e 3 a s h i g R E F L E C T I O N S

Curse Of The Uncircumcised Man

One day, I came on call and got a quick hand-over from the person before me before she quickly dashed out saying casualy: “Have a quite one”. Quite? Yeah right! - not with incompetent GPs out there who do not even bother to look at their patients before sending them to hospital. I quickly went through the admission book.

Here is how the system works. Patients initially go to Primary Care which means their GP or the on call GP (equivalent to local clinics back home). These people make 2-3 times more money than the average hospital doctor. General Practice in UK is a speciality of its own unlike back home where any doctor is called a GP until they specialise. I guess they are what we would call Family Physicians in UAE. These people asses the patient, decide to send them home or send them to hospital. They then call the hospital to organise a placement in surgery or medicine. In surgery (in my hospital anyway), the HO takes the call, decides to accept the patient or not. The thought that a newly qualified doctor can feel confident and competent enough to tell a profession-hardened GP who has been on the job for at least 4 years is amusing: ‘No. You are obviously wrong and you are a crap doctor. Where did you do your crap training? This is a case that you should be able to deal with in the community’ instead of thinking ‘Gouch this older doctor seems genuinely worried and although it doesn’t look like there is anything disastrously wrong with the patient, it sounds like they really need to come in. I must be missing something’ and conclude ‘Yes sure send them in’. The patients’ name then goes in the holy book of admissions where some mysterious mechanism is set-a-start that ends up few hours later with the patients in a hospital bed. Alternatively, the GP can send the patient straight to A&E where he gets seen before coming up to the surgical assessment unit.

So back to my on call night. I looked in the admissions book:’ Query appendicitis, appendicitis, LIF pain, obstruction, abdo pain, GOK (God-Only-Knows), and Paraphimosis‘. Wonderful! 7 patients to come in and the night is still young.

The last one was the only one in; Paraphimosis. It is the curse of the uncircumcised man. They get an erection. The foreskin is tight to begin with and becomes even tighter, and walla; they can no longer retract the head of the penis back behind the foreskin and both parts become swollen. I am told its exquisitely painful. To fix it, you do manual reduction.

I phoned my SHO (brackets are for the unsaid parts of the conversation):

- Evening mate. We have paraphimosis here. I never done a manual reduction. Could you come and help please.

- Why do you need me. I showed you last week, remember? There are few A&E people waiting [that I am just going to ignore for the next 3 hours and sleep until they bleep me again]

- No you didn’t [you fu*k head]. You asked me to do something else [an even more boring job that you didn’t want to do yourself].

- Look I cant come right now. Its simple. Get a pack of ice. Put it around the swollen penis. Hold it for a bit, and push the thing back. it works like magic! [And now I am going back to bed]

- If you say so. I will have ago.

I explained what I am about to do to the terrified forty-something man. He had loads of questions and for every one the right answer seemed: “No. Your penis is NOT going to fall off.” instead of “I understand your anxiety. I can not imagine this to be more painful than your current problem”. He eventually surrendered to my expert opinion and I disappeared for few minutes to get the stuff needed.

If you think anything you have ever done in your life is weird visualise this: A patient sat at the edge of the bed, me sat on a chair opposite, both hands holding the mans’ penis with a packet of ice around it. Both of us think the situation is weird and both try to say something to diffuse the embarrassment, but, every conversation seems to die off 60 seconds after it starts. It was probably one of the slowest 30 minutes of my life. Worse still, after all that, the trick did not work and he eventually had to go for surgery.

Junior doctors are traumatised by these experiences until they don’t care any more I am telling you.

PS: This post is dedicated to all the junior doctors out there.