I was visiting to admit him, a skinny Indian man recently returned from hospital. He was sixty, and previous to his recent surgery had been completely independent. He’d had years of back pain and recently gone in for a surgery designed to relieve pressure in his lower vertebrae. Unfortunately, during the operation, damage had been done to his nerves resulting in a neurogenic bladder. He had lost the ability to consciously relax the sphincter between his bladder and urethra, thereby releasing urine. In other words, he could no longer piss on command.
I was there to educate him on the catheter that had been inserted to ensure his bladder could still empty. I went through the usual process of introduction and listening to his recount of events before beginning to detail how to properly care for his new urinary system. He stopped me, and asked instead if I could remove his catheter.
After digesting his request I explained that couldn’t do as he asked, that without a catheter his bladder would continue to fill, that the pressure in his renal system would build and he’d be in extreme discomfort, and, if left unrelieved, could damage his kidneys.
Again, he stopped me, shaking his head and waving his hands, dismissing what I’d said. He told me that if I removed the catheter he would urinate. He assured me that if he could just relax, he could get a flow going.
I begun explaining about his neurogenic bladder, and again he cut me off, eyes closed and head shaking. ‘They have told me this in the hospital,’ he said. ‘But I know my body. If you take it out, I will be able to pee.’
I empathised with his difficulty in coming to terms with his new disability, but felt a bloom of frustration open in my gut. I tried again.
I explained, patiently, that in fact he’d had the opportunity while in hospital to do exactly that, that the hospital staff had removed his catheter and after an hour had scanned his bladder and found a litre of urine inside his body and not a drop out. I reminded him that they done this on two separate occasions, a week apart, and each time he’d been unable to void.
He was frowning now, jaws clenched as he waved his hands in front of my face. ‘I couldn’t do it there!’ he said. ‘There was too much pressure, with their machines, and their waiting. I am home now. I can do it now.’
I bit down my exasperation while requesting he not interrupt me, and to lower his hands, and explained that anyone with conscious control of their bladder would be able to pee if they had a litre of urine pushing down on their sphincter. He interrupted me.
‘No! Take it out and I will show you. I don’t want it anymore.’
This conversation continued for an hour. Despite my argument that it was in his best interest to keep the catheter in, he continued to command me to take it out. I told him that once the catheter was out, and he failed to urinate, he would be in agony. That his bladder would feel like it was ready to rupture and there would be no one around to insert a new catheter to relieve it. That he’d have to return to the hospital, something he insisted he wouldn’t do.
I explained that I wasn’t saying this to antagonise him, only that it was the truth. He rebutted with threatening to pull the catheter out.
By this point, over the hill of vexation and down again, I couldn’t repress a chuckle. A catheter has a balloon in the tip with a diameter of about four centimetres to hold it in place in the bladder. A male urethra has the diameter of about one centimetre. Pulling out a catheter without the balloon deflated is a painful process.
I detailed this, using the simile of pulling an apricot through a straw, and recommend that he not try it. He told me he would do as he liked.
In the end I slumped back in my seat and said I wouldn’t do what he wanted. He told me to leave.
When I got back to the office I contacted the hospital and informed them of the outcome of my visit, and they madly scrambled to have an ambulance and a bed ready if he did remove his catheter. I hung up the phone annoyed that they had to work harder to compensate for this man’s idiocy.
It’s hard to fight to save someone from themselves. It’s hard when their voice is raised and respect is gone, and you’re debating reason while they’re debating stubborn ignorance. It’s hard to keep caring about their wellbeing when they don’t care about your professional knowledge. And it’s easy to think, ‘Why don’t I just leave them to the consequences of their actions?’
He was one of the bad ones.