Influential case #1

It was my second year of residency and I was on the night shift at San Francisco General Hospital. Just after 2am, I entered room number four of the emergency department. A five year-old monolingual Spanish child was squirming in the arms of his concerned father. The child would rest his head on his father’s shoulder for a few moments and then bend his neck back and scream. He was not crying, but seemed to be overwhelmingly uncomfortable and unable to remain still.

The father immediately told me “he has not urinated in over two days and needs to go very badly”. As I sat him on the gurney, I noted his protuberant abdomen. I then looked at his penis and found his foreskin was completely stuck together at the tip. When he tried to urinate, his foreskin ballooned up like a mushroom but no urine could escape.

I called the urologist but he was unable to come in at that hour. I didn’t know what to do. This was an emergency and this child needed help now, not tomorrow morning.

I called my supervisor, a third year resident, and said “I think this kid cannot wait until the morning. I am going to try and cut his foreskin here and relieve the pressure.”

I will never forget his response. He paused and then said “I want nothing to do with that. A urologist should be doing that. You do what you need to do. You can say that I was informed, but I don’t want to be involved….Good luck.”

I quickly gathered my supplies and ran to the exam room. I told the family and child “I have never done this on a child before, but I have done it many times on newborns. I will do my best.”

I injected the base of his penis with anesthetic and he cried but remained completely still. While sitting between his legs, I used metal clamps to grip the sides of his foreskin at 3 and 9 o’clock. After a few moments of trying to pull the skin apart, I nervously grabbed a scalpel and made a small incision.

The flood gates opened. Urine soaked my shirt, pants and socks. After what seemed like an eternity, the forceful stream turned into a trickle and then stopped.

I was still holding the clamps on his bleeding foreskin, when the young boy lifted his head, smiled and said in a thick Mexican accent “Tank you!”

Moral of the story: You may not have experience with every type of disease or problem, but you must figure out a way to care for your patients. This was the first time I felt like a real doctor!

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