to go to the OR. I ask her to please order the necessary pre-op labs and a urinalysis. On my way up to the OR to drop off an OR request form, I remember that I don’t know which attending is on call with me this weekend. Usually I know this going into my call weekends, but with the last-minute switch and the craziness of the day, I forgot to look.
The attending call schedule is posted in the resident workroom, so I go back up to the seventh floor. I enter the workroom and walk over to the corkboard where the schedule is pinned. I run my finger down the page until I get to this weekend’s date and then run my finger over to the right to find the attending’s name. And it’s Dr.…Weaver! Ah, fuck me, mother fucker! Not Dr. Weaver. That guy couldn’t operate his way out of a paper bag, at least not anymore. He’s got to be about ninety-five years old and has a hand tremor so severe that it must make it difficult to even get a forkful of food to his mouth let alone handle a scalpel around my best friend’s brother’s penis!
I’ve never seen or done a case like this before. I’ve only read about it in a book. The fate of Liz’s future nieces and nephews will be left in my hands.
In good conscience, I cannot allow Dr. Weaver to get near Adam’s penis and this can’t wait until Monday and risk Adam developing some complication from the injury resulting in erectile dysfunction. What am I going to do? Shit, shit, shit!
A very appealing/unappealing thought crosses my mind. I could call a different attending and ask him to come in to cover this case. Oh man, that is such a hospital foul and completely against convention. Weekends off are protected time that everybody respects. But this is a dire situation. I know a surgeon is supposed to be fearless, and I don’t want to show weakness by acknowledging that I can’t handle this. However, if I am honest with myself, I am not prepared to do this case on my own knowing Dr. Weaver is not going to be of any help. I can’t risk a bad outcome just because of my pride for any patient, let alone for Adam. I check the time. 5:14 am. Ugh, this is going to be a really big ask.
The next glaring question is who should I call? Dr. Parikh is fellowship trained in genitourinary trauma and reconstructive surgery, but I know he is out of town at a conference in San Francisco. Another good option is Dr. Hinton. He does some general urology, so I’m sure he’s familiar with this kind of surgery. Another bonus is he lives in the city so it would be easy for him to get to the hospital. Although, before I disturb any of my attendings in the wee hours of the morning, I need to check the status of the OR. I dial x2233.
“OR front desk.”
“Hi, this is Dani from the Urology service. I’ve got a guy in the ER with a penile fracture that I need to take to the OR emergently for a penile exploration and repair. Do you have any cases on the schedule at this point?”
“We’ve got an appendectomy going on right now, but I don’t have any other requests so far. We could probably get you in here around 7:30 am.”
“Are there any other rooms running?”
“No, we only have enough staff to cover the one room.”
“Okay, can you please put me down on the schedule to reserve the spot? The patient’s name is Johnson. I’ll be over in a couple of minutes to formally drop off the OR request form. Oh, and please, please, please let me know if something else comes in that’s going to bump us.”
“Will do.”
“Thanks.”
I find Dr. Hinton’s cell phone number. Okay, here goes nothing. I dial his number and hold my breath. On about the fourth ring a very groggy voice answers the phone. “Hello?”
“Hi, Dr. Hinton, this is Dani from the hospital,” I say in the least intrusive voice I can create.
“Dani, why are you calling me at this hour? I’m not on call this weekend.”
“I know Dr. Hinton, I am so sorry to bother you with this, but I’m kind of in a bad situation, and I was wondering if you could help me.”
As most doctors are capable of doing, his brain immediately switches from sleep mode to wide awake and alert mode when he hears that there is a problem. His voice is now clear and concerned. “What is it, Dani? Did one of my patients come in with a complication?”
“No, nothing like that. I haven’t heard anything from your patients yet this weekend. Um, I’ve got a young guy in the ER with what I think is a penile fracture. I think he needs to go to the OR, but, uhhh, Dr. Weaver is on call this weekend.”
“I see,” he says in an annoyed voice. He certainly has every right to be pissed off about being asked to cover for the on-call attending that is no longer competent.
“Dr. Hinton, I’m sorry, but I’ve never done a case like this before and I really don’t want to render this young guy impotent and Dr. Weaver, is, ummm, he…”
Dr. Hinton stops me. “I understand, Dani.” He sighs and then asks, “Is the OR open?”
“We should be able to start around 7:30 am.”
I hear in the background a woman’s voice ask, “Who is that?”
Dr. Hinton must be talking to his wife. “It’s the hospital. They need me to come in to do a case.”
The woman protests, “But you’re not on call. Plus, we have Maggie’s birthday party this morning!”
“I know, but this shouldn’t take too long. Don’t worry, I won’t miss Maggie’s party,” he reassures his wife.
Ah shit, can you make me feel any worse.
Dr. Hinton then says to me, “Dani, I can help you, but this case had better start at 7:30 am. I’ve got a commitment that I can’t miss starting at 10:00. Got it?”
