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 as an outpatient in my office. I had not been trained in the procedure during my residency training years. The skills I developed then were more focused on 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 sky-rocketed. I soon was scheduling as many as five vasectomy cases per week and was doing them every Friday. I continued at this pace for most of the two years I served in the military. When I began my surgical practice in El Dorado, Arkansas I decided to continue offering the service with the blessings of the local urologist who was the only doctor offering the service then.
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 allow either of them to ask any questions they might have. I offered a mild sedative to the husband to be taken a few hours before the procedure to help 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 advised a simple shaving prep the night before which would shorten the procedure time and avoid some of the discomfort and embarrassment. 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” type 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 led me to believe 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 anything about a 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 requested. I was a bit aggravated I had to take the time to do what should have already done. Besides the shaving always left shaving residue which a shower the evening before always removes.
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 twenty-five gauge 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 don’t think I need an anesthetic shot” 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 crude, profane words, which I quickly let him know he could not use again in my office.
For the next ten 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 nerves. 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 which would be unkind and very unprofessional.
John and I both recovered from the trauma that afternoon. I’m happy to report at his post-op check a week later he couldn’t recall many details of what had happened the week before, except he had gotten sick. It took me several more days to see any humor in the whole affair. After talking with him I think 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 want to have the chance. That we both survived was good enough for me.