18 OPINION
2024
18 OPINION
3 NOVEMBER 2023 ausdoc . com . au
Insight
My real-life learnings
Dr Ruth Myers GP with a special interest in aged care , South Coast , NSW .
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THE field of general practice is wide and varied , and it ’ s a wise doctor who accepts early that they ‘ don ’ t know what they don ’ t know ’.
Fortunately , our opportunities for learning are never-ending — from lazy afternoon medical school tutorials , to death by PowerPoint lectures , to corridor chats with colleagues , to drug-sponsored dinners and the unceasing hunt for CPD points .
It ’ s the ongoing retention of that knowledge that can be problematic .
However , every now and then , a lesson will present itself and the knowledge will be imprinted forever . Here is one such event .
This story starts as I wandered into the adult psychiatry ward over 20 years ago , a young 24-year-old RMO1 on her first rotation of the year .
Overnight , a young man had been admitted in the throes of an undifferentiated psychotic episode . As a bonus , he had been catheterised in ED for acute urinary retention triggered by his antipsychotic medication .
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The nurses , a little wildeyed , had asked me to review him as he was complaining of pain in his penis .
You can imagine my concern .
The patient was 18 years old , 6ft tall , strongly built and acutely psychotic , with a catheter and , it transpired , a paraphimosis .
Not that I knew exactly what a paraphimosis was at that stage .
All I could tell was that this poor guy had been writhing with a purple , red , swollen and incredibly painful glans penis and a retracted foreskin for several hours .
I communicated this information to the urology resident , who conveyed back to me the urgent need for ice , compression and manual manipulation of the foreskin back into position .
The nurses , a little wildeyed , had asked me to review him as he was complaining of pain in his penis .
Unfortunately , the urology resident was also my housemate — and a known joker .
I guffawed and asked him to please come and review the patient and tell me what actually needed to be done .
Which was how — as a very young , very naive junior doctor — I came to be sitting with a very large , very uncomfortable psychotic young man , with gauze soaked in cold topical anaesthetic gel , providing manual compression to a painfully swollen penis tip , under the supervision of my housemate , trying desperately to find suitable topics of conversation to reassure the patient that I did , indeed , have “ the situation in hand ”.
To say that I was incredibly relieved when the foreskin was able to be pulled back into position is an understatement . Doubtless I was not the one most relieved .
My housemate has never forgotten it ; I have never forgotten it .
And that , ladies and gentlemen , is why , between us , we have never since , not once , forgotten to unretract the foreskin after male catheterisation .