“Until I get there,” the urology resident instructed me, “you must apply direct manual compression to mechanically disperse the penile and preputial edema. This will hopefully minimize the swelling and allow for manual retraction by the time I get there.”
So in other words, as my attending so eloquently directed me “grab that thing and hold on tight.”
There are a lot of awkward moments in the emergency department. Many of them have to do with interactions with nurses (I am really sorry my patient threw up on your leg AGAIN yes he can have some Zofran), paramedics (last time I saw you, I am pretty sure you were making out with one of my co-residents in the middle of a bar), and even correction officers (um, please, just un-handcuff him for the lung exam. Fine, you can keep his feet chained to the bed).
Paraphimosis is when, in an uncircumcised or partially circumcised male, the foreskin gets retracted behind the glans penis, starts to swell, and gets stuck in that position. The reason this is an emergency is that this swelling then cuts off blood flow to the head of the penis. The head will start to turn dark and eventually may become necrotic. It’s usually iatrogenic in nature, meaning, we cause it. In this case the patient has a foley catheter in his urethra (secondary to a recent surgery). He resides at one of the homeless shelters that also provides some medical care, and the nursing staff inadvertently forgot to replace the patient’s foreskin after the most recent foley catheter change. This is actually a great case for me, it’s one of the few urologic emergencies and a case up until now I had only read about.
As great of a case as it may be, the treatment is nothing short of mortifying. Very reluctantly I pulled a chair into the room, and for the next fifteen minutes I sat by my 65 year old patient’s side and “mechanical dispersed the penile and preputial edema,” AKA, I very firmly held his penis in my hand. For fifteen freakin’ minutes.
Really? I am really doing this right now? Please, just for a moment, put yourself in my shoes. What are you going to talk about to make this less awkward… football? The weather?
I am a doctor, and this is what I do at work. Really.