The Broken Bone

Although I rarely get sick with the numerous strains of “bugs” that seem to go around our community this time of year, the week prior to my return to work for my next scheduled string of four shifts was spent mainly in bed, coughing and aching and whining about how miserable I felt. Fully recovered, though, I was excited to return to the emergency department to do my fair share of stamping out disease and healing thy patient from illness and injury.

Walking into Room 21 to see my first patient of the day, however, made me cringe just a bit and suddenly, I wished I could have been back in my bed at home for just one more day.

The patient was young, in his mid-twenties, and appeared to be in significant pain. He was alone. His short-cropped hair was calmly neat, belying his grimaced, pinched face and restless arms and legs that rocked his compact body against the cot’s rails in defiance to his discomfort. His nurse, Sam, one of my favorites, was hurriedly placing an IV into the patient’s right arm.

I gently grabbed the patient’s shoulder to gain his attention, introduced myself, and asked him what brought him to our ER today.

“Doc,” he said, taking a quick gasping breath before continuing, “I was banging the shit out of my girlfriend when my penis snapped in half.” I looked from the patient’s face to Sam’s, who nodded his agreement to this patient’s history.

Ugh, I thought to myself, a fractured penis. A fractured penis!!! It had been, thankfully, several years since the last time I had seen a case like this. For some reason, despite my tolerance and calmness during any other conceived emergency illness or injury, penile or scrotal injuries always made me cringe. And I was cringing. Usually, this type of injury occurs with masturbation, unusual sexual positions, or aggressive sexual intensity, to be politically correct.

“Sir,” I said, “when and how did this happen?”

As it turned out, it had happened immediately before his arrival—about 20-30 minutes before we began treating him. And how? Despite his pain, he spoke with great pride and in great detail about his sexual prowess and escapades that lead him to our department. He painted a picture that, short of sustaining a penile fracture, all of us men have failed our partners in the sexual arena. Call it rough sex if you must. And call me a failure, then, if this was the price of success.

After his explanations, I had no doubt that I would be able to provide the detailed social history necessary on this patient’s medical chart. I imagined the pleasant dictation lady turning beet red from embarrassment as she typed his chart up. “Hey, Sally,” I pictured her saying to her co-worker, “come over here and get a load out of this patient’s story! I wonder how his girlfriend is doing?”

After examining this patient thoroughly, and confirming that he indeed fractured his penis, I ordered him up a healthy dose of pain medicine before calling the on-call urologist urgently. This patient would need emergency surgery to repair his penile injury, which really wasn’t a “broken bone,” per se (since the penis doesn’t contain any bones), but rather an insult (or tear) to the vascular columns that engorge with blood during an erection.

Finishing with a few more patients and while waiting for the urologist to arrive to see this unfortunate patient, I went back into his room to check on him and make sure he was more comfortable. He was definitely more comfortable and no longer alone. A much taller, big-boned woman with a similar shortly-cropped hairstyle sat in a chair beside the room’s sink.

I walked up to her, my hand extended, and introduced myself to her. Understandably, she could barely look me in the eye as we shook hands and she shared with me her name. During our introductions, however, her boyfriend blurted out in his pain-controlled state, “This is my girlfriend who I was banging the shit out of when all of this happened.” Talk about making an embarrassing moment more embarrassing for her. “Don’t worry about it,” I consoled her, “we will be taking good care of him.”

The patient didn’t stop there. “Hey Doc,” he said, his eyes slightly glazed over from the medications, “do you think they will be able to save my penis?” Before I could answer his question though, he continued. “Dude,” he said, now apparently more comfortable with me, “you don’t understand—without my penis, I am nothing.” He paused, took a deep breath, and got a sad look to his face. “I am nothing! Nothing…,” he repeated, remorse and fear now dripping off his words.

I reassured him that the timeline of his injury was in his favor—that presenting to us so quickly after this unfortunate event helped with his percentages of a full recovery. I told him that as soon as the urologist saw him, he would most likely go straight to the operating room.

“But, Doc,” he said, “what if they can’t save my penis. Can I get a new one?”

I assured him that most likely, they would be able to save his prized possession. Deciding to have a little fun with him, though, I continued. “But if on the small chance they can’t save your penis, penile construction/reconstruction surgery is very advanced these days. We have a catalog of new ones you can choose from.” I could only imagine him skipping the petite section and going straight to the plus section.

He looked up at me in surprise to my words. “Really?” he asked, before seeing the hint of a smile on my face. Getting the joke, he continued. “Dude, thanks. I needed that.”

Soon after, the urologist came in, examined the patient, and booked the OR suite to take the patient for immediate repair of his injury. He would need an indwelling foley catheter for 2-4 weeks while he healed from his repair, effectively taking him out of commission for a month or so. I truly wished this patient the best outcome.

Before the patient left our ER, as if things couldn’t be any more embarrassing for this patient or his girlfriend, this patient’s mother and sister came in to be at his bedside. How could you possibly explain such an injury to your mother, the one who is wearing the serious look of dread and concern for her son? Or your sister, the one who cannot contain her incessant giggling? And do you show them the injury or just trust that they would understand the explanation? Some things I just didn’t want to know. Although I am not of the moral fiber to condone lying, I sure as hell would have fabricated some type of story to divert my mother’s and sisters’ attentions if I were in the same situation as he. “Umm, Mom and sissies,” I would say to them, “I got a hernia while chasing a purse-snatcher down the street after he knocked over a 90 year-old lady.” And no, I wouldn’t show them the supposed hernia, either.

This patient, however, didn’t care. He did show his mother and sister his injury. Eeewwww, I know. That makes me cringe almost as much as the injury itself. Just as impressive, though, was that his girlfriend had an anxiety attack. Why? This was the first time she had met her boyfriend’s mother. And sister. Talk about memorable introductions to the family. Can you imagine, once again, that conversation? "Hello, Mrs. Smith, nice to meet you. I'm Ellie--the girl who broke your son's penis in half." I, for one, didn’t hold out much hope that this relationship was going to survive this ordeal. But I didn’t think the patient would show his penis to his mother, either, so I could be wrong.

Is there a moral to this story? I guess, maybe. The moral might just be that we should never ever "bang the shit out of" the ones we love. Sweet lovin’ might just be the best lovin’, right?

Oh, and one more moral to this story? Never ever show your mother your penis, no matter what state you may be in, when you are a grown man. That’s just creepy.

Thanks, as always, for reading. If this post and typical ER humor offends, my apologies. But who can blame all of us in the medical field for having warped senses of humor at certain times in our days. I hope this finds you all well…Jim.