Witness Post: The Big “V”

Witness Post: The Big “V”

In June of 1992, a few months after my wife recovered from her child delivery and episiotomy, she was finally able to walk without wincing. She marched into our bedroom one night, after changing another diaper, and announced, “It is time for you to pitch in. Step up and have that vasectomy!” With three young daughters under the age of four it seemed a justifiable request. But what was the rush? Our oldest child was going to be 4 in October; our middle child was 2; and our newborn daughter was three months old. Perhaps I could protest and say, “Not yet!” Her request was on solid ground while my protest was on slippery sand. Eventually it would be my turn. Time to man up.

The agreement to being the father of three children was nowhere near the commitment to labor and delivery that my wife had endured. She had carried the three children in utero for a combined 27 months; I had been the sperm donor and sideline’s “coach.” Her body was stretched, organs moved around, and muscles torn in ways that no man knows. At this point in our lives, to be a fully-participating member in our personal planned parenthood, I had to commit to “the next step:” surgery. It was my turn to take one for the team. Time to have the “Big V.”

During the next few weeks, after the decision to go ahead with surgery, I would learn more about my anatomy and what goes on down there than I had ever imagined.

We lived in Baltimore, Maryland, at the time and had researched the names of reputable urologists who seemed up to the task. We found one who had graduated from the University of Maryland School of Medicine and studied general surgery at Sinai Hospital and urology at Temple University Hospital.  He was a nice Jewish doctor close to my age.

During our pre-op meeting, the urologist said that he had never had a post-op problem with his patients.  He all but promised smooth slicing. He may not have been what the author Abraham Verghese in Cutting For Stone called the “maestro of male nut cutting” but the doctor said he had not missed yet; no children due.  His patients all had sterile post-op ejaculations. How do you spell relief?

The doctor had requested that, on the night before surgery, I shave as much hair from my scrotum as I could.  Quite a tricky business, that shaving bit.  I did the best I could in the shower that night, but I had some pubic hairs that I could not cut without lacerating my gonads and creating more blood than it was worth.  I stopped, in fear that I would need sutures to help me recover from my self-inflicted wounds.

The day of the operation, my wife said that she wanted to be with me the entire time.  The urologist seemed fine with it, as other spouses and girlfriends had accompanied their man to watch the sacrificial snip.  I drove us to Greater Baltimore Medical Center (GBMC) and my wife confirmed that she would drive us home after the brief procedure. The doctor gave me a sedative to relax me and then went about his work, tidying up the area with a razor.  The doctor mentioned that I had an unusual cremaster reflex.  Apparently, the cremaster muscle pulls the testes up closer to the body and the dartos muscle pulls up the scrotum skin and wrinkles.  The left side of my scrotum did not have the typical muscle reaction.  Who knew?

In short order an anesthesiologist showed up and gave me a shot of “novacane” or another local anesthetic.  I was awake during the entire procedure and I heard my spouse’s questions about what the doctor was doing.  He seemed happy to explain the procedure in layman’s terms.  He said something like the following: “I use my thumb and index finger to locate the lymph system, arteries, vessels, nerves and whatnot.  Among those things I locate the vas deferens, which is the tubing I will cut.”  I came to learn that the vas deferens has the largest wall-to-lumen ratio of any tubular structure in the human body, for whatever that is worth.  It is a whip-like structure that can be cut and sewn back together.  If it is cut and sewn closed on each end, that procedure will prevent any seminal fluid from passing through the penis in an ejaculation.  [The process can be reversed, but the doctors warned that the reversal is not always successful.]

The doctor made a small incision in my scrotum skin and pushed the vas deferens through the hole.  He pulled out a short length of the pale, white worm-like tissue, put two clips on the tube and cut out a short section between the clips.  He said that he would send the removed section to pathology for examination, just in case.

The final procedure consisted of sewing shut the vas deferens ends.  He quickly put some stitches in each end, tying it back on itself and reinserting the ends under the skin.  He also put some small stitches in my scrotum to close the incision.

As we left the operating room I remember the doctor giving instructions to the effect, “If you feel any extraordinary pain, please let me know…otherwise, here are some painkillers for the next few days.  You should be fine in about a week to start exercising again.  You will not want to have any sexual activity for a month, and after that you should have ‘protected sex.’  You will want to call my secretary to set up some appointments, three months out and six months out, to make sure the operation is a success.  Good luck.”

We drove home from the hospital and Tracy asked me if I felt all right.  “Sure,” I said wondering why she asked.  “Well I think the doctor may have missed a stitch, when he sewed you back up.”  I was not sure what that meant, but I assured my wife that everything would be fine.  The anesthetic was still working well, so I felt there was nothing to worry about.  Besides the doctor had never had a problem, right?

Within about 24 hours, I was in a lot of pain.  It was surgery after all, I said to myself, so there should be some pain.  I decided that I would take the pain killers to sleep.  It was difficult to urinate, which seemed pretty normal, but my testes really hurt and they were severely black and blue.  It was just blood draining from the operation, I assumed, and it would be absorbed back into the skin in no time.  But by the third day, though, it was getting worse.  My scrotum looked like an eggplant and it hurt a lot.  The doctor had said, “call me if you have extraordinary pain.”  Not knowing exactly what that was supposed to feel like, I did not say anything to my spouse about it.

By the fifth day, however, things looked worse: the bruised area had spread into my entire crotch area.  With my wife’s insistence, I called the doctor and asked for a post-op consult.  She drove me to the hospital.  When the doctor came out and got a look at the vasectomy area, his eyes pop out of his head, “Why didn’t you call me?”  I told him that I did not know what extraordinary pain was, really, and that I thought this might all be normal.  He said it was not.  He directed me to step into one of the observation rooms and undress.  He came in, inserted a long needle, and proceeded to drain my bulging scrotum of blood.

Many CC’s of blood later, the urologist put an additional stitch on the area, and told me to take it easy.  My wife said to me, when we were driving home, “Hoop, I wish you didn’t have such a high tolerance for pain.  We could have had that extra stitch put in days ago.”  She was right.  There is nothing like having a double sack of French aubergines for balls for a few weeks to feel really foolish.

The good news is that blood stopped leaking and the bruise drifted down my legs and into my body in a few weeks.  I made the follow-up appointments and the tests at three and six months were clear: seedless.  My kids would say that this whole story is full of T-M-I, however, for the record, my wife and I have thrived physically and emotionally without incident for the past twenty-something years.