Sunday, May 2, 2010

Man Up, You Wimp!

As a typical guy, there are several painful illnesses that can hit our brotherhood in an instant. No warning given. No "Get out of jail free" pass, either. Just cruising along, having another fine, healthy day and baam!--suddenly you are lying on the floor in severe distress.

The most feared? A testicular torsion. It can happen spontaneously. It can happen suddenly. And if you are the owner of a testicle or two, it can happen to you. Simply put, the testicle can twist on its supporting ligaments and vessels, in essence cutting off the blood supply while stretching and irritating the supplying nerves. Sounds painful, yes? Excuse me for a second while I wipe my eyes--they're welling up just from talking about this one.

Or better yet? Taking a direct traumatic hit to the groin area. We've all seen the funniest home video shows where Dad takes one to his manhood, only to buckle over and writhe in pain. It's funny, sure, as long as it's not one of us that took the shot. And usually, the laughing female voice we hear is the guy's loving wife or girlfriend, still recording. Explain that one to me! Whatever you do, maam, don't put the camera down to help out your man!

At least with these afflictions, though, we can't be compared to a woman dealing with the same illness, shaming us with their inner strength. We can carry on and on and never have to explain ourselves and our pain. Or worry about comparisons.

However, the illnesses we do share with the more stoic and stellar species--you know, the ones with two xx chromosomes--are numerous. Chest pain. Abdominal pain of a million etiologies. Migraines. Broken bones. An asthma attack. The list is long. If you came and worked one shift with me, you would find it very evident that a woman is so much more tolerable and less whiny than a man with a similar problem. Almost always. Us guys? Yeah, for the most part, we are big wimps.

A few months back, I had two patients, a man and a woman, present to our emergency department, within an hour of one another, with the same illness. Unrelated, they were both suffering with kidney stone pain. Pain that was sudden. Pain that radiated from the flanks toward their groins. Pain that they both graded a ten out of ten.

Walking into the woman's treatment room, I found a patient with her eyes closed, breathing deeply in and out. Her tight grips on her cot's side rails were her only clue to being uncomfortable. Calmness permeated her room.

After a brief review of her history, which included a previous history of kidney stones, and a primary exam, I offered her some pain medications, in addition to some IV hydration and nausea medicines.

She smiled, taking me up on my offer. "Thank you, Doctor," she quietly said, "that would be wonderful."

After ordering her CT scan, urinalysis, and baseline blood work, I continued into another treatment room, just two doors down from her, to see the male patient.

I heard him before I even walked into his room. Between the cursing, the moaning, and the angry words directed at his wife, I knew he was going to be a difficult patient to manage.

I walked into the room, ready to briefly introduce myself and obtain a bare-bones history and physical, before offering some similar pain relief. I didn't get the chance to do either.

"God-damn it," the patient said, sarcastically, greeting me, "are you the doctor? I'm in pain here." He, by the way, arrived after the previous patient. The drama in the room was suffocating, to say the least.

I assured him that yes, I was the doctor. After a few more obnoxious words, and some dramatic flailing, he refused to tell me anything about what brought him to our ER. Now, I'm all for giving someone a break when they aren't feeling well, but his actions and words were bordering on ridiculous. "I'm not telling you anything f...ing more until I get some God-damn pain medicines," he said, crossing his arms over his chest. If he hadn't been lying in a cot, I know he would have been stomping his feet.

I know that kidney stones can be painful. I've seen enough patients with them to get that. I also know that I never want to have one. But, I also know that pain does not give one an excuse to be as blatantly rude and disrespectful, with the medical team providing care, as this patient was. Sometimes, a patient may forget that we are on their side. At any rate, it's hard to get under my skin and, after walking out of the previous stoic patient's room, this gentleman succeeded in doing just that.

"Sir," I said, "I understand you are in pain, but I won't let you talk to me or anyone else in my presence in that manner. Do you understand?" He eyed me while receiving my direct stare. "Do you understand me, sir?" I repeated. He nodded yes. "If you cooperate, I will be more than glad to help you after I learn what brought you here and perform a brief exam. I'm sorry if you don't understand this process, but that's how it's going to be done." His nurse, standing by his cot, nodded her agreeement.

Translation: Man up, you wimp!

With a little coaxing from his wife, we arrived at an understanding. As I requested, he provided me with the details of his sudden onset of pain. He was home lying on his couch when he suddenly had been overcome with pain in his right flank area. "I know it's my kidney stones again," he said. "It's just like my last one."

After cooperating, he also received pain medications with some IV fluids and nausea medicines. "Finally," he complained to the nurse, "that took forever." Yes, sir. Twelve minutes to be exact, from the time he was placed in his room until the time we pushed his medications.

Ultimately, both patients had results conclusive of a kidney stone via CT scanning. His, three millimeters. Hers, four millimeters. Both stones were in the UVJ, or the uretero-vesicular junction, the distal part of the ureter, the tube that connects the kidney to the bladder. Both stones were near their journey's end. There was no hydronephrosis, or backed-up fluid, to either's kidney.

I walked into the woman's room and explained her results. She looked more at ease, greeting me with a smile as I entered. "Thank you," she said, continuing to be stoic and kind, her grips lessened on the side rails, "for all you did. This was a wonderful experience." She had refused any further offers of IV pain medications. "I'll be fine," she had assured us. I wished her the best, advised her to return to our ER if she had uncontrolled pain or fever, and sent her home with a prescription for pain medication. She would follow with her urologist in a few days.

She had been an absolute pleasure.

Next, I walked into the man's room and to explain his results. He had received several additional doses of pain medication and appeared much more comfortable, although his complaining nature was still evident. "God-damn it," he said, now rating his pain a one out of ten, "why do I have to suffer with these god-damn stones. Why couldn't someone else get them, instead?" I explained to him that his stone was small, was near the end of passage, and that we would be sending him with a script for pain medications. On review of his previous records, he had always passed his stones without complications. I suspected that this would be no different. I referred him back to his urologist for a follow-up appointment in a few days. Yes, I was sharing the love.

I know this is an extreme example of comparing a man to a woman, with many variables to consider (a family history of stones, the size of the stone, an individual's response to pain, age, etc.). Consistently, though, through my career, women have demonstrated to be much more stoic, mature, and admirable in dealing with illnesses than men. You can't change my mind of that. It could be something as simple as the flu, or something as complex as a myocardial infarction. It doesn't matter, really.

My one buddy has a theory--the more screaming and carrying-on from a patient, the less the likelihood of that patient being seriously ill. Likewise, the more stoic a patient, the more serious the illness. At first, I laughed at him and his observation, thinking he was just joking around. "Seriously, Jim," he said, "just think of all the guys we've treated who were crying when we walked into the room." Unfortunately, after this many years spent in the ER, I've seen his theory prove itself true.

What do you think?

I think us men need to toughen up and start spitting out some nails. Or eating black licorice to grow some hair on our chest. Even throw away that certificate for a pedicure and an hour massage. Hide the cologne. Quit watching "Dancing with the Stars." Maybe, just maybe, we should step up and offer to deliver a ten-pound baby, au natural. That might put our pain in perspective.

On second thought, though, maybe I should hope to get a kick in the balls or a spontaneous testicular torsion instead of any other painful illness...that way, I won't be embarrassed or shamed by my fellow womankind when I start my high-pitched screaming in the ER. Or flailing my arms. Or crying...

As always, thanks for reading. Hope your weekend was a good one. See you next time...

37 comments:

Heather said...

Now I'm crying from laughing!

I had a patient yesterday who was 84, 6'3", and 200 pounds. He tried to kill me. Literally. And the doctor blamed Me (and, for the record, the patient tried to fall out of bed, and I caught him, but he slid down my leg and took my pants with him. It was a lovely situation to be in). This patient had the same surgery that a female patient had and was way more harsh.

I'm going to throw away Jack's doll baby right now! ;)

Anonymous said...

I think women tolerate pain better because of childbirth. Survival of the fittest, pure and simple. If we couldn't tolerate pain, there would be no people. I am, however, waiting for the day when (female) scientists discover a way for men to carry and deliver babies.

rlbates said...

Love your storytelling, Dr Jim!

Katie said...

Kidney stones are not something I want to deal with. Ever. I've got four friends who've had them since I've started college. Neal (our campus minister) got his around 3am our last night in Guatemala. He and I had painted side by side all day the previous day and now he was rolling around on the airport floor in Guatemala City with his head stuck in a garbage can. It was such a contrast to the strong man I see regularly. Even within all of his pain his motto was, "Yes, I have a history of kidney stones, and I'm sure that's what this is. I just want to get home to my wife and kids then I'll go to the hospital." His first job was making sure we got back into the States safely, second to dealing with his pain. Well, he did that by spending the entire three-hour flight back in the lavatory and as soon as we landed it was transportation directly from the plane to the hospital, do not pass go (customs), do not collect $200. Yeah, he was in pretty bad shape by the time he made it to the hospital (but he's fine now). I'd say he won the stoic award, at least in our presence. His wife may tell a different story.

Great post.

<>< Katie

tracy said...

Maybe all the men need to do is "Man Up" and eat a bowl of Banana Laffy Taffy. Ummmmm, good.

Thank you, Dr. Jim

Jabulani said...

I cannot help but think of Billy Connolly when you mention testicles!! However, having nodded my head through much of this post in total agreement with your women-v-men in the pain stakes, let me tell you a story to put the case for men (or perhaps just my husband).

Many years ago (maybe as many as 15), my husband was a butcher. In a distracted moment, he put his right index finger through the bandsaw. It managed to slice a neat chunk right down the side of the finger on the thumb side. So, a little jaunt to Casualty was suddenly factored into his day. I'll skip the gory bit (fascinating I know but some of your readers are possibly already curling their fingers up in pain!), and move on to the bit that says no nerve damage, only just shaved a smidgeon of bone on the knuckle, blah blah blah...several stitches later plus about 300yards of dressing, bandages and tape and he was allowed home. Being the ever-loving wife that I was when he nicked himself with one of his razor-sharp knives, as soon as I saw the dressing, I asked "What the hell have you done this time, you pratt?"

Now, here's the important bit: against strenuous medical advice, he went back to work the next day. He'd been given the strongest painkillers the hospital could give him, which he was busy chewing like candy. Overdosing? Oh yeah, he most definitely was. Dilated pupils. Yup. Babbling. Most definitely. The only sensible thing he wasn't doing ... was going near the bandsaw again. But that was because he couldn't actually get his hand around the frozen meat because of the size of the dressing on his finger!!!!! He was in constant pain and doing his job was severely hampered by a non-fully-functioning right hand, but he was at his post. He was in pain for weeks as the injury healed, and even now still get twinges along the scar.

So why, you may ask? Well, he was the only butcher in the family business and if he wasn't there, they'd have had to shut up shop for a while. That wouldn't have been acceptable to the family, so he had to Man Up and Work On. He'd learned a more painful battle earlier: the pain in his finger was nothing compared to the pain of not showing up for work simply because of an injury.

So yes Jim, I think that sometimes men are capable of coping with pain. Or maybe it just depends on the guy? I should perhaps mention he's totally and utterly crap at getting a cold or the flu or stubbing his toe...

Oh, and can I just mention my stoical son who last summer got stung 5 times by a wasp on his belly and didn't even murmur. The only reason we knew he'd even been touched was because I specifically asked him if he'd been stung and, at first, he said no. It wasn't until one of the other kids mentioned there'd been wasps on his shirt, that I checked. He's come off his bike dozens of times and lost layers of skin, but doesn't make a fuss. My daughter, on the other hand, got stung on the wrist ONCE and dear heaven, I think they heard her creating merry hell all the way to London and beyond. Talk about a complete and utter drama queen!!

God bless you for another great post.

A NURSE said...

I am a little confused here. First you tell men in general to
"grow some hair on our chest. Even throw away that certificate for a pedicure and an hour massage. Hide the cologne. Quit watching "Dancing with the Stars."
- which are presumed to be feminine pastimes...then go on to say they should give birth to a ten pound baby, which is also a female role....shouldn't you be saying that maybe men should be doing the feminine activities so they can handle the pain?? ;)

Anyway....if u want u can read about my hospital visits in my blog. I suppose I tried to downplay the pain, however, whether I was a good patient or not is still up in the air.... :)

Jacqueline said...

I think it's the whole childbirth and cramps thing...especially when it comes to kidney stones...dealing with that for years makes most things seem light in comparison. My mom said kidney stones are worse than natural child birth by a long shot. And lucky me, I'm just waiting my turn on the kidney stone train...everyone on her side of the family has had them...it's just a matter of time. Oh, and she doesn't produce something or another that causes her to have the tendency to form them.

While I have a pretty high pain tolerance, there are 2 specific things that have brought me to my knees both literally and figuratively: horrendous cramps...I'm not talking mild cramps...I'm talking about rip-roaring cramps that feel like someone has been tearing your insides out for hours...and luckily, that very rarely happens...second thing? Gall stones. I was begging for someone to kill me. The pain is THAT bad. Wouldn't wish it on anyone.

WarmSocks said...

Thank you, Dr. Jim, for another great story.

Cal said...

I think the little things that women learn to endure (yearly pap smears, pelvic ultrasounds with a bursting bladder) train us to become more patient in regards to pain. Saying this, I will take pain killers when appropriate and will not put up with pain just for the heck of it!

Anonymous said...

Another wonderful entry...and oh-so-true! (The only exception is very YOUNG women who are convinced that, due to the fact that they are a PRINCESS, there should be no discomfort in their world, dammit!)

Count me in with those lucky few who have had kidney stones AND popped a ten + pound kid out~~~without drugs. The kid was a piece of cake in comparison, by a large margin! And I do think that the life experiences involving pain and bleeding on a regular basis give women a different outlook on "discomfort" and the management thereof.

Of course, if two X chromosomes are combined with "RN" or "LPN" after the name, stupidity can reign. I worked 9 hours on a broken leg because there was not another nursing supervisor available. So, instead of a cast, I wound up with an ORIF of a non-comminuted tib-fib fx and a permanent limp. There is fine line between bucking up and being a moron.

Pattie, RN

Anonymous said...

Ok, I've had enough....your site is going to be deleted from my favs list.
Once again the onslaught on men and their LACK of manliness is too much for me to bear. What a bunch of generalizations!
I myself was back to work in my ER 6 weeks after I got hit by a car. Crushed chest, broken neck, bleed on the brain, shocked three times to jumpstart the heart....
Why don't you read this:
http://www.theothersideofkim.com/index.php/essays/41/
and maybe you can get an idea on how your generalizations came to be.
As for me; I would rather take after somebody like John Wayne or Jimmy Stewart.

Steve

Emily Godsey said...

Great story! I'm a Nurse on a gyn/surg floor and what I see most often are women (besides the occasional medical overflow pts). It always gets me how an 83 year old woman can have a procedure and be completely fine needing minimal pain meds and not causing a scene when it takes more than 2 minutes to bring the med. Then there are these young women in their 20s-30s that act like they are on their death beds, screaming, moaning, crying. I am 24 and it amazes me how some people act. I know you are in pain. I know this. I have had a few pts grab my stethoscope and shake me violently after I have JUST pushed their med. I agree there is NO excuse to be rude and disrespectful. By the way, I have just accepted a transfer to our ER. I'm very excited! Always wanted to work in ER. Any advice?

emmy said...

I pushed out an 8 lb baby naturally, and did a year with cancer. Believe me when I tell you that the kidney stone beats both in pain and nausea. However, it is correct to say that the man in this story needs to put his big girl panties on and deal with it.

Late Fred said...

I know an awful lot of women who have had actual training in how to resist pain. They've been through natural childbirth classes, and the deep breathing that helps with labor pains also helps a lot with other kinds of pain.

Women who have not had this explicit training seem no more stoic than men.

And anybody becomes more able to tolerate pain if you take two minutes to explain some pain management techniques (as long as they are willing to listen).

Pissed Off Patient said...

I think this is more a factor of how each gender is raised. Women are raised to be 'good little girls' where appropriate behavior is emphasized and rewarded. (Although I can see the up and coming 'princess' generation being different.)

Men are raised to 'be men' which means being assertive and not being afraid to make a ruckus.

Perhaps your observation is one of the few examples of gender roles working in the favor of women instead of the more typical against.

Also I've had being a good little pain tolerant girl backfire on me medically.

M

somedaydoc said...
This comment has been removed by the author.
No Pain, No Brain said...

Ok, that's it. I've had it. I'm done! Enough Already! Really!!!

As a man, I just have to say that I am extremely... er... um.. uh.. offended!
Yes, deeply and truly offended by your...uh....uh....um....

What the hell was it that I was so offended by?! Geez, I can't remember. And that's really painful. I mean, really, Really, REALLY PAINFUL!!!

GOD-DAMNIT!

WAAAAAAAAAAAAAAAAAHHHHHHHHHHHHHHHH!
So you're telling men in general to
"grow some hair on our chest." (already got some, check).
"Even throw away that certificate for a pedicure" (not a problem, I'm not metro).
"and an hour massage." (ALRIGHT, HOLD THE FREAKIN' PHONE RIGHT THERE! YOU'VE GONE TOO FAR THIS TIME!!!)

I'll Hide the cologne, quit watching "Dancing with the Stars,"
and all the rest, but nobody monkeys with my massage! Even the thought of that is just too painful to bear!

Ouch...where's the Tylenol?

somedaydoc said...

I'm a big fan of your blog, and as a medical student have also been privy to the rule that the more they complain, the less sick they truly are. I believe it's related to the psych ER rule that the patients who want to stay need to be discharged, and those who want to go home should be admitted.

Anyway, keep up the great work, and also if you or any of your readers are looking for another blog to peruse, please check out mine, at pgysomeday.blogspot.com.

Annemiek said...

Great post.
It seems like every time you try to shove something big through some small tube (kidney/gallstone, kid) it is the worse pain.

Karen said...

"...women have demonstrated to be much more stoic, mature, and admirable in dealing with illnesses than men..."

I already knew that, Dr. Jim :P

Anonymous said...

Yes, I was sharing the love.

Hee hee hee.

Nuclear Fire said...

Counter argument: How many men do you see with fibromyalgia?

Late Fred said...

Hey, where'd the rest of my post go? Was it too long?

OK, I'll be brief. Stereotyping is stupid, and you're not stupid enough to be doing it. Please cut it out.

Marie said...

I really resist men-bashing. I hate it, there are many very good men out there.

Unfortunately, I personally can't find any, but there is anecdotal evidence.

At any rate, I think is it, like everything else, a combination of socialization and biology.

One of your readers is so right, we are raised to be good girls and not bother anyone and always be polite. (An aside, as a teenager I was molested in a theatre during a movie. I reached down into my lap because I felt something moving there and when I touched his hand I APOLOGIZED!!! That's how well brought up I was. lol)

When I fractured my shoulder into four pieces two years ago, for the first time in my life I was involuntarily sobbing with pain and repeatedly apologized to the ER staff for crying.

But I do believe there is also a biological component to help ensure the survival of the species.

If nothing else, it makes for entertaining stories.

Moonshadow said...

Hey Doc, midweek now so I hope you don't mind if I make a comment that's a little off subject. I'm not sure of your age but have you ever happened to watch any of the Emergency series from the 70s? I've been watching them lately on Hulu (http://www.hulu.com/emergency), I'm looking for one particular episode. Oh how things have changed. In one of first episodes they laugh about a guy being drunk, nowadays he would have been tossed into rehab. And the equipment!! The voice recorder in the ER is reel to reel. While watching I wondered what an ER doctor today would think about this blast from the past. :)

Anonymous said...

Actually, I believe that there are equal numbers of men and women with fibromyalgia, and that the sum total of these is ZERO.

But these women would have been the crowd with unspecified "invalidism" a hundred years ago..some folks just luv the secondary gains from their non-existant illnesses. Let's not group all females in with these malingering "ladies".


Pattie, RN

ps...please spare all of us YOUR fibromyalia sob stories. I don't care that Lyrica is on the market, this is still not a disease!

Rositta said...

You are right Dr. Jim, men are wimps. I've had six surgeries in the last two years with another one just two weeks away,and my sweetie changes color just going into hospital with me. He on the other hand once had a little lump removed from his year and he was impossible to deal with. Thank goodness he doesn't get sick very often...ciao

Anonymous said...

@ A NURSE (5/3, 12:05)-- I'm with you there!

Also, I don't see how this post counts as man-bashing' when the insult is actually to the women. Are we not supposed to notice that the biggest insult to a man is to be feminine?

Anonymous said...

The thing about childbirth is that you get something you WANT to keep afterwards as a reward. I can't say kidney stones or gall stones would fall in the same category. >.<

I've had all three of the above, none of them compared to the pain of falling out of a tree when i was 11 and landing sitting up (20ft fall). I honestly thought my head was going to pop off. I have never in my life screamed like I did then. Recovery from the broken tailbone and compression injury of the spine was no fun either.

I had Pneumonia a couple years ago, so i went to the minor emergency clinic. Three days later they called me back in for an emergency follow up xray. Apparently the original was sent off to whoever does their xrays and he called them to have me back in immediately. I had been walking around with a collapsed lung.

I promised them i would go directly to the hospital after the followup xray showed it being larger and not to call an ambulance. The hospital didn't believe me, so they had me do ANOTHER xray before they would put the chest tube in, even though I brought my most recent one with me.

No i didn't feel well, but it doesn't make much sense to act all crazy and quite frankly it takes too much energy to put on theatrics when you just want to breathe easier.

My thoughts are, if it doesn't feel like my head is going to pop off then being quiet and still is better for my own well being.

~R

Peter said...

Hi! During my youth "Down Under" manhood was put to the test when playing cricket! Cricket? It's like baseball except it's a lot more exciting and skillful!

On occasions one was hit below the belt, middle stump actually, and the idea was not to keel over in pain but to, as you would say, Man Up!

How many of us failed to make the grade...lots!

Take Care,
Peter

Jabulani said...

Peter, we in South Africa used boxes. It mitigates the pulverised middle stump somewhat!! Whole new angle on LBW ... :D

I was a cricket scorer at school and the boys took great delight in inserting the box right in my eyeline to see if they could make me blush. Silly boys - I think they thought I was some kind of shrinking violet!! My son has now started cricket and I had to explain the box to him...not sure that's a cool thing for a mom to be doing to her 9yo!!

Freda said...

Am definitely going to try to be stoic in future - have had four children and some trauma in my life so there has been opportunity to try and be brave. Trouble is, I get scared, start to shake and my teeth chatter.... But I am resolved to do my best. Thanks for your blog. I have just stumbled across it.

Anonymous said...

Thanks Jim- I'm glad its not just me that sees this difference. When I encounter a patient like this I always think he is suffering from an acute case of M-A-L-E disease. Now if only there were a cure.....

Anonymous said...

Pattie, RN -- Ever heard of epilepsy? Back in the day, they used to think seizures were the result of demonic possession. Isn't it possible that science hasn't caught up yet to fibromyalgia? Or maybe you do go around telling your patients with a seizure to "get thee to a church."

Have Myelin? said...

I've had kidney stones and I've had a baby. I'd rather have a baby because it hurts far less.

AND when the doctor told me I wasn't pushing hard enough during childbirth I told him I wanted to see him shit a watermelon!

He didn't say another word to me....and my son was born a few minutes later. =)

Anonymous said...

My brother trims cow hooves for a living and gets a kicking, in the groin, every so often. Wonder why he doesn't have kids? :-)