The charge nurse asked me to respond to a code yellow: an extremely urgent, situation saying only that it was a man in hemorrhagic shock, with almost no blood pressure, who had arrived by car, pale, confused, sweating profusely, and mumbling about castration. Addressing the critical problem first, we immediately began pumping saline through three large bore IVs, sent blood for lab work, hooked up oxygen and the usual monitoring equipment. His blood pressure and pulse began began to move in the right direction, and he became more alert. Nurses don’t usually make stuff up about castration, so without comment I exposed his genitalia.
The entire perineum was grotesquely engorged with purple subcutaneous blood despite four soft drains of the sort usually placed surgically to allow escape of serum or blood. A purplish black hugely blood swollen penis was all that was left of the genitals. A ragged row of poorly placed stitches ran from its base to the anus, along an irregular midline incision that slowly oozed dark blood. By providing IV fluids and perhaps blood, the emergency was essentially over; next, call a surgeon to repair the damage; even that would be simple. But where the history and its legal consequences would lead was more complex; and to my mind, far more interesting. Despite being around emergency rooms all my professional life, beginning in 1954 as an $8 per night moonlighting medical student, I had never seen, heard of, or even imagined, this case. After so many days and nights in ERs I innocently, and wrongly, believed myself aware of the entire sexual range of behavior in our society.
A brief health history was not particularly revealing. My patient was a computer programmer, lived with his male partner, was in good health, took no medicines, and even had a current tetanus shot. His moderate obesity was of no medical concern at the moment.
“ You live in New York? But of course this isSacramento”
“Well,” I said, “You have definitely been castrated. Was it an assault?”
“No. I paid for it.”
“Couldn’t you have had that done professionally?”
“Too expensive. Too many hassles. My partner told me not to do this, but it’s always been a fantasy of mine.”
He explained that several years ago he became internet connected with some people who shared fantasies of castration. That led to sharing erotic castration phone sex.
“Three years ago I purchased an actual fantasy experience in Chicago. Expensive, but I work hard and make good money. It was splendid, incomparable to anything else I’ve ever done. This year the same people offered it in San Francisco.”
“But” I ventured, “this seems to be the real thing. Did you plan on that?
“Do you want to press charges?”
“You know? I think I’ll be very happy with the result. I couldn’t get this done anywhere for $5000 and it would take years to convince people.”
“Do you mind telling me how it went?”
“It was in San Francisco. They said fly to Sacramento for security.”
He was blindfolded during a long ride; he remembers a toll bridge. When the blindfold was removed he found himself in a room with lots of light, a gurney with and IV hanging on the side pole, and people in surgical gowns.
“It was absolutely overwhelming, unforgettable; but over too soon, right after an IV was started I don’t remember anything; the very next thing is my Sacramento contact waking me in my motel room. The sheets were soaked with blood. I was terribly weak and had vomited. He drove me here.”
After my patient’s admission to the surgery service, my duties were complete, right? Wrong. Years ago a physician’s only obligation was to a patient. If a person with a knife wound in the back said he fell on his knife, that was it. The State ended that primitive contract, claiming a right to try to protect everyone from everyone and everything, through legislation and regulation. So, dutifully (and to avoid fine, imprisonment, loss of license, litigation, and who knows what else; no one car read all the fine print!) I called the police both locally and in San Francisco. But since my patient said he didn’t want to press charges or even provide significant details, they didn’t want to hear more or even to interview him. The San Francisco cop I spoke with found the episode neither alarming nor particularly rare. “It’s freedom, like Joplin said. He ain’t got nothin’ left to lose. Down there anyways. Like, no more worries.” I recorded the badge numbers in the record, looked ruefully at the wall clock, and picked up the next patient’s chart.