doctor

The Snip, Part 2

This is the second part of a three-part blog post about my vasectomy. Did you read the first part, yet?

My vasectomy was scheduled for Tuesday afternoon, so I left work early in order to cycle up to the hospital: my plan was to cycle up there, and then have Ruth ride my bike back while JTA drove me home. For a moment, though, I panicked the clinic receptionist when she saw me arrive carrying a cycle helmet and pannier bag: she assumed that I must be intending to cycle home after the operation!

It took me long enough to find the building, cycling around the hospital in the dark, and a little longer still to reassure myself that this underlit old building could actually be a place where surgery took place.

My tweet: "Arrived at vasectomy clinic. It's the most well-hidden, badly-lit, shady-looking building I've ever seen on a hospital campus." — My tweet upon arriving at the clinic.

Despite my GP‘s suggestion to the contrary, the staff didn’t feel the need to take me though their counselling process, despite me ticking some (how many depends primarily upon how you perceive our unusual relationship structure) of the “we would prefer to counsel additionally” boxes on their list of criteria. I’d requested that Ruth arrive at about the beginning of the process specifically so that she could “back me up” if needed (apparently, surgeons will sometimes like to speak to the partner of a man requesting a vasectomy), but nobody even asked. I just had to sign another couple of consent forms to confirm that I really did understand what I was doing, and then I was ready to go!

I’d shaved my balls a few days earlier, at the request of the clinic (and also at Matt‘s suggestion, who pointed out that “if I don’t, they’ll do it for me, and I doubt they’ll be as gentle!” – although it must be pointed out that as they were already planning to take a blade to my junk, I might not have so much to worry about), which had turned out to be a challenge in itself. I’ve since looked online and found lots of great diagrams showing you which parts you need to shave, but the picture I’d been given might as well have been a road map of Florence, because no matter which way up I turned it, it didn’t look anything like my genitals. In the end, I just shaved all over the damn place, just to be sure. Still not an easy feat, though, because the wrinkled skin makes for challenging shaving: the best technique I found was to “stretch” my scrotum out with one hand while I shaved it with the other – a tricky (and scary) maneuver.

Where to shave before your vasectomy: front and side of the scrotum. — If I’d had a diagram like this, rather than an Italian street map, I might have stood a better chance of just shaving what I needed to shave.

After sitting in the waiting room for a while, I was ushered through some forms and a couple more questions of “are you sure?”, and then herded into a curtained cubicle to change into a surgical gown (over the top of which I wore my usual dressing gown). The floor was cold, and I’d forgotten to bring my slippers, so I kept my socks on throughout. I sat in a separate waiting area from the first, and attempted to make small talk with the other gents waiting there. Some had just come out of surgery, and some were still waiting to go in, and the former would gently tease the latter with jokes about the operation. It’s a man thing, I guess: I can’t imagine that women would be so likely to engage in such behaviour (ignoring, for a moment, the nature of the operation).

There are several different approaches to vasectomy, and my surgeon was kind enough to tolerate my persistent questions as I asked about the specifics of each part of the operation. He’d said – after I asked – that one of the things he liked about doing vasectomies was that (unlike most of the other surgeries he performs) his patients are awake and he can have a conversation while he worked, although I guess he hadn’t anticipated that there’d ever be anybody quite so interested as I was.

Warning: The remainder of this blog post describes a surgical procedure, which some people might find squicky. For the protection of those who are of a weak stomach, some photos have been hidden behind hyperlinks: click at your own risk. (though honestly, I don’t think they’re that bad)

With my scrotum pulled up through a hole in a paper sheet, the surgeon began by checking that “everything was where it was supposed to be”: he checked that he could find each vas (if you’ve not done this: borrow the genitals of the nearest man or use your own, squeeze moderately tightly between two fingers the skin above a testicle, and move around a bit until you find a hard tube: that’s almost certainly a vas). Apparently surgeons are supposed to take care to ensure that they’ve found two distinct tubes, so they don’t for example sever the same one twice.

Next, he gave the whole thing a generous soaking in iodine. This turned out to be fucking freezing. The room was cold enough already, so I asked him to close the window while my genitals quietly shivered above the sheet.

Iodine-soaked scrotum being injected with anaesthetic (not mine; from a medical textbook)

Next up came the injection. The local anaesthetic used for this kind of operation is pretty much identical to the kind you get at the dentist: the only difference is that if your dentist injected you here, that’d be considered a miss. While pinching the left vas between his fingertips, the surgeon squirted a stack of lidocaine into the cavity around it. And fuck me, that hurt like being kicked in the balls. Seriously: that stung quite a bit for a few minutes, until the anaesthesia kicked in and instead the whole area felt “tingly”, in that way that your lips do after dental surgery.

Vas clamp pulling the vas to the surface (not mine; from a medical textbook)

Pinching the vas (still beneath the skin at this point) in a specially-shaped clamp, the surgeon made a puncture wound “around” it with a sharp-nosed pair of forceps, and pulled the vas clean through the hole. This was a strange sensation – I couldn’t feel any pain, but I was aware of the movement – a “tugging” against my insides.

Vas pulled through a hole (not mine; from a medical textbook)

A quick snip removed a couple of centimetres from the middle of it (I gather that removing a section, rather than just cutting, helps to reduce the – already slim – risk that the two loose ends will grow back together again) and cauterised the ends. The cauterisation was a curious experience, because while I wasn’t aware of any sensation of heat, I could hear a sizzling sound and smell my own flesh burning. It turns out that my flaming testicles smell a little like bacon. Or, if you’d like to look at it another way (and I can almost guarantee that you don’t): bacon smells a little bit like my testicles, being singed.

Next up came Righty’s turn, but he wasn’t playing ball (pun intended). The same steps got as far as clamping and puncturing before I suddenly felt a sharp pain, getting rapidly worse. “Ow… ow… owowowowowow!” I said, possibly with a little more swearing, as the surgeon blasted another few mils of anaesthetic into my bollocks. And then a little more. And damnit: it turns out that no matter how much you’ve had injected into you already, injecting anaesthetics into your tackle always feels like a kick in the nuts for a few minutes. Grr.

The removed sections of my vas, on a tray (actually mine)
You can see the “kink” in each, where it was pulled out by the clamp. Also visible is the clamp itself – a cruel-looking piece of equipment, I’m sure you’ll agree! – and the discarded caps from some of the syringes that were used.

The benefit of this approach, the “no-scalpel vasectomy”, is that the puncture wounds are sufficiently small as to not need stitches. At the end of the surgery, the surgeon just stuck a plaster onto the hole and called it done. I felt a bit light-headed and wobbly-legged, so I sat on the operating table for a few minutes to compose myself before returning to the nurses’ desk for my debrief. I only spent about 20 minutes, in total, with the surgeon: I’ve spent longer (and suffered more!) at the dentist.

"Happy Vasectomy" card from Liz and Simon — Later, I would receive this “Happy Vasectomy” card from Liz and Simon. Thanks, guys!

By the evening, the anaesthetic had worn off and I was in quite a bit of pain, again: perhaps worse than that “kick in the balls” moment when the anaesthetic was first injected, but without the relief that the anaesthetic brought! I took some paracetamol and – later – some codeine, and slept with a folded-over pillow wedged between my knees, after I discovered how easy it was to accidentally squish my sore sack whenever I shifted my position.

The day after was somewhat better. I was walking like John Wayne, but this didn’t matter because – as the nurse had suggested – I spent most of the day lying down “with my feet as high as my bottom”. She’d taken the time to explain that she can’t put a bandage nor a sling on my genitals (and that I probably wouldn’t want her to, if she could), so the correct alternative is to wear tight-fitting underwear (in place of a bandage) and keep my legs elevated (as a sling). Having seen pictures of people with painful-looking bruises and swelling as a result of not following this advice, I did so as best as I could.

Today’s the day after that: I’m still in a little pain – mostly in Righty, again, which shall henceforth be called “the troublesome testicle” – but it’s not so bad except when I forget and do something like bend over or squat or, I discovered, let my balls “hang” under their own weight, at all. But altogether, it’s been not-too-bad at all.

Or, as I put on my feedback form at the clinic: “A+++. Recommended. Would vasectomy again.”

(thanks due to Ruth, JTA, Matt, Liz, Simon, Michelle, and my mum for support, suggestions, and/or fetching things to my bed for me while I’ve been waddling around looking like John Wayne, these past two days)

The Snip, Part 1

I’d like to start with a joke:

Is there a difference between men and women?

Yes! There’s a vas deferens.

What’s no joke, though, is the human population explosion. There’re just too damn many of us, as I explained last year. That’s the primary reason behind my decision, held for pretty-much the entirety of my adult life, to choose not to breed.

I’m fully aware that the conscious decision to not-breed by a single individual – especially in the developed world – makes virtually no difference to the global fate of humanity. I’m under no illusion that my efforts as a vegetarian are saving the world either. But just like the voter who casts a ballot for their party – even though they know it won’t make a difference to the outcome of the election – I understand that doing the right thing doesn’t necessarily have to have a directly quantifiable benefit.

That’s why I’m finally taking the next obvious step. Next month, after literally years of talking about it, I’m finally going to put my genitals where my mouth is (hmm… maybe that wasn’t the best choice of words)! Next week, I’m getting a vasectomy.

I first asked a doctor about the possibility of vasectomy about a decade ago. He remarked upon my age, and said – almost jokingly – “Come back in ten years if you still feel the same way!” I almost wish that I still had the same GP now, so that I could do exactly that. Instead, I spoke about a year ago to my (old) GP here in Oxford, who misled me into thinking that I would not be able to get the surgery on the NHS, and would have to have it done privately. Finally, a second doctor agreed to sign off their part of the consent form, and I was good to go. The secret, it seems, is persistence.

I suppose I'll be eligible for a Golden Snip Award. Click through for more information. — I suppose I’ll be eligible for a Golden Snip Award. Click through for more information.

I’m sure that this is a decision that won’t be without it’s controversies. And believe me: over the course of the most-of-my-life-so-far that I’ve hinted at or talked about doing this, I’m pretty sure I’ve heard all of the arguments. Still: I feel like I ought to pick up on some of the things I’ve heard most-often –

What if you change your mind?

Even despite medical advances in recent decades in vasectomy reversal, vasectomy should still be considered a “one way trip”. Especially when I was younger, people seemed concerned that I would someday change my mind, and then regret my decision not to spawn children.

I suppose that it’s conceivable – unlike my otherwise potential offspring – but it’s quite a stretch, to believe that I might someday regret not having children (at least not biologically: I have no problem with adopting, co-parenting, fostering, or any number of other options for being involved in the upbringing of kids). I honestly can’t see how that’d come about. But even if we do take that far-fetched idea: isn’t it equally possible that somebody might ultimately regret having children. We take risks in our lives with any choice that we make – maybe I’ll someday regret not having taken my degree in Law or Chemistry or Rural Studies. Well then: c’est la vie.

Do you just not like children?

Children are great, and I’d love to get the chance to be involved in raising some. However, I don’t define myself by that wish: if I never have the opportunity to look after any kids, ever, then that wouldn’t be the worst thing in the world: I’d just spend my years writing code in a house full of cats. I have no doubt that raising children is great (for many people), but just like there are plenty of people for whom it’s not great, there are also plenty of people – like me – who could be happy either way. No biggie!

There are those who have said that this laid-back “take it or leave it” approach, especially when coupled with the more-recent act of rendering myself infertile, will make me less attractive to women. Leaving aside the implicit sexism in that claim, wouldn’t a fair retort be to point out that a woman who is looking for monogamous breeding probably isn’t my “type” to begin with!

But you should be breeding?

This argument’s usually based on the idea that I’m somehow genetically superior and that my children wouldn’t be such a strain on the world as somebody else’s, or that mine would have a significantly better-than-average chance of curing cancer, solving world hunger, or something.

The explosion of planet Earth. — Only sterilisation can prevent the detonation of the planet. Maybe.

And let’s face it, any child of mine would be just as likely to be the one to build a really big bomb. Or create a super-virus. Or just engineer the collapse the world’s economies into a prehistoric barter economy in a technophobic future anarchy. Attaboy.

In any case, I’m pretty sure that my personal contribution to the betterment of the world ought not to be a genetic one. I’d like to make a difference for the people who are around right now, rather than hypothetical people of the future, and I’d far rather leave ideas in my wake than a handful of genes. I’m sure that’s not the case for everybody, but then – it doesn’t have to be.

Or are there some arguments that I’ve missed? If you’re among the folks who feel really strongly about this, then you’ve got about seven days to make them, and then it’s off to the clinic for me! Just remember: what’s right for me isn’t necessarily what’s right for you, and vice-versa. Just because I use Emacs doesn’t mean that some other, inferior text editor might not be the right choice for you.

I wonder what my surgeon might say to the possibility of me live-tweeting the process? Would anybody be interested? (I promise not to include any photos.)

(with thanks to Nina Paley for permission to use the comics)

Story I Heard This Morning

There’s nothing worse than a snotty doctor’s receptionist who insists you tell her what is wrong in a room full of other patients. I know most of us have experienced this, and I love the way this old guy handled it.

An 86-year-old man walked into a crowded doctor’s office. As he approached the desk, the receptionist said, “Yes sir, what are you seeing the doctor for today?”

“There’s something wrong with my dick,” he replied.

The receptionist became irritated and said, “You shouldn’t come into a crowded office and say things like that.”

“Why not? You asked me what was wrong and I told you,” he said.

The receptionist replied, “You’ve obviously caused some embarrassment in this room full of people. You should have said there is something wrong with your ear or something and then discussed the problem further with the doctor in private.”

The man replied, “You shouldn’t ask people things in a room full of others, if the answer could embarrass anyone.”

The man walked out, waited several minutes and then re-entered. The receptionist smiled smugly and asked, “Yes? ”

“There’s something wrong with my ear,” he stated. The receptionist nodded approvingly and smiled, knowing he had taken her advice.

“And what is wrong with your ear, Sir?”

“I can’t piss out of it,” the man replied.

The Doctor That DOESN’T Just Tell You What You Want To Hear

I went to the doctor this morning to discuss the side-effects of the lariam tablets. I’d made the appointment just a week ago, when I was still having weird mood swings and not being able to sleep, like, at all. Since my last tablet, though, last Tuesday, I’ve been pretty much fine: nothing worse than the weird dreams, which I can cope with. I kept the appointment anyway.

“What I really want to know is,” I told the doctor, “Are the bad side effects – the ones I had in the first week – likely to come back? Is lariam one of those things that, if you get your body attuned to it, it’ll be fine from then on… or is it somewhat more random and unpredictable?”

“All I can say,” replied the doctor, and here’s the best line in the entire dialogue, “Is that if it were me, I wouldn’t be taking lariam.”

Lovely. Thanks, doc.

In any case, he’s agreed to write a prescription for a more expensive but less-controversial drug, which I can collect later in the week if my third pill (tomorrow) makes me go weird again. He seemed quite keen to switch me to it immediately, but I’ve opted to give lariam a go for a little longer yet.