You gotta drink lots of water, thats the secret, Tom would repeatedly tell the others. He enjoyed being the expert although this was almost all the advice that he could remember to give.
He was right though plenty of water to flush the blood away. The prostate can bleed a lot when it is cut, and you dont want it to clot and block off the urethra. Drinking plenty of water helps produce more urine, and reduce the risk of clotting.
I was just relieved that none of the men had heart failure. Heart failure means your heart is struggling to pump the blood around your body. If you add more fluid, you put more strain on the heart.
There was only one other piece of advice that Tom managed to remember and it was a tip I wished hed forgotten. Tom had the other men so in fear of me that they were distracted about their operations the following day.
As the men spoke about what I was going to do to them, I stood outside their room, hidden. Timing was everything: at the height of the discussion, I burst into the room.
Okay boys, whos first?
Silence.
It was six oclock in the evening and it was time for the boys to have what they had been dreading. It was enema time. I didnt want to give the boys a chance to get away, so I had given them no warning. I entered their room fully armed and ready for action.
The protests began immediately.
Ive just been to the toilet; you dont need to go waving that bloody thing round, you might poke an eye out, said Tom.
The others followed his example.
Yes, Ive been to the toilet as well; I refuse to have one.
You cant force that on me, I have rights.
The reason for the enema was simple. The doctor didnt want to risk his patients becoming constipated, as this would put pressure on the prostate, and potentially increase post-operative bleeding. (Just for the record, they check your prostate by sticking a finger up your backside.)
When I explained to them that it was either have an enema or the surgeon wouldnt operate, the men soon gave in.
But I still had the difficult job of choosing who to give the enema to first. I knew that if I picked the wrong man, he would kick up a fuss and exaggerate about how uncomfortable the procedure was. Since it was all Toms fault, I briefly considered doing him first; instead I picked Joe because he seemed the quietest, but sure enough, I picked the wrong man.
Its blackmail, thats what it is, he complained as I tried to pry his buttocks apart.
Stop fighting me and bend your knees up more, I ordered. Youre making this much harder than it needs to be.
I managed to see the target and tried to insert the tube.
Arrrgh
I began to squirt the water, hoping to get some inside.
Arrrgh
Joes butt cheeks were so tightly clenched, I was miles away from the bulls eye and water was dripping down all over his backside and my gloved hands.
Joe, just relax and it will be over soon, I kept on saying.
Relax, he said with indignation, relax? You lie here and let me stick things up your arse and try to relax. Arrrgh.
He may have had a point, but I had a job to do. By the time I had finished, more enema fluid had spilt around Joes buttocks than up his rectum, but I had had enough and so a truce was called.
I pulled back the curtain and my three remaining patients had gone rather pale. I couldnt help but smile. They turned paler still. The sight of a grinning male nurse with an enema in one hand and a roll of toilet paper in the other must have been pretty frightening.
Thats bloody murder, what you done in there, boy, said Simon, his voice trembling.
Daryl made the sign of the cross. I imagined bursting into a macabre sort of laugh, but held myself in check.
I approached my next victim Daryl. He had nowhere to go; he was trapped in the corner.
No one got away that night.
Several years after this incident, I found myself in a urological ward in a large London hospital preparing to give some men their pre-surgery enema when the doctor in charge asked me what the hell I was doing.
I explained that this is what we were instructed to do at home.
That went out with the dark ages; it hasnt been used in years, unless there is a specific need.
What our surgeon had prescribed was fine, but procedures and protocols change, and some doctors dont change as quickly as others certainly not quick enough for Joe and the rest of the lads.
Dr Baker
Like most professional environments, in hospital wards you have to learn to work with all sorts of people, even people who may be difficult or even unpleasant to be around. However, sometimes when the work pressure is particularly intense, cordial relationships are not always possible. When this happens in my line of work, everyone can suffer.
Dr Baker had been the head urologist at the hospital for many years. He had worked so long and so hard for the local urology patients that nearly every man over fifty knew of him. The old men only talked good of Dr Baker, and I cant say that I blame them. He was the only urology surgeon that the city had, and he had saved a lot of lives and improved the quality of many more.
The New Zealand government had decided that the urology waiting list needed urgent attention. Many elderly men were pottering around their homes with a tube up their penis for more than a year, and during that year, many of these men had also presented to the local emergency room with blocked catheters, urine infections, bleeding, or a combination of all three.
The solution was simple. We got funding for 40 extra prostate operations, which would need to be performed over three weeks, on top of an already full surgery list.
Forty prostate operations is a huge amount to undertake in three weeks. Performing this many would keep two or even three normal urology surgeons busy for that time. It isnt just a matter of doing the actual surgery; its also a case of making sure patients recover with as few complications as possible.
The ward only had 26 beds. Considering a common stay for a prostate operation was between four and seven days (and that doesnt take into account the extended stays due to complications such as excessive bleeding or infection), this certainly seemed a tight schedule. It was nice of the government to give us the money, but it would have been nicer still if theyd given us some additional doctors and nursing staff to get us through those three weeks. Instead, all operating fell upon the shoulders of Dr Baker.
Dr Baker went into a prostatic trimming frenzy. He would begin operating at seven in the morning and when five oclock came around he just kept on snipping away. Time meant nothing to him he continued to operate well into the night. He reminded me of Dr Frankenstein working feverishly in his lab. The theatre staff said they had never seen him quite like this before, he was manic and even more-short tempered than usual.
With such a large volume of patients being put through the system, the amount of work for the nursing staff, as well as the junior doctors, was also immense. We were overrun with patients. Everywhere I looked I could see them comparing notes, deciding whose urine looked the least blood stained and whose the most. The old boys were pottering around cautiously, always careful not to stretch their urine bags too far, get tangled up in the tubing, or forget the whole thing altogether. It always made me cringe with sympathy whenever I saw someone forget their catheter bag and then be literally pulled up short by their manhood.
To make matters even worse, we still had other non-urological patients to care for. There were still the odd general surgical patients as well as the medical patients, plus two days a week we had to take new patients from the emergency room. I had a tough job making sure I didnt forget about my non-surgical patients, but there was one person who felt the brunt of the frenzy more than anyone.
Lisa was the urology registrar working under Dr Baker. She had been working for him for six months as part of her surgical rotation and she was having a pretty tough time of it. The problem was not just the work, but because she was female. Everyone knew Dr Baker was irritable with his female staff.
I cant keep on like this. Theres too much work to do for one doctor, Lisa declared.
Lisa was in tears after the Saturday morning ward round. Lisa wasnt the first and definitely wasnt the last female doctor to cry after a ward round with Dr Baker. At his best, he was barely tolerant of women, but in the event that something was not done his way, then any woman involved would get a verbal battering. Id sometimes make the same mistake as a female colleague, like leaving the catheter tubing on top of a patients leg, instead of under it, and he wouldnt say a thing.
No one knew why Dr Baker behaved this way towards female nurses and doctors, although there were plenty of theories. Mine is that he felt women should be subservient to men. I got this impression from the way he would order women to do tasks, but he would ask me politely. At other times he would only ask me to do certain jobs, complex jobs which he usually did himself, like flushing blocked catheters. I could easily see Dr Baker working in a ward 20 or 30 years ago, where nurses had firm boundaries to what their jobs entailed, and where the ward sister controlled the place like a military barracks. I could even imagine him having the nurses standing at attention while this god-like being did the ward rounds.
All that really mattered was he made an already challenging job much more difficult and unpleasant.
I can handle working for such an unpleasant man, Lisa began, but hes left me to do it all. I hardly ever see him.
Lisa went on to explain that aside from this mornings ward round, she hadnt seen or been in contact with Dr Baker all week. He wouldnt answer her calls, and made no effort to contact her. She felt she had no support and was worried that she would make a mistake.
I asked Lisa if shed let me tell the other nurses how she felt. She was reluctant at first, but when I explained that she wasnt alone, female nursing staff had admitted to having problems with Dr Baker, she agreed.