Circumcision is in the news this week, and while I am lucky enough to have avoided all discussion of whether or not it's okay since I have two daughters, I do have a story to share. Far be it from me to not add my two cents, you know...
I was working as a surgical assistant for a group of plastic surgeons. I had assisted on cosmetic surgeries like face lifts, tummy tucks, eye lifts, liposuction (eww, the grossest of all), nose jobs. I witnessed amazing reconstructive surgeries to remove burn scars and skin cancers. I had sat for hours helping to reattach nerves and blood vessels in hands and even assisted on a surgery to remove a man's big toe and put it on his hand as a 'new' thumb after he lost his in an industrial accident. Our surgeries ranged from 30 minutes for a carpal tunnel surgery to eight hours for microsurgery or complicated reconstructions. I was pretty sure I had seen it all, but I wasn't ready for James (not his real name).
James was a 15 year old African American boy whose parents had chosen not to have him circumcised at birth. His parents emigrated from Uganda where it was unusual, if not downright strange, for male children to be circumcised (the stories of female circumcision are another issue altogether and one I'm not ready to address here). They hadn't even considered the possibility although the doctors at the American hospital where James was born encouraged them strongly in that direction. James was born in the 1980s when most American physicians were of the opinion that circumcision was 'cleaner' and 'more hygeinic'. They were also convinced that it was painless since the babies couldn't express their discomfort in actual words.
Unfortunately for James, high school is a time fraught with conformist tendencies and, although he was a handsome, athletic young man, showering after gym class had become torturous. Not only was he in the minority because of his skin color, he was the only boy who was not circumcised. His peers had never seen an uncircumcised penis and were convinced he was deformed. Word spread like wildfire in August and soon this young man was ostracized because of a decision his parents had made upon his birth. He begged his parents to let him get circumcised.
I was assigned to assist with the surgery and, although I felt sorry for James that he would have to suffer through having a female in the room while he was naked, I was intrigued. At the age of 26, I had never seen an uncircumcised penis either, and I was curious. We agreed that the doctor, a black man of Nigerian descent, would do all the pre-surgical counseling so as not to further embarrass James, and I would only enter the operating room after he was asleep. They discussed the option of local anesthesia, but the thought of someone poking a needle into his penis was nearly enough to stop James' breathing right then and there.
In contrast to the atmosphere in the OR during most of our surgeries, this was a quiet affair. The CD player broadcast a Seal album and there was no joking or discussion of our weekend activities. Dr. M meticulously explained the anatomy and talked about how this procedure wasn't even taught in many of the world's medical programs because it was unheard of outside the U.S. The reverence in the room was thick as we thought about the clash of conformity and culture. The surgery was simple and took no more than 15 minutes and I left the recovery room before James awoke. The physician gave him the follow-up instructions: ice, pain relievers and minimal activity for a few days.
The next morning I listened to the messages that had come in overnight. James' mother's voice was shaky and brittle - he was in a great deal of pain. Was there some prescription we could give him? Another message an hour later was slightly more concerning: there was some redness and a great deal of tenderness. Could we please call back first thing in the morning? I checked with the doctor and called to reassure his mother. Had he been moving around a lot? Being careful to wipe after urinating? Had he continued to ice the affected area? She was mortified to ask, but not nearly so embarassed as he was to answer her.
Three days later James returned for a post-op check. He came in wearing baggy grey sweatpants and a t-shirt whose slogan was obscured by the slump of his broad shoulders. He shuffled across the waiting room refusing to meet my eyes. It took all of my restraint to keep my mouth shut and my hand from rubbing his shoulder as I would do for any other patient of mine. I opted to stay out of the exam room but the doctor came out with a furrowed brow and some concern about the amount of swelling.
It took about 10 days for James' surgical site to fully heal and the swelling to subside, but I wonder if he'll ever be able to shed the sharp pain of embarassment from the entire ordeal. I also wonder what he'll decide to do if he has a son...