by Robert J. Lanz, LCSW
The normally loud and busy trauma room had decelerated to a slow crawl, everyone busying themselves with some chore: reading an x-ray, catching up their chart notes, pouring over lab results, those kinds of quiet time activities. There wasn’t much anyone could do at the moment as the young gangster lying there in bed with a bullet lodged uncomfortably close to his spine, closed his eyes, shut out the room and wished it were happening to someone else—specifically, someone from the gang who had shot him.
The bullet was not close enough to do any spinal cord damage, but close enough for everyone in the ER to ponder how this guy had gotten so lucky, avoiding paralysis by less than half an inch. Some of them might have even believed that he had it coming, being a member of the knife and gun club that sent a steady stream of patients in our direction. Most of the club members ran up huge bills that went unpaid except for some money that we received under a law that punished cigarette makers by making them pay for trauma victims who, on any other night, would probably be trauma perpetrators.
This happened with enough frequency that not everyone in the room was generating a full empathetic response to the lucky gang banger. No one knew what say to a young man who had spent most of his life screwing up, while everyone else in the room had been models of discipline, having put in long and hard hours to get where they were. What could you say to a guy who was living life more or less at the other end of the spectrum, engaging violence on a regular basis, being the pitcher some days and the catcher on others? It was pretty obvious what position he had played in that night’s game. It was equally obvious he had a psychology none of them could understand, so they just stood around marveling at the X-rays showing just how close you can come to being totally fucked without actually having to pay much of a price for your behavior.
When no one in a room full of intellectual power like that of our trauma team knows what to say, I look upon it as an opportunity to put on a good social work show. That’s my job, the show, and I knew just the approach that would get the room’s attention. Time for a lesson, I thought, time to make some heads turn. Maybe this time I’ll get fired for what I say, and the lesson will be mine. I knew I’d be walking a pretty tight line with this crowd but this crowd wasn’t my patient, this gangster was.
In another life a long time ago, I had worked in a juvenile hall full of guys like the one laying there acting tougher than he felt. I learned a lot from my job in those years and I thought it might be about to pay off. Either that or I was going to cross the line that separates professionals from non-professionals and say goodbye to an otherwise good career. But the most important thing was the patient, and I will always choose to take a risk in order to save a life, just as a surgeon would do if he thought it was the only thing that might work.
I walked up to the patient and started talking. The effect I wanted to have on him might have been lost had I introduced myself as the ER social worker. That’s a low status job in a hospital, and a lot of people, especially people who’d been recently stabbed or shot, don’t care to hear about things like post-traumatic stress disorder and complicated psychological concepts. If I let the little thug think I was a doctor, my next move would almost make sense.
With ER activity at a lull, a few heads turned in my direction when I started my pitch.
“We have one more test that we need to do with you before we complete our neurological exam. It’s called the Dick Test. It goes like this. I want you to reach down between your legs and grab your dick with your hand and give it a good squeeze. Either hand will do.” He gave me a funny look, but after some of the other tests we had done, including testing his sphincter muscle with a finger, this probably didn’t seem too far out and unlike the sphincter test he would at least get to use his own hand. How bad could it be?
He reached down under the covers and made a little movement then withdrew his hand.
“OK, I squeezed my dick. Now what?”
“I want you to tell me what it felt like.”
“It felt like I was squeezing my dick.”
“Good. That means you aren’t paralyzed. When you’re paralyzed and you squeeze your dick, you can feel your dick in your hand but you can’t feel your hand on your dick. It feels like you’re squeezing someone else’s dick.”
I let that thought sink in a little. He looked like a guy who would normally fight or shoot somebody at the mere suggestion that he would have a dick in his hand other than his own, or that he would have the slightest idea as to how that might feel.
“Another half inch in the wrong direction and that bullet would have put you in a wheelchair for life and you would never feel your dick again. Well, you could feel it in your hand, but you would never feel it in the way you like best. It would never get hard again. You’d never feel it that way.”
The worried look on his face let me know that I had his attention. When anyone starts telling a guy there might be something wrong with his dick, it’s serious. When a doctor starts talking about it, it’s worse than serious.
“If you were paralyzed, maybe it would be better that you couldn’t feel your dick, because then you wouldn’t feel it when you put the catheter up it three or four times a day to drain your urine. When you’re paralyzed your dick doesn’t work that way either. You’ll have to learn how to put that tube up inside yourself because no one else is going to do it for you. Not your mom. Not your girlfriend. Not your homies. No one’s gonna want to touch your limp dick. In fact they won’t even want to be around your limp dick because it always leaks and you start to smell like a wet diaper all the time.”
The crowd was silent. The kid was silent. Every eye was on me, and a lot of the docs probably thought I was going too far, especially the new guys. They may have been right, but I definitely had everyone’s attention. I didn’t care so much about that, but I did care that I had the kid’s attention. This was his life. And at his age, his dick was probably one of the most important parts of it.
“Because you have to pee through a tube, you will get a lot of urinary tract infections. You will know when they happen because they happen inside your body where you can still feel pain. Then you have to come to the hospital to get taken care of again. A lot of good-looking nurses you might normally be sexually attracted to will only cause you to be embarrassed, because they will be grabbing your lifeless dick and putting the tube up it for you. Most guys just close their eyes and pretend to be somewhere else when this happens, because it makes it a little easier. Most guys are probably thinking, when their eyes are closed, ‘Damn, I shouldn’t have gone out that night.’ Of course, by then it’s too late.
“Sitting in that chair all the time, you’ll get big sores on your butt but you won’t feel them until they’re all infected. Maybe you won’t even know they are there until you smell them. Everyone else will smell them too but there probably won’t be too many people around then. No one wants to hang around with a guy in a chair that smells like piss and death. And then you have to come back to the hospital again to get the sores fixed and you’ll be thinking again, ‘Damn, I shouldn’t have gone out that night.’”
His jaw dropped a little, and I kept going.
“Do you have any idea what it must be like to take a shit when you can’t feel anything below your waist? How do you know when you have to go? You don’t, so maybe you will shit your pants, but you won’t feel that either but you’ll smell it. Maybe your mom will be there, if you’re lucky, and when she’s cleaning the crack of your butt for the third time that day she’ll be thinking, ‘Damn, I wish he didn’t go out that night. He never would listen to me.’
“Some guys learn how to put their finger up their butt to manage their bowels so they can control the time of day they shit. If it was you, I’m sure when you did it you’d be thinking, “Damn, I should have stayed home that night.’
“You’ll learn to hate climbing stairs, going out in public, going to the store, going to the movies, and making eye contact with pretty girls and watching people dance. Getting in and out of cars is hard. You’ll probably never work again, so you will sit around with nothing to do but watch TV. You’ll never play sports again and you’ll never have sex again. You’ll wish for death but won’t have the courage to do it. Your life will be a living hell. The things that you wouldn’t want to do even once, you’ll be doing every day for the rest of your life. Learning to live in the chair will be the hardest thing you ever do, and some guys never learn. They sit around in their chair on the corner hanging out just like always and some day they’ll get shot again. Maybe they won’t even feel it in their dead legs. They’ll probably be thinking, ‘Damn. I shouldn’t have gone out tonight.’”
The kid squirmed, his face a desperate scowl. “No more. No more,” he yelled. “I don’t want to hear it no more.”
“Okay. Anyway, it’s time for your CT scan. You’ll have something to think about when you’re laying there on the table.”
They rolled him out of the room and I just stood there, ready to face whoever had the least tolerance for my brutality. I’d been hard on the kid, I’ll admit. Maybe too hard. Maybe so hard that nobody wanted to get in the same line.
Then one of the younger surgical residents walked up. “That was very unprofessional,” he said. “And I don’t think you should use that kind of language with a patient. He’s just a kid.”
It’s hard to know what to say when the person confronting you is twenty-five years younger and has probably had the majority of his life experiences in a library or a lab or a nice clean hospital somewhere, a guy who believed he was doing and saying the right thing. Part of the surgical training is learning to be assertive and definitive, and you can’t take that away from a doctor in front of his colleagues. I resisted my desire to slam this fresh kid, speaking calmly.
“I spent six years in jail working with kids like him. They aren’t afraid to die. They aren’t afraid to go to prison. They’re tough guys. But no guy is too tough to worry about something happening to his dick.” I let the line hang in the air for few seconds and turned to walk away.
“Let’s see what he has to say when he comes back from the CT scan,” the young doctor said.
I walked away before things could turn ugly. No one else stepped up to confront me.
Later, when the kid came back after completing all of his trauma business in the ER, I noticed he had both his hands under the covers. Maybe he was feeling his dick again, I don’t know. He was about to go upstairs for a couple of days of IV antibiotics and treatment for his wounds and because he was only seventeen, they were taking him to the pediatric ward. As he rolled by me, I thought about the irony of that. Our eyes met and he reached up and grabbed my arm.
“Hey, doc. Will you come up and see me later?”
“Yeah, sure,” I answered as he rolled away.
The young resident looked up in disbelief. The rest of the team just smiled. The Dick Test. That’s one you won’t hear about in Grand Rounds. But I’ll tell you where you might hear about it. On the street. When this young man gets out and reunites with his gangster buddies and they want him to go out and do the gangster thing with them, shooting up the neighborhood, trying to knock off a few enemies, maybe taking a few rounds in return, he won’t go. He’ll tell them about the Dick Test.
“Do you know what happens when you get shot in the back, man? You’re paralyzed. And when you’re paralyzed, you’re never going to feel your dick again! Fuck that man, I’m going home.”