I used to be an Emergency Medical Technician at a very busy Emergency Department. Given that about 70% of all patients that walk in the front door just need little more than a bandage, my job was to treat those low acuity patient under the supervision of a NP/PA or MD/DO. Simple things like removing sutures, bandaging wounds, and assisting the providers in more complicated or invasive procedures. I have three kids that liked to stick stuff where it didn’t belong when they were toddlers and I became quite adept digging things out of ears and noses. Naturally, I became the go-to person for removing foreign bodies and resolving foreign body entrapments in our Emergency Department. I have extracted a ton of weird stuff from ears and noses– things that I didn’t think were possible to get in those spaces to begin with. I had a very high success rate and was generally trusted to be able to handle almost any situation that presented itself.
A few years ago a 30ish male patient walked in the front door of the ER complaining of a “ring stuck—down there.” On more than one occasion I have dealt with patients getting piercings infected or irritated and being unable to remove them due to swelling, or because whoever did the piercing didn’t educate the patient on how to remove the jewelry. My first impression was that this was a simple case of a “Prince Albert” gone wrong, a painful but generally uncomplicated problem. If you don’t know what a “Prince Albert” is, don’t worry—I didn’t know until after I began working in Emergency Medicine.
I asked the patient to step into the exam room so that I might examine him, treat him quickly, and get him discharged home with as little embarrassment as possible. What I did not expect to see was a solid metal ring encircling his genitalia, loose enough so that blood was able to flow into the area, but tight enough that it hindered blood flow out of the area. He admitted that he purposely placed this ring around his genitalia three days ago. After three days of entrapment, the ring had caused his twig and berries to become kielbasa and grapefruit. Suddenly my uncomplicated issue became very complicated as it was 10 p.m. in a crowded ER and as a male myself the thought of performing a fasciotomy for compartment syndrome on another male “down there” made me queasy.
First things first, I got another, more experienced provider involved and applied ice packs to the area, then tried a combination of triple-antibiotic ointment and water-based lubrication to remove the device. This led to much yelling and discomfort for the patient. Apparently, he and his partner, who wasn’t there by the way, were not picky in their choice of rings and on close examination of the approximately ¾ inch thick, 3 inch diameter solid metal ring, I found pitting and rust on the surface causing the skin around the device to become even more raw and irritated than had it been a clean and smooth device. Now we could add tetanus shot to the order set.
When lube technique became obviously futile we discussed other options and next settled on a Dremel-like ring cutter. The ring cutter we have available to us was designed for soft metals, it takes a minute or two to cut through a simple gold band. I grabbed a stool and prepared for a long, tedious task of cutting through this giant chunk of metal with my face less than a foot from another man’s swollen junk. About two minutes later, we all agreed that this was not working. The ring cutter had started throwing up sparks, which was not helping the patient emotional state. Additionally, cutting the metal caused it to heat up significantly and even pouring water on the metal was not keeping it cool enough for the patient to tolerate.
We didn’t want to add thermal burn to the list of complaints, so we went back to the drawing boards. We were beginning to get a bit desperate at this point. I even checked with our security team and got their industrial sized bolt cutters but the ring was too thick to get the cutters on. Stop for a minute and picture THAT: a patient without his trousers on, lying in a gurney with his swollen junk exposed while an RN and MD watched me, the EMT, stand on a stool for leverage with three foot long bolt cutters trying to get the blades around the ring encircling his genitalia.
By this point the patient had been in the exam room for nearly two hours with a steady stream of RNs and providers offering suggestions and trying to help, but it was time to throw in the towel and call for a surgical consult.
Usually a surgical consult takes about an hour to get to us, but in this case, word had spread and I had a surgeon in the exam room in less than 15 minutes. He agreed with me that a fasciotomy would be less than ideal, so he wanted to try and remove it by other means. First thing he did was ask for some gauze wrap. He then began to tightly wrap the patient’s junk then manually squeezing the organ to try and force the blood past the ring to reduce the swelling. While my supervising physician and I did think of doing that, we felt that it would be too painful and could increase the potential of compartment syndrome.
I mentioned this to the surgeon who looked at me dead in the eye and said, “That’s the difference between you medical docs and surgeons. We don’t discuss. We just do. We may not always be right, but we are NEVER unsure of ourselves.”
The surgeon ended up performing conscious sedation and using a high speed industrial cutting tool to remove the ring. He sent me this picture later:
*****
“What is your pain level on a scale of 1 to 10, where zero would be no pain, and 10 would be if you had an attack of kidney stones while in active labor, and while all that was going on, you were set on fire. Starting with your genitals. And then you were disemboweled, and the bowels that were removed were then also set on fire. And then while you were running around in active labor, passing a kidney stone, on fire with your bowels also on fire, you accidentally stepped on a Lego with your bare foot. And that Lego was also on fire.”
“It’s an 11.”
Medicine can be funny. It can be sad, painful, inspirational, but also sometimes funny. “11 out of 10” is a collection of humorous medical stories from practitioners in all fields, ranging from physicians to nurses to EMTs to medical students. Some are totally true, some are exaggerated, and some are mostly fiction. But every single one of them aims to put a smile on your face.
All profits from this book will be donated to Deworm the World Initiative, a charity that aims to treat parasitic infections in children in developing nations.
Check out the book here.
Book Excerpt From 11 out of 10: "Prince Albert"
