Catheter Conundrum

In my second week of working as a doctor, I was double, triple, and quadruple checking everything I was doing. Why? The persistently looming thought that every doctor has after transitioning from medical school to being a real life doctor – just don’t kill anyone.

The result? A backlog of work – an inevitable consequence of inefficiency. As I was plowing through it, one of my new fellow doctors came moseying down the corridor onto my ward – stethoscope around neck, shirtsleeves rolled up, and a slow, slightly penguin footed gait – asking if I needed any help. He had either mastered this whole efficiency thing, or literally had no work to do. He claimed the latter, so I easily accepted his offer. An old man needed a urinary catheter – my kind colleague offered, on the condition that I act as the assistant – fair enough.

The gentleman at the end of the ward required the catheter to measure urinary output. We eventually got the equipment from the equipment room and down the corridor we went.

The poor old guy wasn’t in the best shape – and he knew it – so much so, he didn’t care what we did to him, even if it meant shoving a rubber tube up his penis to properly monitor him.

My colleague got into position at the patient’s right hand side, I on the left. The chap seemed to forget how to lift his buttocks off the bed and pull his pajamas down, often the case with frail patients who become institutionalized, meaning we had to do the classic ‘PJ Shuffle’ – where you sort of wriggle the pajamas down past the waist and bum, exposing his manhood.

First step in the catheter insertion process is to clean ‘The Area’. Now in men with foreskin, this means pulling the foreskin back, exposing the…end of the penis…so that you can give it a really good scrub down. Believe me, sometimes it really is a good scrub down.

After cleaning ‘The Area’, it’s time to inject the lubricant up the urethra, to help with that annoying rubber tube that’s about to follow.  Now, some people advocate that you hold the penis for a couple minutes after injecting the lubricant, to allow the anesthetic properties of the lube to work. In reality, holding another man’s penis for 2 minutes can seem like a lifetime…after all, it only takes about 10 seconds to catch up on the weather.  If you choose the waiting technique, when the conversation goes awkward is usually a good indicator of when to insert the catheter. In other words, at pretty much the same time as if you chosen not to have the conversation in the first place.

The patient in this instance was looking up at the ceiling – probably best – as the sight of a 1 foot long rubber tube going into your penis is enough to make anyone flinch. (There’s usually a flinch at some point, however, as the catheter makes its way past the prostate.)

It was time for my colleague to insert the catheter. He looked like he was threading the eye of the needle – except the thread in this case was a massive rubber tube, and the needle was the head of the penis…almost the same thing really. Oddly enough, I’m more experienced with the catheter.

It was my turn to do some work. You know you’re in the bladder when the urine starts flowing from the catheter. I know. Obvious, isn’t it. My colleague struck gold. I hooked the catheter up to the collection bag, before my colleague injected water into the catheter’s balloon to prevent the undoing of the work he had just done.

Now all that’s left is to put the foreskin back into place, preventing what is called a paraphimosis – or a tightening of the foreskin behind the…end of the penis.

I take my attention away from my colleague and begin to clean up, but out of the corner of my eye, I see he’s still looming over the gentleman’s manhood, appearing to struggle.

Uh oh.

What’s wrong?

It appears the foreskin is stuck – how unfortunate.

My colleague continues to struggle.

The lubrication that he’s been using is too slippery – it’s everywhere – literally everything he touches just slips away.

I’ve been there before, I know what he’s going through, you feel as though you’ve forgotten how to use your hands.

But I can’t help. I’m feeling impotent.

It doesn’t take TWO men – two doctors – to pull another man’s foreskin back into place…does it?

No.

The struggle continues.

My colleague is as focused as can be. I’ve never seen such determined eyes.

It seems like it has been an eternity.

I can’t help but giggle for a second, before conveniently obscuring my quivering face from the view of the patient. The urine is draining fine. The patient continues to look up at the ceiling, blissfully unaware of what’s going on, or so he led us to believe.

Staying very professional the whole time, my colleague decided to diffuse the situation:

“Just need to put you back where you were, Sir”.

Put you back where you were? Meaning; ‘your foreskin is stuck, Sir, and there’s TOO MUCH DAMN LUBE on your penis, so I’m having a little difficulty getting your foreskin back where it belongs, Sir!’

My colleague eventually got this gentleman’s foreskin back to its resting position. Whether the patient realized this little blip in the situation I don’t know. But I’m never going to forget looking over, and seeing my colleague repeatedly pinching the old gentleman’s willy, like he was milking a cow, trying to overcome that ever so slippery lube, and defiant foreskin.

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