Tales of Survival: Wife Knows Best

August 1, 2009

bellevue.jpgBellevue Hospital, the nation’s oldest public hospital and the heart of our residency program, provides unique and unforgettable training for new physicians.  It is probably safe to say that every resident who trains at Bellevue graduates with a lifetime of stories about the experience. “Tales of Survival” was created to convey some of those stories.

Melissa Price MD

As a second year medicine resident, we are required to rotate through the Bellevue Emergency Department for a solid month’s time. To describe this rotation as a unique experience would be a serious understatement. I will never forget the day my life crossed paths with Mr. K and his wife.

I was running through the differential diagnosis for a young woman that I had just seen when my thoughts were swiftly disrupted by the roaring screams of a man and the heavy shoe shuffling of the EMS workers moving his stretcher. I caught a glimpse of a pale, thin man in his mid-60’s as he was wheeled into my domain; his cries mixed with his wife’s shrills created a tangible agony. Surrounded by nurses and pastel curtains, I could not imagine what was going on, nor what awaited me beyond that mundane cloth. I sprinted over to him…there before me was a violet, engorged penis base suffocating inside the ridged neck of a white, plastic bottle.

My confusion shifted to urgency and I soon learned that Mr. K suffered from severe narcolepsy. While watching television that afternoon he needed to urinate but was too tired to walk to the bathroom. Instead, he urinated in this nearby bottle, unintentionally fell asleep after relieving himself, and forgot to remove what would become a choker for his penis. When his wife found him on the sofa an hour later, she saw that his penis had become trapped inside the plastic container. Four hours of attempting to remove it unsuccessfully had ultimately resulted in their visit to the ED- this bizarre circumstance that I was now part of. I immediately gave boluses of morphine. The senior resident and attending scurried over before I could close my gaping jaw. The patient was placed under anesthesia and what proceeded from that point on was an hour of epinephrine-driven plastic cutting with a ring-cutter, packs of ice, and steady hand holding of genitals this way and that; the swelling grew angrier and time ticked uncooperatively. The ring cutter finally gnawed its way through the ridged, surprisingly indestructible, plastic bottle neck! Sighs were heard around the room as hearts dropped back down from necks.

Everyone had left, urology examined the patient without concern of long-term damage, and I was to wait for Mr. K to awaken from his sedation. Hours passed and he remained asleep but arousable. Had we given him too much narcotic? Did he have a bad reaction to the anesthesia? Vitals were stable and organs were pumping and inflating as they were supposed to. I walked away to wait some more. “Honey, take this now,” his wife said to him in a fine Brooklyn accent as she gently placed a tab of methylphenidate on his tongue. I watched the proceedings of a swallow form in his throat. Mr. K awoke within seconds and smiled at his wife.