Sunday, August 2, 2009

Bleeding Penis...Where Do I Go...Am I Going to Die?

Well, this was a good one...Working the night shift, picked up a chart with a chief complaint of "I"m bleeding from my penis." The patient was a 24-year-old male. I walked into the room and he was with a young woman approximately his age at the bedside. He was lying on the stretcher wearing sweat pants and had his hand in his pants holding his crotch. You can't make this shit up!

I said, "I understand that you have some bleeding from your penis."

His reply, "Yeah and it hurts," with some anxiety.

"OK, does it hurt when you try to urinate?" I asked inquisitively.

"Well, no, I'm afraid to try," he replied with more anxiety. "Do you think I will be able to have children?"

I replied with some reassurance, "Well, I think so, but let me take a look. Where you doing anything when this happened?"

Timidly he responded, "Well, ahhh, no not really." His fiancee, replied, "You have to tell him, it's OK." So I'm thinking...this is going to be a good one...

"Well its kind of embarrassing (with a blush). I was having sexual intercourse and I felt pain and when I took out my penis there was blood all over the place, I lost a lot of blood and it hurts, I want to have kids, were engaged," rather embarrassingly. make a long story short...I checked his equipment out and he had a small laceration of his foreskin which needed a few stitches. Hey, anything is possible. I actually see more vaginal trauma following sex then penile, but all bets are off. Guys are always freaked out about their apparatus working properly! This guy was going to be fine and he survived the stitches, not that bad with local anesthesia since I'm really not that heavily handed with any potentially painful procedures. I think he was happy that he was going to live. I actually never saw anyone die of penile hemorrhage but anything is possible. This guy was in no danger, but I had a chuckle for the rest of the shift. Sometimes I tell people, "I decided to be an emergency medicine physician since I find humor in the misfortune of others." Something I call "black humor." But seriously, I do smile...there is so much other misfortune in this field...

That said...why am I commenting on this patient? Well, first, it's funny, not for the patient, but certainly funny from my perspective. Guy has sex...hurts penis...gets freaked out that he will never have an erection...thinks he's bleeding to death...etc. But all joking aside, that's why I'm here to help people like this.

What bothers me is all the politicians and policy makers who think that visits to the ED like this are unnecessary. Hmmm maybe not if it was their penis or vagina....There was a recent study published concerning the health care in Massachusetts which cited that many ED visits were unnecessary. The researchers took the discharge diagnosis for patients and retrospectively judged whether or not the patient could be treated by a primary care physician. Honestly, if you have a good primary care physician, this problem could be taken care of by that person. Most primary care physicians - internal medicine physicians don't do stitching in my area...What is a person suppose to do at 1:00 a.m. I know if they called their physician they would be instructed to go to the ED. Sooooo, despite what politicians think, there aren't as many unnecessary ED visits...certainly this patient perceived an ED visit!

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