True Story from the Psych Unit

I'm taking psych call this month at a large hospital. Call duties include consults from the ER, consults from the med/surg floors (rare, since they're after hours or on weekends), "behavioral emergencies" throughout the hospital, and covering the inpatient psych unit, which houses 40-50 patients. I would just like to throw in there that my psych calls are nearly as stressful as my medicine float shifts--psych call is not easy.

A couple of weeks ago, my urology elective experience suddenly and unexpectedly came in handy.

(If you're squeamish, stop here.)

I had just returned a page from the nurse in the emergency room and was hearing about a patient I had to see (the usual "super urgent" med refill type) when I received 2 pages in about 1 minute from the floor. GODDAMN, dude, I'm on the phone with the emergency room! I'm sorry, but people need to learn some pager etiquette!

Ahem.

I returned the page with a slightly snarky "Did someone page Dr. TS TWICE? Can I help you?"

A slightly panicked male nurse answered "Yes, doctor, patient so-and-so has gotten his, ah, his penis caught in his zipper."

WTF???

"Uh, is it, uh, is it still stuck? Is it bleeding?" (I was stuttering and nearly speechless)

He assured me that it was not bleeding, but was still stuck. Holy Christ! I called the ER and told them I had a medical emergency to deal with on the floor (at which point I was "reminded" that there's a policy to see ER patients within 20 minutes of arrival--Eff You, guidelines! The nurse actually asked me why the floor nurses couldn't just "deal with it" themselves. Um, it's not YOUR junk caught in a zipper, but if it were I doubt you could wait an hour while I deal with Ms. "I didn't know how to operate the automatic refill telephone number"). I raced upstairs.

The patient was lying on his bed so calmly I didn't realize it was the right man, until I saw his fly hanging open. It seemed to be an accidental injury (although I'm sure weirder things have happened). I donned gloves and did a quick inspection--whoo-ee, that skin was really wrapped in the zipper. (I warned you about the squeamish thing!) I left the room and paged urology.

"Um, hi, this is the psych intern. I have a patient with his penis caught in his zipper. What do I do?"

Uro: "You pull."

WTF??? ARE YOU KIDDING ME???

He wasn't kidding. I went in and attempted to pull on the zipper, but the patient freaked out (naturally) and wasn't going to tolerate it. I paged urology back and explained the situation.

Uro: "I can come up there if you want, but I'm just going to pull harder."

WTF???????????????

The nurse on duty wouldn't let me take the patient down to the emergency room, since "this is a hospital up here, there's no reason a patient can't get treatment up here just like anywhere else." I had no choice. I asked for a bottle of lidocaine, a syringe, and some wound dressing materials. We got the patient into the treatment room, I did a little local anesthesia, gave him a Vicodin, donned my gloves again, and PULLED.

It didn't budge (but at least this time the patient didn't feel a thing).

We found a suture removal kit with a pair of forceps, which I used to try to get a grip on the zipper. This time when I pulled, it moved a teensy bit. I had the male nurse try to pull, I tried to pull, but we made almost no headway. I carry trauma shears in my pocket (you never know when these bad boys will come in handy) so we tried cutting the zipper off the pants and then cutting the zipper in half. Now, we were left with even worse leverage. I was beginning to freak out, thinking OMG WTF I JUST RUINED THIS MAN'S PENIS!

The patient started talking to us at that point. He said he'd had this problem before (WTF???) and had seen a doctor with similar complaints before. He then reached down, grabbed hold of the zipper, PULLED, and the zipper broke in half; he PULLED again and it came off his skin. I nearly fell over with shock, amazement, relief, and nausea; the male nurse had turned around and was unable to watch.

True, he had several lacerations that I cleaned with iodine and dressed with ointment. I put him on some antibiotics (his hygiene wasn't so great, and god only knows what was on that zipper), and we found him some sweatpants and some briefs. I also lectured the patient on a) wearing underwear and b) tucking it back while zipping up his pants. Honest to god, this was a grown man. I actually told him "Dude, you only have one of these, TAKE BETTER CARE OF IT."

One of the highlights of the evening: I wrote an order in the chart to this effect: "Patient to wear briefs and non-zippered pants while injury heals."

Not exactly what I had in mind when I signed up for this (but certainly a great story!)