SEX
To be a good doctor, you have to master a paradoxical art. You need to get close to a patient so that they will tell you things and you will understand what they mean. But you also have to keep distant enough not to get too affected. This distance keeps both parties safe. A doctor can’t afford to faint at the sight of blood or retch on smelling faeces. And the last thing a person wants when they have been told awful news is for their doctor to start crying. But sometimes, you feel the likeness between you and your patient more than the difference. Sometimes, your own body declares its fallibility as if in sympathy for the person you are consulting, or your heart defies you by responding just when you least want it to. One of the most difficult things is learning how to manage sexual matters in hospital life. It’s like going through adolescence all over again.
The first time I ever touched a stranger’s penis, I was lucky enough that it was a patient under general anaesthetic. The old man, who had been wheeled unconscious into the operating theatre from the anaesthetic room, was due for a left hemicolectomy for cancer, a long operation which requires a urinary catheter for monitoring.
I was a house officer. I knew I loved being in theatre but as yet had no useful place in it. I was standing awkwardly in one of the corners when my handsome registrar invited me to initiate myself. I accepted enthusiastically, admitting my ignorance of the procedure, and was grateful when he agreed to show me what to do. A nurse arranged a trolley with all the bits we would need, and Adonis and I approached the patient’s naked groin.
I put on a pair of sterile gloves. ‘Now,’ Adonis instructed, ‘one hand is clean. One hand is dirty. With your dirty hand, swab the penis.’ Struggling to prevent the words ‘dirty’ and ‘penis’ from conjuring certain private fantasies about myself with this surgeon, I began to blush. I washed the man’s glans.
A small coterie of theatre staff were enjoying my clear discomfort, as my registrar continued. ‘Now, with that hand, hold the penis still. And with your clean hand’ — a breeze of relief at not having to keep hearing the word ‘dirty’ lightened my blush here — ‘take the lignocaine jelly and introduce it into the meatus.’ What I now saw as my useless, trembling and woefully clean, never-to-be-meaningfully-dirty hand fumbled with the man’s limp organ and the vial of jelly which I hoped would disappear into his penis poured out all over his groin. Adonis, from his lofty position of experience and romantic obliviousness, began to find my incompetence amusing. ‘Pull back the foreskin and introduce the catheter.’ No penis, all foreskin, the task seemed impossible. The slippery prepuce appeared to have no underlying structure to be retracted on so that the end of the foot-long catheter kept popping out of the baggy eye of the man’s penis, flicking jelly around with every jaunty boing. Nurses and theatre underlings tittered. Adonis woundingly quipped, ‘I thought you might have been better at this. Not your first penis, surely?’ ‘My first floppy one, yes!’ was all I could hotly reply.
Adonis eventually finished the job for me, but for weeks afterwards I was greeted in operating theatres the hospital over with sniggers from senior surgeons, identifying me as the one who had declared herself used to handling firmer members.
Another awkward encounter, which made me feel like I had been cast back to peripuberty, occurred during an on-call. I was asked to see a post-operative orthopaedic patient suffering from what is known as phimosis. This is a painful condition which occurs if the foreskin is pulled back over the head of the penis for any length of time. The band of retracted skin acts like a tourniquet, impeding drainage of blood from the penis and causing it to balloon painfully. In hospital, it may happen when a nurse or doctor has forgotten to pull a foreskin back into position after inserting a catheter.
It was the middle of the night when I arrived on the orthopaedic ward and I was immediately able to make out a low groaning, separate from the ward’s collective groan. Steve, the burly chief nurse, led me to Mr Ashton’s bed, drew the curtain around me and the patient and, with an encouraging wink, left us to it. Leg and cast on a pillow, Mr Ashton’s head was thrown back in disquiet. His swollen, discoloured penis lay like a dark lighthouse against the horizon of the sheet’s edge.
He was a young man. We were contemporaries. I tried to chase from my mind the idea that, in other circumstances, I might have met him at a party. I found myself perversely grateful that his pain left no room for embarrassment between us. He looked wildly at me and whimpered a little. I began to talk to him in a quiet voice, not because it was night-time but because I wanted him to look at me and think me quiet and therefore gentle, since what I began to explain to him was that I was going to put his sore penis into my hand and squeeze it. As soon as I said ‘squeeze’, I added ‘very very gently’, but what I didn’t detail was that I would then start to squeeze it harder and harder until I chased all that pooled blood back up more proximally so I could get the foreskin noose loose and put things back where they belonged.
I took his next whimper for assent and, like someone on slow spool, finger by finger, enclosed as much of the head of his penis as I could in my hand. It felt as if the two of us were hardly touching. Mr Ashton drew breath at this point, his worst fears of vengeful womanhood perhaps allayed. Then, gradually, I began to apply more pressure, first just enough for the small muscles of my hand to relax their still semi-extended position, then more. In a curious inversion of other similar contacts, I felt rewarded as the contents of my grip began to shrink. I carried on applying pressure bit by bit. After about five minutes, I was clenching Mr Ashton’s penis with all my might. As all the remaining trapped blood migrated northwards from the end of his organ, the young man’s discomfort eased and what had previously looked like agony gave way now to nude shame. In the artificial dusk of the ward, we were suddenly just two young strangers, one holding the other’s penis.
Mr Ashton said thanks and clearly couldn’t wait for me to leave. I felt satisfied with a job well done but also wanted to make myself scarce. Steve made some obvious joke or other on my way off the ward and another task called me elsewhere.
The penis also makes its presence felt more subtly in the medical workplace. Before I had even thought of becoming a doctor, while studying English up north, one of my tutors sought the help of his surgeon brother to refurbish his kitchen. The evening this constructive individual arrived in town, I was at a small student dinner party at this tutor’s house. We were eating meat and his brother ate a lot of it. We were telling young person’s stories about our gap years, about the only adventures we had ever had, postcard-sized. His tales of cutting and thrusting in the operating room made ours seem small and silly. This Mr Silk had a few photo albums in his car, which he showed us over coffee. They were full of before-and-after pictures of tumours followed by smooth expanses of flesh; compound fractures followed by straightened limbs with neatly stitched skin. At the end of the meal, Mr Silk peeled an apple in front of us all, and we watched as a regular ribbon of skin eased its way from the fruit in a perfect, unbroken coil.
At twenty-two, I was amazed, so when a full evening of my attention was rewarded with a singular invitation to visit my tutor’s brother in his operating theatre whenever I might next be in London, I accepted without hesitation.
Less than a month later, I took the train south one weekend to stay with an aunt. On the Saturday, I arose at dawn and caught the first tube to Mr Silk’s private operating suite. I felt a great sense of excitement as I was shown to the women’s changing room and handed my first ever surgical scrubs and cap. I remember as new the oddly industrial smell of the fabric, like hard dusty tarmac. And the feeling of being almost undressed, with only the starchy top and bottoms to brush against skin and underwear.
When he saw me, Mr Silk hugged me to his chest, then welcomed me into his theatre with exquisite grace. I was introduced to his urbane anaesthetist and his various helpers. He showed me what everything was. I mistook this for courteous surgical convention. It would take me fifteen years from this point to reacquire the feeling of being ‘someone’ in theatre, for more authentic reasons.
He then performed an athletic and dramatic hip replacement. I don’t recall much of the procedural detail, complete neophyte as I then was. What has remained is a more sensate memory. The music of the anaesthetic equipment, heard for the first time with its hums and peeps and sighs. The mixed aroma of clean hard surfaces and the loam of the body’s upturned soils. The migrainous glare of the theatre lights. The pared-down gestural language between the players.
When the operation was over, the patient wheeled out, the orderlies gone, Mr Silk produced a bottle of champagne from the anaesthetic fridge, and he and I and the anaesthetist stood in theatre and drank it all from those small slush-white beakers that have corrugated sides and usually hold children’s squash. Knowing nothing of the mores of private medicine, I took this for surgical commonplace, a kind of post-sacrificial bonding.
Afterwards, my tutor’s brother took me out for lunch, and a sense of wonder and excitement and exhilaration at what I had seen poured from me limitlessly throughout the meal, so that all potentially awkward m...