Remember Nadia Comaneci? Montreal Olympics, 1976? At age 14, she won three gold Olympic medals, receiving several perfect scores of 10 along the way. I was nine, five years her junior, and I remember being completely enthralled with both the Olympics and Nadia. Especially Nadia. When she looked into those Olympic cameras after finishing a routine, I just knew her big smile was meant for me. Yes, even at 9, I had a little bit of a pathetic yearning to me.
Unfortunately, my next patient in Room 33 was no Nadia. Not even close.
I walked into the room to find a 52 y.o. male lying in the hospital cot, writhing in pain. He looked older than his stated age, was short in stature, and chunky. His wrinkled forehead merged fluently into his bald scalp, framed by a skillful comb-over. His wife, wrapped tightly in her overcoat, had pulled up the corner chair to sit alongside her husband's cot. As she nervously tucked wisps of gray hair behind her ears, the concerned look on her face tightened.
"Sir," I asked, after my brief introduction, "what happened?" I wasn't going to pussyfoot around when he appeared to be in so much pain.
"Ohh, ohh," he moaned, "I slipped in the shower." With those words, both of his hands instinctively went under his sheet to his groin area.
"What did you hurt? Your hip? Your head?" I asked, looking from him to his wife.
"No," his wife jumped in, "he did a split. Like a cheerleader. He hurt his groin."
"A split? Like a cheerleader?" I asked, my mind immediately picturing Nadia and her floor routine. "You mean as in a full split to the ground?"
The middle-aged man nodded "yes" as his wife spoke again. "Yes, that's what we mean."
I could hardly picture this patient bending over to tie his shoes, let alone having one foot slide north while the other headed south. It sounded like a true, black-and-blue ball-smacker. And at his age, no less! My thoughts of Nadia, unfortunately, were replaced with images of this patient in his shower. Naked. Dripping wet. Finishing up his wash cycle. And slipping. Laying on the bathtub floor, under the hot streaming water, yelling for help. Ouch. Dreadful.
Suddenly, my groin hurt, too.
"I'll be right back, sir," I assured him. "I'm going to go find your nurse and order some pain medication for you." Male groin pain is a true emergency in my book, any day. After all, you know how wimpy us men can be. Women, on the other hand, are tough as nails. They laugh at pain like this.
I found his nurse, who promptly brought this patient some injectable relief. After that, I was able to get a better history and perform my physical exam.
This patient had had a long, exhausting work-day and, short of a drink, all he had wanted was to have a nice, relaxing shower to wash away his stress and burn down his tension-candle. As he was finishing, ready to turn off the shower nozzle, the freak accident happened. His forefoot slid forward, along the length of the slippery bathtub basin, while his back foot slid in the opposite direction, towards the drain. All the while, his groin ligaments tautly stretched to their limit. When they would give no more, he felt the horrendous pain from the strain.
Did I say "ouch" yet? I did? Okay, then how about "Oh, shit!"
So, there he laid, in a split position, the warm water continuing to rain down from the shower-head onto his naked body, his groin aching and throbbing. Luckily, he didn't strike his head or hurt any other part of his body. Just his groin. Not to say that his split was graceful, mind you, but at least he kept the injuries to one area.
"Help me," he yelled, praying his wife would hear him.
She did. Not knowing what had happened, she called 911. Promptly, our prehospital emergency crews arrived, untwisting this patient's legs before drying him off (I don't think that was in the job description). They helped him into a robe before transporting him to our ER.
His physical exam? Well, it probably goes without saying, but this patient smelled clean, in an Irish-Springy kind of way. I wish all my patients could smell this good. Otherwise, his vital signs were stable. He had no neck pain. No head pain. No chest or abdominal pain. No extremity pain. Again, just pain in the groin. Pain that made this patient twist his unsettled body back and forth in his cot, probably aggravating his pain more. On testicular and scrotal exam, he had only some minor tenderness, which told me that his ball-smacker was no perfect 10. No swelling or abrasions. His hips and pelvis seemed stable, and I couldn't reproduce the pain by rocking his pelvis or rotating his hips. All good. The only thing I could really find, sadly for him, was significant inguinal ligament pain, made worse with his own torso-twisting.
We x-rayed his hips and pelvis to confirm that there was no fracture. And there wasn't. Sometimes, a ligament can avulse a small section of bone from where it is attached, but, luckily, I didn't see any avulsion fractures, either. We also performed an ultrasound on his testes, and, I'm glad to report, his jewels were without any significant trauma. Mild swelling at best. Nope, despite this fall, I don't think the patient would be packing much heat in his Levi 501 Button-flys.
It looked like he had a pure and painful ligament strain.
After controlling his pain and reviewing his tests, our ER team was able to get this gentleman up from his bed and have him walk in our hallways. Despite a little wider and inhibited gait, he did much better than I had anticipated. With every step he took, though, I found myself thinking "ouch," "ouch," "ouch." We offered him crutches in the event he got too sore to walk, but encouraged him to walk as much as possible without them. We advised him that if he wasn't significantly improved after a few weeks of conservative therapy, his family doctor may need to pursue a CT scan or MRI of his pelvis. Finally, I gave him icing instructions ("Yes," I assured him, "you do need to pack your groin with some frozen vegetable bags.") and some prescriptions for pain control. "Oh yeah," I thought to myself, "and don't attempt to run a marathon in the next few weeks."
The patient seemed to appreciate all of our efforts. I hope as much as I appreciated his flexibility.
Even though I work out frequently, including some intense stretching, I could never imagine doing a full split. Never, ever. I'm still cringing thinking about this poor guy and his accomplishment. Between discovering me and the laughing spell that would follow, I don't think my wife would have been able to call 911. She's the type that needs to see blood if you want to call yourself injured.
How this guy was able to walk after his fall was beyond my comprehension. I actually thought of including him in my "Heroes Among Us" column, but realized that half of my readers, the ones with two XX chromosomes, probably wouldn't find him so heroic. But when I think of a patient and hear Rocky's theme song playing in my mind, it's at least worth the consideration, right?
As I stood in the hallway and watched our tech transport this patient, via wheelchair, from his room to the ER pick-up bay, where his wife was waiting, I couldn't help but let my mind wander back to amazing Nadia again. A perfect 10. Can you imagine? The first gymnast ever to achieve such an honor. Heck, she was probably doing a split as her mother birthed her. I just don't know how the human body can do such things, though.
As for this patient, I thought back to the details of his slip and fall. I ran and got a sheet of paper, wrote on it, and held it up for the ER team to see. They all chuckled.
3.5. Because I was not the Russian judge, I was very generous with my score.
Although this patient was a long way from a perfect 10, in my book, he still deserved a gold medal. Or, at the very least, a pair of dangling bronze trophy balls.
And a bag of frozen peas.
As always, huge thanks for reading. Next post will be Friday, April 9th. I want to sincerely thank those of you who wished me a Happy Birthday and a Happy Easter in your kind comments. It was a great, memorable weekend. Especially, I thank those of you who shared a piece of your life story with us...very cool.
Showing posts with label ultrasound. Show all posts
Showing posts with label ultrasound. Show all posts
Wednesday, April 7, 2010
Wednesday, February 17, 2010
A Mother's Cry
It happened again last week. Among the hustle and bustle of a crazy shift. A pre-hospital radio call from an ambulance team that nobody ever wants to receive.
"We're bringing you a child in cardiac arrest."
Noooooooo. Word traveled quickly through our staff, and the mood immediately got very somber as everyone prepared the resuscitation room for this child. We could only pray that the child being brought to us would respond to our life-saving measures.
Nurses ran to get the intubation and IV trays, pharmacists ran to get the resuscitation cart with all the emergent medications, techs ran to get the EKG and ultrasound machines, and respiratory therapists ran to get a ventilator. Two of us physicians were working with a slew of residents, and we all reviewed our mental checklists and tried to enter our objective frames of mind. Organized frenzy.
My partner requested to be the lead physician during the resuscitation. Being young and recently-trained, he wants to save the world. We all want to save the world, I guess, but for now we'd focus our energy on saving this child. I assured him that I would stay in the room and help with the resuscitation efforts.
The ambulance arrived. With a sad nod of his head, a trusted paramedic gave answer to our searching faces. No response. Yet. We all caught our breath as our hearts plummeted.
We transferred this child to our hospital cot. We emergently intubated this child, checked for any pulses, and continued CPR when we found none. IVs were hard to establish, so I started an intraosseous line by sticking a needle into this child's left tibia. Aggressive fluids were given. Medications were administered. Ventilations were forced into uncooperative lungs.
Efforts continued. My partner followed the life-saving protocols but didn't get any response from this child. Prayers were whispered. Seconds were watched as they ticked on the clock. Slowly, as slow as any time had ever passed, a heartbreaking realization permeated the room. We might not succeed.
My partner ran to the family room to discuss options with this child's parents, while I continued to follow all the resuscitation protocols. We had nearly maximized all of our medications. And still...nothing. CPR was continued, ventilations were continued, more medications and hydration were given.
My partner returned to the treatment room. He looked at me expectantly, and I shook my head "no." My partner shared his conversation with me. Dad was still at work, and Mom was in the family room with our social workers, waiting for family to arrive. She had been invited back to watch the resuscitation efforts, but declined. Her child had been through this once before, because of chronic, ongoing medical problems, and had survived. Surely, she thought, her child could survive again.
After almost an hour of failed heroics, with absolutely no response to any of our interventions, we confirmed what we were most afraid of. There were no palpable pulses. There was no cardiac activity, confirmed on monitor and with our bedside ultrasound. There were no spontaneous respirations. There were no signs of life from this child.
There would be no miracle.
My partner asked if anyone in the room objected to his prounouncing this child's death. Nobody objected, since we had all been involved in trying to save this child's life. We knew the efforts that had been put forth were monumental. No attempt had been spared by our team to bring this child back. Unfortunately, and for unexplained reasons, the fates held different plans. My partner announced the time of death.
I requested a nurse to clip some of this patient's hair for the family. I crossed myself after my silent prayer. I fought my tears. Hell, we all fought our tears. I consoled my partner, who, like me, has three young kids of his own. Slowly, a wave of profound sadness and nothingness swept across us. What good are any of us if we can't save a child's life? My partner went out to the family room to deliver the awful news.
Then, time stood still. From two hallways away, I heard the haunting sound. A sound that I knew was coming. A sound that is played over and over in my mind for days after an event like this. A sound of profound anguish. A sound of utter disbelief. A sound of infinite pain.
A mother's cry.
Slowly, as we all knew would happen, the mournful wails of crying crescendoed, and our emergency department came to a stand-still as Mom was escorted through our halls into her little child's room.
Despite our best attempts at maintaining our objectivity, and despite the fact that there were many more patients waiting to be treated, our ER staff cried collectively and gave consoling hugs to one another. We are mothers. We are fathers. We are brothers and sisters. We are sons and daughters. We are friends. We are human. And, we were broken.
Dad arrived just minutes after Mom was escorted to the room, and the cries of desperation were repeated. This time, husky and deep. Slowly, though, his cries softened and dissipated, until there was but one lone cry that began again. Higher-pitched. Guttural. Primitive. Emanating from the womb. A cry that conveyed the raw anguish and helplessness that only such a profound loss as losing your child could bring.
God Bless this mother. God Bless this father. God Bless this child. And may God Bless and watch over this family. And all of us.
If only life were filled with just happy moments...As always, thanks for reading. Next post will be either Friday, February 19, or Monday, February 22. See you then...
"We're bringing you a child in cardiac arrest."
Noooooooo. Word traveled quickly through our staff, and the mood immediately got very somber as everyone prepared the resuscitation room for this child. We could only pray that the child being brought to us would respond to our life-saving measures.
Nurses ran to get the intubation and IV trays, pharmacists ran to get the resuscitation cart with all the emergent medications, techs ran to get the EKG and ultrasound machines, and respiratory therapists ran to get a ventilator. Two of us physicians were working with a slew of residents, and we all reviewed our mental checklists and tried to enter our objective frames of mind. Organized frenzy.
My partner requested to be the lead physician during the resuscitation. Being young and recently-trained, he wants to save the world. We all want to save the world, I guess, but for now we'd focus our energy on saving this child. I assured him that I would stay in the room and help with the resuscitation efforts.
The ambulance arrived. With a sad nod of his head, a trusted paramedic gave answer to our searching faces. No response. Yet. We all caught our breath as our hearts plummeted.
We transferred this child to our hospital cot. We emergently intubated this child, checked for any pulses, and continued CPR when we found none. IVs were hard to establish, so I started an intraosseous line by sticking a needle into this child's left tibia. Aggressive fluids were given. Medications were administered. Ventilations were forced into uncooperative lungs.
Efforts continued. My partner followed the life-saving protocols but didn't get any response from this child. Prayers were whispered. Seconds were watched as they ticked on the clock. Slowly, as slow as any time had ever passed, a heartbreaking realization permeated the room. We might not succeed.
My partner ran to the family room to discuss options with this child's parents, while I continued to follow all the resuscitation protocols. We had nearly maximized all of our medications. And still...nothing. CPR was continued, ventilations were continued, more medications and hydration were given.
My partner returned to the treatment room. He looked at me expectantly, and I shook my head "no." My partner shared his conversation with me. Dad was still at work, and Mom was in the family room with our social workers, waiting for family to arrive. She had been invited back to watch the resuscitation efforts, but declined. Her child had been through this once before, because of chronic, ongoing medical problems, and had survived. Surely, she thought, her child could survive again.
After almost an hour of failed heroics, with absolutely no response to any of our interventions, we confirmed what we were most afraid of. There were no palpable pulses. There was no cardiac activity, confirmed on monitor and with our bedside ultrasound. There were no spontaneous respirations. There were no signs of life from this child.
There would be no miracle.
My partner asked if anyone in the room objected to his prounouncing this child's death. Nobody objected, since we had all been involved in trying to save this child's life. We knew the efforts that had been put forth were monumental. No attempt had been spared by our team to bring this child back. Unfortunately, and for unexplained reasons, the fates held different plans. My partner announced the time of death.
I requested a nurse to clip some of this patient's hair for the family. I crossed myself after my silent prayer. I fought my tears. Hell, we all fought our tears. I consoled my partner, who, like me, has three young kids of his own. Slowly, a wave of profound sadness and nothingness swept across us. What good are any of us if we can't save a child's life? My partner went out to the family room to deliver the awful news.
Then, time stood still. From two hallways away, I heard the haunting sound. A sound that I knew was coming. A sound that is played over and over in my mind for days after an event like this. A sound of profound anguish. A sound of utter disbelief. A sound of infinite pain.
A mother's cry.
Slowly, as we all knew would happen, the mournful wails of crying crescendoed, and our emergency department came to a stand-still as Mom was escorted through our halls into her little child's room.
Despite our best attempts at maintaining our objectivity, and despite the fact that there were many more patients waiting to be treated, our ER staff cried collectively and gave consoling hugs to one another. We are mothers. We are fathers. We are brothers and sisters. We are sons and daughters. We are friends. We are human. And, we were broken.
Dad arrived just minutes after Mom was escorted to the room, and the cries of desperation were repeated. This time, husky and deep. Slowly, though, his cries softened and dissipated, until there was but one lone cry that began again. Higher-pitched. Guttural. Primitive. Emanating from the womb. A cry that conveyed the raw anguish and helplessness that only such a profound loss as losing your child could bring.
God Bless this mother. God Bless this father. God Bless this child. And may God Bless and watch over this family. And all of us.
If only life were filled with just happy moments...As always, thanks for reading. Next post will be either Friday, February 19, or Monday, February 22. See you then...
Monday, January 18, 2010
The Amazing Race
To understand this next patient, you need to do me a favor. Ball your hand into a fist. Now, rotate your fist either way as far as you can. When you can't rotate any farther and your forearm muscles feel tense and strained, imagine that you are Stretch Armstrong and continue rotating your fist for a full rotation. Pretty amazing, yes? Now, do the impossible and imagine another full rotation. And then another.
This is exactly what happened to Javier's testicle. Javier, a handsome but frantic eight year-old, had presented to our ER around 10 a.m. just a few weeks back. He had been born with an undescended testicle and had been closely followed by our pediatric urologist, who most recently had seen him just a month prior. Because his testicle had finally decided to spontaneously show up for this life, Javier's doctor was debating whether to surgically anchor his testicle down to keep it in place. Yep, a suture from his testicle to his scrotum.
Unfortunately, on the morning Javier had presented to our ER, he had awoken at 2 a.m. with sudden and severe left-sided groin pain. He was comfortable lying perfectly still, but the minute he moved or someone approached him to palpate his groin area, he was beside himself. You couldn't help but feel sorry for the poor kid who, despite his pain, was trying his best to be courageous.
After some morphine and a brief exam, in which he wouldn't even let me get close enough to thoroughly examine his genitalia, we proceeded with a very quick workup to figure out where his pain originated from. His urinalysis came back clean, just as I expected. Good blood work. The test that I most needed was an ultrasound of his affected testicle. To complete this test, because he was in such intense pain, we needed to give Javier an additional generous dose of morphine. The ultrasound tech was then able to manipulate Javier's scrotum to view his left testicle.
Sure enough, the ultrasound revealed that he has no blood flow to his testicle--a diagnosis of "torsion" of the testicle. So, from above, your fist = Javier's testicle. All the vessels that lead to and from his testicle had been twisted and rotated to the point that they closed off and were no longer delivering significant blood to the testicle.
Javier was in danger of losing his boyhood. Cringe-worthy stuff, I must say. I'd cry, too. I could only hope someone would be kind enough to load me up on morphine. And lots of it.
Javier, by this time, had been in pain for approximately nine hours. Time was "of-the-essence," so to speak, to save his testicle (after 6-8 hours, we begin to seriously worry). There are several manipulations one can sometimes attempt in the ER to save the testicle but, again, I couldn't get near Javier's testicle to really palpate it, let alone manipulate it. I was very close to giving Javier some anesthesia in our ER in an attempt to urgently "unrotate" his testicle. Thankfully, though, his pediatric urologist was close-by (from our earlier alert to her) and arrived in just minutes to take Javier to the OR. The race was on to save his testicle.
After establishing the diagnosis, I had a chance to go spend some time with Javier and his family. Javier and his uncle were well-versed in English, but his father wasn't. Fortunately, his uncle did a fantastic job of translating and by the end of our conversation, Javier's father had given permission to surgically repair Javier's testicle.
Poor Javier, though, was crying inconsolably now, probably as much from the fear of the unknown as from the pain of his testicle. More morphine, please.
I should have saved my drawings explaining the testicular torsion from that day. If I may say so, they were beautiful. Stunning, actually...NOT. They were a complete mess, like most of my attempts at drawing are. I should probably spend more time at home practicing how to draw a realistic testicle, so I'll be ready the next time. I would just need to be very careful about where I leave these practice drawings lying around. And who knows, maybe with a little practice I'll become the male version of Georgia O'Keefe!
What explanation Javier and his family understood best, though, was my fist and my attempt to rotate it. They understood that this "was not good" for the testicle. Bad, actually. To reinforce the seriousness of the situation, I brought a medical book into the room and was able to show them a legitimate picture of the testicle and how it had rotated on itself.
I have great news to share with you, though. Javier still has two functioning testicles! Oh, he sure does! Yes, yes--of course I'll wait for the cheers to die down. After the pediatric urologist made her scrotal incision, she was able to unrotate Javier's testicle and it immediately "pinked-up," meaning blood-flow had been reestablished. She later shared that his testicle probably survived this long because of two reasons; 1) his testicle rotated only a couple times, and loosely at that, and 2) the rotations probably didn't completely cut off his blood supply and a trickle flow of blood may have sustained the testicle. Lucky ball! She tacked it down so that this would hopefully not happen again to brave Javier. Yep, a suture from his testicle to his scrotum (did I mention this already?).
Regardless, I'm just happy that Javier can still face his world with two functioning balls. Let's face it--there is a reason we call them "jewels," and, as any guy will testify, it's better to face the world with two of them instead of one.
If things hadn't worked out for Javier, though, he would still have had one functioning testicle and worse things than that exist. I'm just glad that, in a few years, he won't have to go pick out a life-like prosthesis. Hmmm--decisions, decisions. A steel ball? Wooden? Saline-filled? I personally would go for the steel ball, after living through residency. Come to think of it, though, imagine what a chick-magnet a ten-pound prosthetic testicle could have been for Javier, regardless of what it was made of!
Initially, I thought we had helped Javier win The Amazing Race, saving his testicle and all. But after thinking the prosthesis thing through, maybe not.
Sorry, buddy.
Hats off to Javier for being a brave little boy. As always, thanks for reading. The last round of comments were very cool. Next post will be Wednesday, January 20.
This is exactly what happened to Javier's testicle. Javier, a handsome but frantic eight year-old, had presented to our ER around 10 a.m. just a few weeks back. He had been born with an undescended testicle and had been closely followed by our pediatric urologist, who most recently had seen him just a month prior. Because his testicle had finally decided to spontaneously show up for this life, Javier's doctor was debating whether to surgically anchor his testicle down to keep it in place. Yep, a suture from his testicle to his scrotum.
Unfortunately, on the morning Javier had presented to our ER, he had awoken at 2 a.m. with sudden and severe left-sided groin pain. He was comfortable lying perfectly still, but the minute he moved or someone approached him to palpate his groin area, he was beside himself. You couldn't help but feel sorry for the poor kid who, despite his pain, was trying his best to be courageous.
After some morphine and a brief exam, in which he wouldn't even let me get close enough to thoroughly examine his genitalia, we proceeded with a very quick workup to figure out where his pain originated from. His urinalysis came back clean, just as I expected. Good blood work. The test that I most needed was an ultrasound of his affected testicle. To complete this test, because he was in such intense pain, we needed to give Javier an additional generous dose of morphine. The ultrasound tech was then able to manipulate Javier's scrotum to view his left testicle.
Sure enough, the ultrasound revealed that he has no blood flow to his testicle--a diagnosis of "torsion" of the testicle. So, from above, your fist = Javier's testicle. All the vessels that lead to and from his testicle had been twisted and rotated to the point that they closed off and were no longer delivering significant blood to the testicle.
Javier was in danger of losing his boyhood. Cringe-worthy stuff, I must say. I'd cry, too. I could only hope someone would be kind enough to load me up on morphine. And lots of it.
Javier, by this time, had been in pain for approximately nine hours. Time was "of-the-essence," so to speak, to save his testicle (after 6-8 hours, we begin to seriously worry). There are several manipulations one can sometimes attempt in the ER to save the testicle but, again, I couldn't get near Javier's testicle to really palpate it, let alone manipulate it. I was very close to giving Javier some anesthesia in our ER in an attempt to urgently "unrotate" his testicle. Thankfully, though, his pediatric urologist was close-by (from our earlier alert to her) and arrived in just minutes to take Javier to the OR. The race was on to save his testicle.
After establishing the diagnosis, I had a chance to go spend some time with Javier and his family. Javier and his uncle were well-versed in English, but his father wasn't. Fortunately, his uncle did a fantastic job of translating and by the end of our conversation, Javier's father had given permission to surgically repair Javier's testicle.
Poor Javier, though, was crying inconsolably now, probably as much from the fear of the unknown as from the pain of his testicle. More morphine, please.
I should have saved my drawings explaining the testicular torsion from that day. If I may say so, they were beautiful. Stunning, actually...NOT. They were a complete mess, like most of my attempts at drawing are. I should probably spend more time at home practicing how to draw a realistic testicle, so I'll be ready the next time. I would just need to be very careful about where I leave these practice drawings lying around. And who knows, maybe with a little practice I'll become the male version of Georgia O'Keefe!
What explanation Javier and his family understood best, though, was my fist and my attempt to rotate it. They understood that this "was not good" for the testicle. Bad, actually. To reinforce the seriousness of the situation, I brought a medical book into the room and was able to show them a legitimate picture of the testicle and how it had rotated on itself.
I have great news to share with you, though. Javier still has two functioning testicles! Oh, he sure does! Yes, yes--of course I'll wait for the cheers to die down. After the pediatric urologist made her scrotal incision, she was able to unrotate Javier's testicle and it immediately "pinked-up," meaning blood-flow had been reestablished. She later shared that his testicle probably survived this long because of two reasons; 1) his testicle rotated only a couple times, and loosely at that, and 2) the rotations probably didn't completely cut off his blood supply and a trickle flow of blood may have sustained the testicle. Lucky ball! She tacked it down so that this would hopefully not happen again to brave Javier. Yep, a suture from his testicle to his scrotum (did I mention this already?).
Regardless, I'm just happy that Javier can still face his world with two functioning balls. Let's face it--there is a reason we call them "jewels," and, as any guy will testify, it's better to face the world with two of them instead of one.
If things hadn't worked out for Javier, though, he would still have had one functioning testicle and worse things than that exist. I'm just glad that, in a few years, he won't have to go pick out a life-like prosthesis. Hmmm--decisions, decisions. A steel ball? Wooden? Saline-filled? I personally would go for the steel ball, after living through residency. Come to think of it, though, imagine what a chick-magnet a ten-pound prosthetic testicle could have been for Javier, regardless of what it was made of!
Initially, I thought we had helped Javier win The Amazing Race, saving his testicle and all. But after thinking the prosthesis thing through, maybe not.
Sorry, buddy.
Hats off to Javier for being a brave little boy. As always, thanks for reading. The last round of comments were very cool. Next post will be Wednesday, January 20.
Subscribe to:
Comments (Atom)
