Sunday, November 20, 2005

Stand up

And on the next day....

The next day was largely full of fairly unwell people, but over lunchtime I heard something rather disturbing about a patient who had been seen at Shipton. In this case the fault was not Shipton's. I'll let you work out whose fault it was.

This, too, contains sexual references.

Anyway, what had happened is a man had turned up to the Shipton ED with an erection and a detailed sheet of instructions. This caused the consultant, Dr Prong, some concern, principally because the erection had now been going eight hours and was an unhealthy dusky blue colour.

It emerged that the gentleman concerned had recently begun treatment at one of the new impotence clinics that have arrived in town. He had been having injections of something we call caverject - you inject the stuff into the base of the penis and a few minutes later, Thunderbirds are go. Everyone (presumably) is happy.

By the way, when I was a medical student I managed to accrue not only a pair of Viagra boxer shorts, but a Viagra wall clock and a calculator in a kind of wooden stand - you pressed this button and the calculator slowly rose from the horizontal to the vertical. At Hogarth I managed to get lots of free samples, ostensibly to treat people with anti-depressant induced or anti-psychotic induced erectile dysfunction, which were certainly not abused for alleged recreational purposes by doctors.

Anyway, back to our upstanding citizen. He was actually in considerable discomfort and considerable danger. The condition is called priapism (a painful, prolonged erection) and it is dangerous because it impairs blood flow through the penis. The erection is not caused by sexual excitement and it is not relieved by ejaculation - it's a longer term thing. Erections have been known to last for days - and the longer it lasts, the worse the consequences are, including irretrievable impotence and amputation.

Do not, by the way, inject cocaine into your penis. Priapism may result.

One surgical response to priapism is called a Quackel shunt, and I think another is the El Ghorab procedure. Neither of these names inspires much confidence, one sounds like a dance move and the other like some military atrocity. But by God, they're better than ongoing priapism.

The way the patient told the story he'd basically been sent home with this stuff and told to inject increasing amounts of it until it worked. Dr Prong said he had rarely seen a man so uncomfortable as this man.

Doctor Prong tried everything. The first thing he did was aspiration - sticking a hypodermic needle in and withdrawing 150 mls of blood (about the size of a restaurant glass of wine). The offending organ deflated momentarily but returned to full size within a minute or so.

Dr Prong started injecting the antidote into the base of the penis - 50 micrograms of phenylephrine, then 100 micrograms, then 150 - finally ending up with sticking one of those butterfly things in the penis and giving 500 micrograms every three minutes until things came good - all the time getting ready to send this guy off to the urologists at the Royal for some kind of emergency somethingorother. Maybe some shunting, perhaps a bit of quackling.

Anyway, things eventually came good, but only after what Dr Prong said was heroic amounts of phenylephrine. Dr Prong reassured the man that there was every likelihood that "regional tissue ischaemia had been minimised" (good with penises, less so with people), and the man seemed grateful.

"So" said Dr Prong, a life-long fan of public medicine. "I have to tell the clinic about what treatment we gave, I've written a letter - do you think you'll be going back?"

And the man, who at sixty nine years was still a large and powerfully built figure, clenched and unclenched his fist a few times and looked at Dr Prong and said "Oh, I'm going back there. Just the once."

Anyhow, thanks for listeing. Less visceral posts next time.



Blogger Chade said...

Keep em coming. This is Gold! Gold I tell ya! Don't listen to the monkeys. It's not gold in them darn hills, it's in yer head!
Seriously though, this is some great stuff for comedy. Although, maybe it's just funny if you aren't a part of the story...

7:40 PM  
Anonymous Camilla said...

I'm not a boy, but ... OWWWWWWW.

Wish I could have been a fly on the wall during his return visit to the clinic.


A sort of deflating sound?

11:48 PM  
Blogger Champurrado said...

Jeesh.... Can't stop crossing and uncrossing my legs, doctor. Maybe less is truly more in some cases. Once again, thanks for the terrific running enlightenment commentary.

Would someone actually inject cocain!?!

1:05 AM  
Blogger Foilwoman said...

Let me just saw . . .ewwiie!!!! And I'm so glad I'm female. Our plumbing may be much more complicated, but ew, ew, ew. And again. Ew.

And I believe you, truly. None of the Viagra giveaways were used for the amusement of medical professionals. None of them. The check is in the mail. You'll still love me tomorrow. Etc.

1:30 AM  

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