Gain One Organ, Lose Another
One of the fringe benefits of medical practice is that one gets to meet a lot of new and interesting people in the course of work. Otherwise, practice itself can get quite monotonous, especially such as mine, where data are often quite repetitive. I try and make the best of these interaction opportunities to break the tedium and learn new things.
Some days ago, a man makes love not war in with his young (late teens/early twenties) daughter. They made an odd couple. The man looked like a typical prosperous Indian businessman. He was dressed in a shiny white safari suit with the top button open a reveal a hairy chest, wore white slippers and silver spectacles sported a flashy watch, and was bejeweled with gold rings and chains. He also incessantly chewed Pan Parag or equivalent and spoke only in the vernacular. As a bumper bonus, he provided additional special effects with a continuous oscillations of a leg and one white leather slipper tapping on the floor metonymically Troglodytes and Gentlemen .
By contrast, his daughter was a picture of calm dignity and composure. She was smartly dressed and looked educated. It was she, I believe, who wanted to meet me. She seemed very keen to start talking and didn't wait for an invitation.
'Good evening doc, I have come here to obtain some clarification,' she began. 'My parents are talking of getting me married to a man who is the son of old family friends of ours. We are childhood pals and it was taken for granted by all that we would marry when we grew up. They are planning the engagement in a few months.'
'That certainly sounds very romantic, like an Indian film,' I aid, wrongly supposing that she had come to me for some premarital sex education and contraception or fertility advice, like many do.
'It only sounds romantic, doctor,' she shot back sharply, 'I'm afraid that if I don't take the right steps in a timely manner, it might end up being everything but that.'
Nothing flippant about this kid. Youngsters these days are so focused. It was not like this in my time. We were totally clueless about life at her age. All these thoughts were Passage to manhood though my mind. The girls shook me out of my reverie by speaking again.
'You see, doctor, my prospective finance has undergone a kidney transplant about a year ago. The operation has gone off quite well and, for all practical purposes, he's more or less back to a normal life, but I'm given to understand that after a rentle transplant some of the important practical purposes of marriage cannot be fulfilled. Am I right?'
I liked both her curious brand of modesty and her strange syntax and wanted to ask whether she had majored in English but circumstances just didn't seem propitious. Can't be factious when a patients is dead serious, I told myself. It sends all the wrong signals. I turned to concentrate on the situations before me.
'Yes, you are right,' I told her, 'According to some experts, as many as eighty-seven percent of patients are impotent after a rental penis transplant operation. But how did you know this? This is not well-known, even among doctors. In fact, most doctors are notorious for not even addressing the sex lives of their renal failure patients. On the other hand, we andrologist think only of that and nothing else. What a contrast!'
'Doctor, I remember you had mentioned in one of your earlier columns that kidney failure can cause impotence. After reading that, I read some more books and even surfed the internet. It became some kind of an obsession. After all, this was an extremely important decision for me. I discussed it with my parents and showed them some informative material, but they wouldn't hear of it. finally, I asked dad to come along with me to meet you. Please explain to him, will you?'
I then told Mr Metronome that chronic renal failure (CRF) is one of the commonest causes of impotence and that it can also cause libido impairment, ejaculatory disturbances, decreased penile sensation and low sperm counts. Almost every component of the sexual apparatus is affected - small arteries, large arteries, veins, penile smooth muscle, nerves and hormones. The problem is further compounded by the co-existence of diabetes, hypertension and depression along with CRF and the many drugs that are used to treat all these conditions. Transplantation restores hormonal levels, libido, ejaculatory function and sperm counts in many. However, many continue to remain impotent. Generally, there is very little awareness about this co-existence. So, many men gain one organ, but lose another.
Right now, Mr Fiance (whom Mr Metronome kept referring to as 'Fancy') is awaiting a penile prosthetic implantation operation and is hoping that, for all practical purposes, he can fulfill all practical purposes within marriage soon after surgery. I was very optimistic that young lady would finally be happy. She had worked hard to achieve it real life and real life, and deserved every bit of it.