I sat in the consultation room with my chin leant on a fist, whilst the forefinger tapped my cheek slowly. My face was twisted in deliberation, pondering over my patient’s presentation and the how best to broach the subject.
“Hmmm . . . ” my eybrows furrowed, “does it hurt?”
“It smarts a bit. Uncomfortable I’d say.”
My patient stood directly in front of me, trousers and boxers round his ankles, family jewels thrust forward in presentation. They had an inguinal hernia. A very obvious inguinal hernia at that. So obvious, their intestines had bulged and spilled out from the inguinal origin in their lower abodomen, and ballooned the left scrotum to at least 5x the normal size. It pushed the gentleman’s “trouser snake” way off to their right, and his ball-sack hung close to his knee.
“Yes. I can imagine”
“I think you need to go to hospital”
“Oh. Ok. Will you refer me for an appointment then”
“No. I think you should go now.”
“I’m not sure”
“In fact, I’m going to order you a taxi”
“Yes. A Taxi”
“To take you to hospital”
“Well, can’t it wait?”
“Till next week. I’m busy this afternoon”
” . . . What makes you so busy you can’t get this seen to. Immediately. Do you understand how serious this actually is?”
“Yes. But I need to be somewhere. This afternoon”
“I’d rather not say”
This went on. And on. I explained all of the issues associated with this presentation – strangulation of bowel, perforation of bowel . . . both! But he didn’t want to go at that point. The best I could do was persuade him to self present at A&E “later in the day once he’d done what he needed to do”. And then that was it, he left.
Being an ECP means I get to sit in consultation rooms and see patients who come in with different presentations. Most of my work has been in Walk In Centres and Minor Injuries Units and I’ve been doing it, on top of paramedic work, for the last three years.
I like it. I’ve learned so much and I can honestly say it’s improved my clinical skills. However . . . testicles! I have to see and handle testicles. On a truck as a medic, if someone presents with an issue involving private parts, at best we’ll have a look – you know, to rule out bad stuff – and then gladly take them to someone else who can take it further.
Unfortunately, I am now that person. And, working in centres that have a majority of female nurses in them, it only figures that I’ll end up having to see the male appendages. Well, fuck my luck . . .
My second patient looked slightly bashful.
“I’ve been having lots of sex with my missus lately and now its a little red and itchy. Wanted to know if it’s alright”
“What’s red and itchy?”
“You know . . . ‘it'” On the last word, the patient motioned subtely toward his private parts.
My shoulders dropped. In my head this clearly sounded more suitable for a sexual health clinic and not a Walk In Centre. Why me! Oh I remember – the nurses had said something like “Oh Binder, there’s someone we’ve left for you in the queue. Testicular pain. Perfect for you **sniggers**”. Yeh – thanks. I think.
I asked the patient if he would mind lying on the couch and pulling down his trousers. However, at that invitation the patient couldn’t wait. Before I could counter with a “No! Stop!”, he’d pulled down his trousers and ‘whipped’ out his “gentleman friend”.
A penis, not too dissimilar in size to an extra large salami but twice the weight, had sprung free and landed with a solid “thud” onto the desk, shaking everything as it did and nearly denting the desk.
The patient looked genuinely proud for christ’s sake!
“Seriously!?” I said – not entirely sure I was meaning his rudeness in using my desk or the sheer size of it.
The patient pulled back his foreskin – with two hands!!!
“Oh – come on!!! Really!” This was all too much for me.
But, as it happened, the patient had balanitis. A redening and spotting of the “glans” (helmet). And, after a good history and quick examination, no other issues found. As there was a suspicion on a bacterial infection, anti-biotics were prescribed as well as fungal cream – and advice/referral to sexual health clinic!
As I say, being a Paramedic, we have the luxury of avoiding unnecessary examinations of peoples’ bits and pieces, and simply take the patient to someone who can! However, if you want to move ahead into the area of advanced clinical practice, well, you are now that person “who can”. And testicles, bits and pieces, private parts etc are all part of the package that you’ll have to deal with.