I was bewildered for a moment. “Jim, I don’t know what to say. You’re calling me to see if I am OK? I was planning to call you this afternoon to see how you were doing. I just don’t believe this happened when all the tests were so normal,” I muttered with pain in my voice.
We spoke as friends-in-mourning for a bit more, but Jim never came back to see me as a patient. It would be too hard to revisit his loss and grief.
I worried more in the years that followed about headaches, and I ordered more CT scans than were probably medically indicated.
“I have never had a vasectomy fail yet,” I began when counseling my patient. “But one out of 500 vasectomies do fail for various reasons, so your odds are good. I should note, however, that you are my 500th vasectomy.” I used this joke routinely when counseling patients prior to the procedure.
An email much later, from the wife of this same patient, had an address that began with ‘SixKidsMom@.’ She was asking me to schedule another vasectomy for her husband. I had done his vasectomy the previous year when they had only five children. It had obviously failed as she had just delivered child number six. The other possibility could be another man in her life, which I did not want to discover, so I pulled his records to see if the six-week sperm count was negative.
“Congratulations on your new daughter. This is a surprise for both of us,” I began over the telephone.
“Yes, it is, but we’re both quite happy. I do think we should look into another vasectomy, however. That is much easier than having my tubes tied.”
“Absolutely. Did your husband ever come in for the sperm count last year after his procedure? I don’t see one in his records.”
“No, he did not. I know that because I asked him to do it about a hundred times.”
“OK. I’ll get him to give me a sample soon, and obviously, that will show active sperm.” I paused for a response. “There are not any other men in your life are there?”
“Doc, seriously? I had five children and a husband to take care of. No time in my life for another man,” she laughed.
“Sorry. It’s just a doctor-question I needed to ask before I get him back on the surgery table,” I finish apologetically. “You know he is my first ever vasectomy failure.”
I have made lots of mistakes over the years. I have given an elderly patient an antibiotic that caused kidney failure, and another patient took my prescribed medicines that resulted in heart failure. I have missed lots of correct diagnoses that should not have been missed. I try to remember the long list of diagnostic guesses that have been proven incorrect because I learn much more from my patients than I do from medical books.
And I try very hard not to make the same mistake twice.
This was Chapter 69 of my new book Swords and Saints A Doctor’s Journey – Enjoy.
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