Sunday, May 31, 2009

All Together Now

It was swollen and about the size of a Twinkie.

About an inch in from its end was a little slit about 3/8ths of an inch wide. His scrotum was also swollen; to the size of a softball. Because of his severe phimosis he had developed yeasty infections under his unretractable foreskin. I think this was the root of his other problem: endocarditis. Maybe that was the origin of the infection. Anyway, he had huge mitral vegetation, like the one pictured here:

The urologist wanted to place a Foley catheter into his bladder. Usually that's a nursing task, but the patient had such an unusual anatomy the doc wanted to do this himself. We got a smaller sized catheter, but still he had difficulty passing it through the tiny foreskin opening and then into the urethra. I suggested some morphine for the patient, got the doc's okay, and in a couple minutes got it into the poor guy.

Unable to sense the urethra, the doctor looked up at me and said "You know, I think I'm going to need to do this with a Kelly clamp."

"And some more morphine?" I suggested.

"Yeah. A bunch," the doctor replied.

I like that doctor a lot. He's one of the best in the city. Patients, nurses, and fellow doctors like him too and his work is greatly respected.

I loaded the patient up on the flowery drug of dreams and he said he might even go to sleep later. The doctor wished him nightie night.

The guy couldn't help but remain awake though because the urologist had to insert the Kelly into the tiny slit opening of the foreskin, fish around a bit (there were a few drops of blood,) and then poke that into his urethra. He then opened the clamp a little to spread the target urethral opening wide enough and slid the Foley catheter on and into the bladder. Despite the morphine the patient was grasping the bedrails for all his life. He was in agony, and then...


The doc wrote his notes and I cleaned the patient up a little. Twenty minutes later he was fast asleep and maybe even showed a bit of a relaxed smile upon his face. That I like. I'm not the only one.


dbackdad said...

Sweet mother of god. I'm in agony even thinking about it.

Anonymous said...

*whimpers* then crosses legs...

Those are the worst, at least your urology guy was considerate enough to let you give morphine. We've had a couple where they just go for it, regardless, it's really quite inhumane.

But that echo is awesome, did the vegetation flop around with each beat? It's pretty cool looking when it does, kind of like a min-game of Pong inside the left ventricle.

wunelle said...

Aaauugggghhh (clamping hands over area in question)!!