Some of the most humorous experiences I had as a surgeon came as a result of doing vasectomy for men desiring to have the procedure done as an outpatient in my office. I had not been trained in that procedure during my residency training years; rather I was trained to do major operations such as gall bladder surgery, colon and stomach surgery, and numerous cancer treatment procedures. I did my first vasectomy while serving in the Air Force, and when word got out on our base I was doing them the demand was so high I had to schedule 5 vasectomy cases per week every Friday. I continued at that rate most of the 2 years I served in the military. When I began my surgical practice in El Dorado, Arkansas, I decided to continue offering that service with the blessings of the local urologist who was the only doctor offering the service at the time.
For a man to have the procedure I required he be in a stable marriage, then I would have both he and his wife come in for a consultation during which I would fully explain the procedure. I would use a simple drawing to show exactly how the operation was done, and how I would prescribe a mild sedative to take the evening before the procedure to relieve any anxiety. With the sedative and use of a local anesthetic just prior to the procedure there would be very little pain experienced. I also explained a simple shaving prepthe night before which would shorten the procedure time and avoid some of the discomfort. I would give both the husband and wife the opportunity to ask any questions and welcomed them to spend as much time as needed during this visit. I believed the time spent and the information given would lessen the fear factor every man has concerning this operation.
John E. and his wife came for a pre-op visit requesting a vasectomy, and I went through the entire process with them. I was acquainted with him from high school days but didn’t know him very well. He had always seemed friendly but had what is now referred to as a “red-neck” personality. I recall on this visit his wife had a few questions which I answered, but when I asked if he had any questions, he responded with, “Nope. Let’s get on with it!” I scheduled the procedure for the following week on a Friday afternoon.
On the appointed day John came into the procedure room wearing his usual John Deere ball cap and with a cheerful countenance which made me think he had taken the sedative. When I asked if he had taken the pill to help him relax, he had a quizzical look on his face and said, “I didn’t know about any pill.” I should have known he didn’t hear a word I had said the week before. As I was getting him ready for the operation I saw he also had not done the simple shaving prep I required. I was a bit aggravated I had to take the time to do what he should have already done.
With all the preliminary steps completed John leaned back with his hands behind his head, and with his cap still on, he said, “I’m ready to go.” I got the syringe with the very tiny 25 guage needle used for the local anesthetic, and he looked down and asked, “What is that for?” I again explained the use of a local anesthetic, and he said, “Doc, you may not know this about me, but I’m a black belt karate, and I have taken blows to my body which would kill a bull and I didn’t feel any pain at all. When I get myself psyched up I just don’t feel pain.” I said, “Well since you are now psyched up you won’t feel this little needle stick which will only last for 3 to 5 seconds.” The instant that needle entered his skin, his “psyched-up black belt karate” flew out the window and he screamed the loudest scream every heard in my office! He also used several expletive-deleted words, which I let him know he could not use again in my office.
For the next 10 minutes, he squirmed and sweated like no other man on which I had done a vasectomy, complaining all along this was the worst thing he had ever endured, and I was killing him. I knew very well from long experience the operative field was numb, and what he was “feeling” was due to a bad case of nervousness. Just before I put in the final sutures he suddenly sat up and vomited a huge amount of stomach contents directly on the operative field. The vomitus looked like partially digested chili. I let it sit there a short time while he settled down and I asked, “John, did you just eat?” “I had a bowl of chili just before I came in.” “John, I told you last week not to eat lunch or anything for 6 hours before you came in so your stomach would be empty! If this gets infected, it is all your fault.” As he lay his head back, and I began cleaning up the mess, John said, “I feel a whole lot better now.” I didn’t respond to his remark fearing I might say something at the moment which would be unkind and unprofessional.
John and I both recovered from the trauma that afternoon, and I’m happy to report at his post-op check a week later he didn’t recall too many details of what had happened except he had gotten sick. It took me a couple of days to see any humor in the whole affair. After talking with him I had the idea he still believed he could get himself psyched up to the point of feeling no pain. I never had another chance to prove him wrong, nor did I ever desire to have that chance.