I was working a shift at a failing Urgent Treatment Centre (UTC) in town, which was thankfully rarely busy due to the low quality of care. It used to be an Emergency Department, but the connecting hospital has slowly been gutted of most of its departments over several decades, leaving a walk service that many of the local residents, and some paramedics, still believe to be a fully functioning AnE (quite understandably). For example, a patient who was in status epilepticus (which is a really fucking long seizure, for those non medical), was brought in by an ambulance, after the paramedics had driven past a fully functioning Emergency Department as it was busy there. Thankfully some valium up his arse resolved the patient’s seizure, and he could lay on a bed with none of the life saving equipment needed if he started to seize again (he survived).
I digress. I had just spent 15 minutes debating with a 36 year old female patient over the cause of her shakiness and erratic mood. She argued that her symptoms were related to menopause. I argued that they were due to the two bottles of wine she drank a day. Her poor GP had previously gone to the effort to do blood tests to confirm she was not menopausal, so she had sought a second opinion in her local UTC. I explained that alcohol withdrawal can cause similar symptoms, and asked if she had considered reducing her alcohol consumption. She told me to “mind your own fucking business” and stormed out of the department. I was never taught how to deal with this at medical school, so I made a joke about it with a colleague and buried it deep within me, to add to a pile that would eventually all bubble up into a mental breakdown several years later (we’ll get to that at some point).
One of the local mental health nurses approached me and clearly wanted my attention.
‘Are you okay Angela?’
“Perry, can you review the patient in cubicle 3?’
‘Yeah of course. Though I thought he was here in a mental health crisis, has he taken an overdose or something?’
‘No…erm… just ask him what he’s been doing… in his bedroom.’
Obviously this piqued my interest and I approached the cubicle with this patient in immediately. A nervous looking 20 year old man was sitting in a chair, arms crossed and looking slightly ashamed.
‘Hi there Mr Kids, my name is Perry, I’m one of the doctors here. One of my colleagues has asked me to come and have a chat with you, do you know what this would be about?’
‘Erm, I think… erm… I think it’s probably this thing I’ve been doing for a while’
He was scratching at his own wrists and looking very uncomfortable, so I tried to put him at ease.
‘Well, I’m all ears, and I’ve heard it all before so please don’t be shy, i’m just here to help if I can’
‘Well, basically… I love taking Crystal Meth. So what I do, is I get a bag in, hide in bedroom away from my parents, and put some music on, usually MGMT, and dim the lights. I get really, really high, and i get this strange urge, to do this thing with the curtains…’
He paused for a few seconds. I was extremely excited, but kept the poker face that I’d learnt to use when I could tell a patient is going to say something batshit crazy.
‘So what I do is, I get completely naked. Then I take the one of the curtains, and wrap it in a tight knot around the base of my bollocks, and I gradually tighten the knot, increasing the pressure more and more, until eventually it cuts the skin and i start to bleed. Then I have another massive key of meth up my nostril, then I keep tightening the knot until I pass out….’
My silence was deafening. I’ve heard some bamboozling behaviour in my career, but this was top of the crazy league.
‘Erm.. well’
I am rarely speechless…
‘How often do you do this?’
“I’ve done this once a week for about… five years’
I asked the relevant questions to confirm there were no problems with his ability to urinate or ejaculate, and examined him to assess the situation. His genitals looked liked the last bits of a fruit bowl encircled at the base by a 5 year old donut, long past its best. I checked for any signs of infection, which there were none, and was happy that he didn’t need to be admitted into a hospital as an emergency.
‘So Mr Kids, you don’t seem to have done any permanent damage to your urinary system, as the scar tissue all seems confined to the superficial skin around your scrotum (ballsack). I would see your regular GP to get referred to a specialist though, just in case you need a scan to confirm.’
‘Thanks doc, is that all?’
‘Yes. Although perhaps ask your parents to invest in some blinds’
Junior Resident Doctor 