There is a long list of afflictions I hope to never suffer from personally, but chief among them is Fournier’s gangrene.
Fournier’s is a rapidly progressive necrosis of the genitals and perineum. Fortunately, it is rarely seen outside the narrow demographic of 400-pound, poorly-controlled diabetics. Unfortunately, Kentucky is the 400-pound, poorly-controlled diabetic capitol of the world, so I saw not one, not two, but three cases of Fournier’s during my four weeks on Urology.
The only treatment for Fournier’s is immedate debridement of all affected tissue. The operation itself is the sort of thing surgeons dream about–good, old fashioned cutting. Our surgery intern was allowed to be first assistant on the case; his reaction to this was not unlike how I might react if someone said, “Jonathan, Van Halen is playing in town tonight, but Eddie’s not feeling so hot. Can you cover for him?”
Those of us less excited about surgery, however, would refer to a procedure like this as “really fucking disgusting”. The smell alone was the stuff of nightmares; surgeons walking into the OR area, two hallways away from where the procedure was taking place, would sniff the air and say, “Wow, who’s doing a Fournier’s?”
As unpleasant as the procedure sounds, however, the post-op care is far worse. The wound is left open for a long time, as any further gangrenous areas will send the patient back to the OR. Even worse, however, is the fact that the patient is usually left without a scrotum. It will eventually be rebuilt by brave plastic surgeons, if the patient makes it long enough (most don’t), but in the interim, the boys are left hanging in the breeze. When the dressing on the wound is changed–a frightening enough prospect in itself–the testicles must be gingerly wrapped in gauze.
As the medical student (that is, the “bitch”), my job twice a day was to assist with this production. That meant that twice a day–the first of which was often before I had even had my coffee–I had to go see two different patients and hold up their testicles while a resident gently bunched gauze around them.
As I did it, I couldn’t help but think about how, someday, I’d be relating all of this to a psychiatrist.