Timeless Medicine: A Dose of Compassion

Taylor, Sara

Compassion for others is an integral part of being a physician. It bleeds into our souls making us better at remaining human and recognizing our limitations. When our compassion tank is empty, we are prone to burnout and have difficulty connecting with our patients. In turn, fostering self-­‐compassion can dampen the feelings of self-­‐doubt that accompanies the vast amount of information we have to know in Family Medicine.

I have never professed to know everything, or even close to it, in Family Medicine. The same applies to my specific work within the area of sexual health. However, no matter where you work in medicine, you must be prepared to recognize an emergency when it presents itself. When the young man entered our clinic one morning complaining of difficulty urinating, I didn’t know I would be presented with a medical emergency in a seemingly otherwise typical clinic morning.

I scanned the nurse’s notes on his chart that indicated he had been having trouble urinating since the previous night following sex and his penis was swollen. I walked into the room to see him and by all accounts I was unalarmed. He was a 25 year old, slim, blond-­‐haired man, wearing a hoodie, sweat pants and a ball cap. He was standing and greeted me with a cautious smile, not in any visible distress.

“Hi, my name is Dr. Taylor. I understand that you are having trouble peeing since last night. Can you tell me more about it?”

His accent matched his French descent, but he could clearly articulate his complaint. “Well, I was with my boyfriend last night and we were about to have sex.” He looked at the floor, starting to appear nervous, wiping his hand on his gym pants as though they were wet with perspiration. With intermittent eye contact, he started to tell me more about the events leading up to his reason for coming in. “Umm…I missed”, searching for the words, “when I tried to enter him, and then my penis hit something hard on his low back.” He took a moment before continuing. “I heard a ‘crack’ from my penis and it hurt really bad.”

I was starting to get a picture of what had happened and was trying to hide growing concern. I gathered some more history then I clarified that it was time for the physical exam portion of the visit. I imagined this was extremely difficult for him as a look of apprehension took over his smile. Body language and expressions are often valuable tools I try to not overlook when communicating with patients.

I left the room so he could sufficiently disrobe and get comfortable on the examination table. While I was in the hallway, I started to think about the possibilities of what could be going on. Despite 13 years of clinical practice there is so much I have never seen. The chart was up in the next room. I knew someone was waiting for me, however, I also knew my patient needed my full attention.

I knocked on the door to notify him I was entering the room and then I proceeded to the side of the bed. He was lying down looking at the ceiling with a sheet covering his pelvic area. He said he was distracting himself by looking at the pictures on the ceiling, which had all seen better days displaying curled edges and faded images of European scenery.

His voice cracked, barely audible. “I want to warn you -­‐ it looks pretty bad.”

I moved the sheet aside and was completely unprepared for what I saw. His penis was grossly deformed, swollen and discoloured. His urethral orifice was not visible. I now understood the eggplant analogy for a penile fracture. I don’t always appreciate comparisons to food when it comes to medical conditions, but in some cases, they can be surprisingly accurate.

I did a brief exam, concerned to not do any further harm. There was no need to order invasive investigations or expensive imaging at this point to know a penile fracture was the diagnosis. We discussed the urgency of his diagnosis and I explained that the injury would need to be repaired surgically. I was overcome with compassion for this young man. His initial appearance of calm had long since faded and he expressed how he truly felt in that moment.

“I knew something was very wrong. I just hope they can fix it. I can’t imagine a life without sex.”

I respected his honesty and searched for words of reassurance. Self-­‐doubt started to enshroud me as I didn’t want to give false hope for something I didn’t even know what the outcome would be. What I could give him was a dose of genuine compassion.

“It took a lot of courage for you to come in today. I understand your fears and concerns. I wish there was more I could do, but we will notify the emergency department you are on your way and you will continue to be in good hands.”

We sent him to the hospital with a letter in hand after a call was made to the triage nurse. I reflected on the misfortune of the situation and disappointment there wasn’t more I could do.

A note eventually arrived at the clinic from the Urologist, confirming that he had a penile fracture from a rupture of the corpus cavernosum. Unfortunately, he was left with a complication of erectile dysfunction. I wish that his story had a different ending, where he was able to lead a life parallel to the one before his injury. I was now more concerned about his emotional health as I thought back to the look on his face as he left the clinic that morning.

I did what I could by recognizing the urgency of the situation when he presented to our clinic, and the Urologist did what he could to manage the injury. But such is

medicine, leaving us humble and powerless at times, and triumphant and masterful at other times. This young man reminded me about two timeless aspects of medicine -­‐ history taking and physical examination remain the cornerstones of patient care despite technological advances; and a dose of compassion can help wounds that cannot be seen. We must embrace compassion toward our patients and ourselves.

Theme: Physicians | Médecins
Theme: Patients | Patients
Theme: Health Care Delivery | Prestation des soins de santé 

Stories in Family Medicine | Récits en médecine familiale [Internet] Mississauga ON: College of Family Physicians of Canada. 2008 --.




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