Apparently I Wasn't Clear That it Was MAJOR Surgery...

So I saw a patient in my office. He was a middle-aged guy asking if he could be circumcised. I inquired as to his motivation and he explained that he had recently converted to a religion where circumcision was the norm. In addition, he and his wife had recently had their newborn son circumcised-- again, citing religious reasons. The whole exchange was pretty routine. He had clearly done his homework on the procedure and was already fairly knowledgeable about the risks, the procedure and the recovery afterwards. He wondered if he could be referred to the same physician who had circumcised his son. I explained that infant circumcision and adult circumcision were very different procedures performed with very different techniques, and that adult circumcision would be performed by a urologist in the operating room. I emphasized that this is not a minor procedure, that it is often performed under general anaesthetic. Due to my anti-circumcision bias, I admit to often emphasizing the risks and the complications associated with this elective, cosmetic procedure. I also explained that as this is no medical indication for circumcision, he would be required to pay for the procedure out-of-pocket. He nodded, picked a urologist, and I filed the consult request.

Fast forward about a week. I had taken a few professional leave days off to study for the CCFP exam (T minus 5 weeks and counting) so on my first morning back I sat down with my supervisor to catch up on any issues that had come up during my absence.

"You saw Mr. A last week, didn't you?" he asked me.

"That was the guy asking about getting circumcised, right?"

"That's the one. He got circumcised."

"What?" I was confused. There was no way he could have gotten in to see a urologist that fast for a non-emergent situation, let alone be seen, booked and had the procedure performed.

"Apparently, he decided not to wait."

My preceptor explained-- he had gotten a courtesy call from the ER while I was away. Our patient was being admitted for observation after significant blood loss. Apparently, my patient and a friend (which begs the question... what kind of 'friend' would agree to assist in something like this) decided that it would be a good idea to simply pull his foreskin out over the glans, press it down against a cutting board and 'circumcise' him with a newly-sharpened carving knife. No anaesthetic. Ouch.

He underestimated the bleeding. After attempting to stem the flow of blood with direct pressure for a considerable length of time, he became increasingly light-headed and his 'friend' called an ambulance.

Sigh. Where is Darwin when you need him?