chat

It was the morning my second day in the hospital: I was awoken well before dawn by the screams of my roommate calling for his nurse to bring him pain medication. My roommate had a history of opioid misuse/abuse; it was very difficult for his treatment team to find a safe dose of any medication that could relieve his pain for a significant amount of time. A series of nurses came in to explain that they couldn’t give him any medication until it had been prescribed by a doctor. A physician's assistant came in to evaluate his pain, then a hospitalist came to repeat the evaluation and write a prescription. The entire process took nearly 90 minutes.

My first urologist performed another bedside aspiration and irrigation procedure. Though I was anesthetized, the pain was such that I kept passing out: by the end of the procedure, I was begging to be sedated. I was told later in the day that I would probably need surgery, a Barry shunt, on Monday or Tuesday.

The rest of the day was very much a blur: I had periods of opioid-induced stupor punctuated by excruciating pain. I recall that my daytime nurse asked why I had been taking so many showers: being unable to find an alternative, I had developed a system of using our room’s shower as a makeshift urinal.

On Monday, I met the “weekday urologist” who was accompanied by a medical student. I had a third aspiration and irrigation procedure; the penile nerve block was performed differently and was more effective, leading to a much less painful procedure. At the end, the medical student was asked to get a sample of penile blood. I was bracing for the needle and not paying attention to where the medical student was about to put it. I felt a most amazing pain in the glans of my penis, my heart rate spiked, an alarm sounded, and I felt my entire body go limp as I passed out. I came to a short time later with terrific waves of pain radiating throughout my body and a frightened medical student looking down at me. I was scheduled for surgery on Tuesday morning.

I overheard that my roommate was unable to receive IV medications and would need a PICC line. The hospitalist offered him a variety of oral pain medications, all of which he refused/declined; with most of the drugs it was clear that he was declining them by name alone and seemed to be confusing them for other drugs, often of a different class. The conversation was becoming heated when I decided to insert myself. I tried to calm the situation by asking if he would be willing to try the generic name of a drug he had already been offered; thankfully, the other doctor realized what I was doing and wrote a prescription for the drug. I would like to say that I was helping to relieve the suffering of another human being, but in reality I just wanted a few hours of peace and quiet.

Later that morning, I was reminded that I was in a teaching hospital when it came time for rounds. By this time toxicology reports, laboratory results, and serological tests had come back and my case was deemed “interesting”; this sort of thing is fairly unusual in men my age and state of health. I was soon visited by a doctor and their team of interns and medical students, then another, and another. With every group I was asked: when did you last have sex, when did you last masturbate, do you use any drugs or supplements, what did your parents die of, what did your daughter die of, etc. Then, with exception to the hematology team, I was invariably asked if they could examine me.

The first team that visited helped to “preserve [my] modesty” by giving me what I can only describe as a dick pillow, that covered my lower abdomen and inner thighs while leaving my genitals, and only my genitals, completely exposed. Probably aided by the pain killers, I found myself marveling at the absurdity of the situation: instead of just uncovering when necessary, my penis and testicles were framed and highlighted like a conjoined secondary patient. I don’t recall this happening, but apparently after a dose of pain medication, I asked for some googly eyes in an attempt to surprise the next team—my request was denied. When the team did come in, I ended up doing a Señor Wences style dialogue with my penis during the examination. The staff were kind enough to pretend I had done nothing out of the ordinary; my roommate, however, filled me in on every cringey detail.

I had my first surgery on Tuesday. Due to an administrative error, I had been NPO for a little over 18 hours. I was unable to urinate that morning and, consequently, my surgery was moved forward a few hours. I had not urinated for between 8 and 12 hours. While under twilight sedation, a medical student or intern inserted a catheter and the last thing I remember was a feeling of relief and a panicked voice saying, “No, no, no. It’s overflowing.”

I woke up to find my penis still fully erect but now attached to my leg via a Foley catheter anchored to the same. As the sedation wore off, I recall being uncharacteristically worried about my foreskin being reduced post procedure, because I had heard horror stories about American clinicians mainly training with/for circumcised men. It’s in the procedure notes that I told the surgeon, “Don’t circumcise me, [yo or bro].”

I was still in a great deal of pain and the procedure had not been a success. From this point, I was kept well sedated except for brief periods where it was allowed to wear off so that I could provide informed consent or answer questions in a rational manner. That Thursday, I had a more radical procedure, which seems to have been successful.

My urologist came by to remove my newest Foley catheter and drop off some literature about penile implants. They were surprised that I was able to achieve an erection and frankly so was I after I watched a video of the procedure, which was far more radical than what I had pictured in my head. I was also surprised to learn that my shitty insurance will fully cover a top of the line penile implant, while I have to pay out of pocket for an ambulance ride between hospitals and a steep copay for chemotherapy drugs.

Back on my shit

Before my second surgery, I had some imaging done and they discovered a shadow, which turned out to be a tumor. Long story short, I have liver cancer again, though it’s of a different type from the first time. I had surgery a few days ago. The tumor was small and respectable—so good news. But, I’m going to be on another course of chemotherapy for a while.