The simplest treatment is sometimes the best

“I am really uncomfortable and in pain,” said Elaine tearfully as I met her in the preoperative area for the first time. She had a very sad and difficult history, dealing with complications from childbirth nearly two years ago. She had developed a communication between her rectum and vagina, which allowed feces to come out vaginally. Despite multiple surgeries from reputable medical centers in NYC, the problem recurred. And she just had surgery from another expert in Philadelphia two days ago.

Elaine lived locally and came to our medical center unable to urinate. She had over 1200 cc in her bladder (40 ounces), and despite attempts from ER nurses, doctors, and even our own urological staff, no one was able to place a catheter in her bladder, the pain becoming increasingly unbearable. She was just too swollen, and her urethral anatomy distorted.

“You’re going to have to take her to surgery, maybe when she’s relaxed — it will be easier. Or you may have to settle for putting a suprapubic catheter [a tube placed into the bladder from the lower abdomen],” relayed one of my associates, as I was on call — and it was past 5 p.m.

I walked towards Elaine and her husband and introduced myself to as the urologist on call. I asked if they would humor me and let me try once to place a catheter in her bladder before giving her anesthesia, assuring them that “I am really good at placing catheters.” (Through years of practice I have discovered that my thin fingers and hands have given me a huge advantage in small spaces.)

They reluctantly agreed. I felt for her urethra blindly. In a few minutes, I was able to slip the catheter into her bladder returning clear urine — the site of clear urine coming out of a catheter placed after difficulty is pure heaven for a urologist.

Elaine started crying tears of joy, and her husband sighed in relief. Not only was she out of pain, but her expression conveyed a small victory — victories that were all too absent in her medical care.

Placing catheters is relatively simple on the spectrum of skill needed to be an expert urological surgeon. The degree of difficulty of other cancerous operations I do is far more complex and generally more tedious. For Elaine too, her medical history is complex and likely will be for some time. But at that moment, in the simple act of placing a catheter, I had healed her needs for the moment, and the tears of joy on her face were priceless.

P.S. Elaine’s catheter came out the following week, and she has been voiding fine since.

Naeem Rahman is a urologist and can be reached at his self-titled site, Naeem Rahman, M.D.

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