Under the Knife

The following is all true.

“Your testicles are on fire,” said Dr. Poffenberger. “But don’t worry. I’m going to put them out.”

In fact, the acrid tang of burning flesh did hang in the air, but I just chuckled. Rodney Poffenberger was my urologist, and he was a bit more than halfway through giving me a vasectomy.

My wife and I had talked about this on and off since our son, Sam, was born. It had been a nightmare pregnancy — Karen’s high blood pressure and lousy medical care in Cincinnati almost killed her and Sam. Literally; I’m not exaggerating. Sam is in fact named for Dr. Philip Samuels, Karen’s OB/GYN in Columbus, Ohio, who saved their lives.

The same conditions that caused Karen’s high blood pressure also means she’s not tolerant of a many typical birth control medications. All this in mind, a vasectomy seemed the right thing to do. (Dr. Poff commented that it’s the most convenient and cost-effective form of birth control.)

I know I was supposed to be scared of the prospect of someone snipping away down there, but honestly, I wasn’t. I knew it was a quick and routine outpatient procedure — heck, it barely qualifies as an “operation” — and I’ve never been terribly squeamish anyway.

But I am bad about making appointments. It’s some sort of psychological block. So Karen, who uses the same primary-care physician I do, got me the referral and an appointment with Dr. Poff.

So I went to his office at Lewis-Gale Medical Center, where the receptionist ensured the whole waiting room knew what I was there for by announcing it loudly to one of the other office staff. Then it was into the exam room.

Dr. Poffenberger is a young guy, mid to late 30s, I guess, and very friendly. This is important to me in a doctor. He shot off a series of rapid-fire questions: Why did I want to do this? Did I understand the risk? Did I understand that a small percentage reverse themselves? He told me there would be little pain, and that the whole thing was pretty quick.

“You do this a lot,” I said, remarking on his speedy delivery. At that, he slowed down and smiled.

“I could do them in my sleep,” he agreed.

“Let’s say you stay awake for mine.”

Then he gave me a quick exam. “Here,” he said, taking my hand and moving my thumb and forefinger to grasp a piece of flesh. “You can feel the vas deferens under there.”

“Oh,” I said. He may have thought I was being squeamish, but in fact it was simply a matter of not caring. As long as he knew where they were, I was cool.

And that was it. Ten minutes and done except for making the appointment. Dr. Poff usually did the procedures on Fridays, so if there was some swelling or pain I wouldn’t have to miss work. Before I left he gave me a 1980s-era booklet called something like, “You and Your Vasectomy,” full of breathless prose about the huge decision you’re making, yada yada yada. Being a 21st century guy, it was nothing I didn’t know; the same information had already come through the tubes of the Internets to my home.

Still, one picture caught my attention: It was of the man, post-op,laying back in a recliner while his wife stood next to him with a platter of food.

“How,” I asked Dr. Poff, “do I get that?”.

“That you have to work out with your wife.,” he said. “I just show you the picture.”

With that, he directed me to his secretary, told me to read the booklet, call with questions, and by the way shave myself the day before my operation procedure. I set a date about two weeks away.

About the shaving thing: My wife told me that some doctors were shying away from that, because the zillions of little cuts it causes were more dangerous than not doing it. Thinking I had an excuse to avoid the whole thing, I called Dr. Poff to ask. I spoke to his secretary. She explained that sorry, but Dr. Poffenberger prefers that his patients shave.

“Okey doke,” I said.

“But only below,” she said. “Underneath. You know what I mean?”

Oh, temptation — temptation to say, “Um. no. Could you explain it to me?” I resisted. “Oh, sure,” I said instead.

Note: Gillette’s Venus razor for women is kick-ass. They should color it red, call it “Mars,” and open a whole new market.

The Day

I told my boss I had to skip work the Friday of my procedure for “minor surgery.” Not a problem. Off I went to Dr. Poffenberger’s.

After a short stint in the waiting room, I was brought in to the examination/operating room by one of the receptionists.

“Take everything off below the waist and cover yourself with this,” she said, handing me what was essentially a three-foot-square piece of tissue. She then proceeded to putter around the room while I stood there. Should I wait for her to leave? She was a receptionist, not a nurse. After about half a minute I decided that it was her problem, not mine. I started to undress. She left a few moments later.

I considered leaving my socks on as some sort of odd protest, but decided against it — in for a pound and all. So I sat on the edge of the exam table and waited. And waited. And waited.

The room was ice cold, made worse by the fact that I was half undressed. The radio was playing lite ’70s music. There was nothing to read.

I continued to wait, with nothing to do but shiver and think of the Seinfeld “shrinkage” episode and how glad I was that the ’70s were over. And wait some more.

Twenty minutes later, Dr. Poffenberger appeared and apologized. There had been an emergency. Not a problem — it I had an emergency that required a urologist’s attention, I would hope his other patients would wait.

Still, I was cold, half naked, bored, and had been stuck listening to bad ’70s music for a good half hour. Now the guy who was going to take a scalpel to my nether regions was behind schedule and possibly in a rush. Great. Anything else the universe cared to toss in my direction?

“Do you mind if one of my medical students watches?” Dr. Poff asked. “She’s been observing all week.”

Ah, yes. The cute medical student. I knew something had been missing. “Oh, sure,” I said, resigned to my fate. “Why not?”

“I’ll do a quick exam, then cover you up before I bring Miss Wolf in,” he said.

Miss Wolf? What am I, stuck in a letter to Penthouse? And the idea that he would cover me before he let her in, only, of course, to uncover me moments later to do his thing — well, it seemed an odd nod to modesty.

But that’s what he did, and naturally Miss Wolf was cute. Being seen by her under these circumstances didn’t bother me, but I would have preferred not to have been sitting in an ice-cold room for half an hour first.

“If this room was any colder you wouldn’t have anything to work on,” I groused.

They laughed. “Sorry about that,” Dr. Poff offered. (I learned later that the entire office suite was freezing, and my wife had left the waiting room so she could warm up.)

Pleasantries concluded, I lay back and it was time to play ball. So to speak.

Cutting up

Forgetting the whole waiting-freezing-chatting thing, the vasectomy itself only takes about 15 or 20 minutes. But there was, in fact, plenty of chatting, mostly of Dr. Poff giving me the play by play.

He complimented my shaving, and even suggested they could have a job for me. I politely declined, but was glad I had done it myself. On the counter was the alternative: a razor about the quality you would get at a motel that offers free toiletries for the forgetful.

“I wouldn’t want that thing near me,” I said, indicating the dollar-store razor.

“I don’t blame you,” agreed Dr. Poff.

Thus the worst part of the whole procedure was, actually, the disinfectant spray. Not just because it too was ice cold, but because I knew it didn’t have to be.

“Ack!” I said. “Couldn’t you warm that up?”

“Sorry,” said Dr. Poff. I wondered about a urologist who was so used to apologizing, but decided not to think about it.

A vasectomy is a fairly simple procedure. Two tubes — the vasa deferentia (that’s the plural for vas deferens, if you forgot your Latin) — carry sperm from the testicles. They’re cut. And if the sperm can’t get through (they’re absorbed into the body instead), the little lady can’t get pregnant.

If left to their own devices, though, the vas have a tendency to reconnect, much to the surprise of the woman holding a pregnancy test with two little lines on it. Thus a urologist will do his best to prevent that. In Dr. Poffenberger’s case, that meant physically separating the ends, clipping them off, and cauterizing the ends. Two belts and suspenders, as it were.

So after shocking me with the disinfectant spray, Dr. Poff injected a local anesthetic and waited till I was numb — or at least number than that cold had already left me.

Then it was down to business.

A small incision (guys, don’t think about it), maybe half an inch long, gives the doctor access to the vas. First one side, then the other get the cut-clip-burn treatment. And Dr. Poff explained each step, pausing at one point to ask, “Do you not want to hear this?”

“I don’t mind,” I replied. “I just don’t want to see.”

So he did his thing while Miss Wolf watched and assisted. We all chatted through the whole thing.

“You’re doing really well,” Miss Wolf said at one point. “Really well.”

“Really?” I said. I wasn’t actually doing much besides making small talk.

“Oh, trust me,” said Dr. Poff. “You are.” I shrugged.

When it came time for the cauterization, Dr. Poff warned me, “You’re going to smell something burning.” A moment later I did, which is when he made his “Your testicles are on fire” comment.

“Do you have, like, a list of urologist jokes?” I asked. At our first meeting he warned me, “Don’t piss off a urologist.” Ha.

“We have a few,” he admitted. “We tell the receptionist not to answer the phone, ‘Urology, can you hold?’”

Speaking of which, at one point the receptionist — the same one who had brought me in — walked in to talk to the doc. She saw what was going on and made an effort to look away. It was more for her benefit than mine; at that point I couldn’t care less.

Assaults on my dignity aside, the procedure itself was barely uncomfortable. There was some tugging, and it wasn’t much fun when he had to grab and cut the vas on the far side of the incision. It felt like he was pulling on a cord attached somewhere in my gut, like a mild version of being kicked where a guy shouldn’t be kicked.

And then it was done. One small stitch, and we were into the post-op instructions: keep it clean, take this antibiotic, etc.

“When can I… you know?” I asked.

“Oh, you can have sex in the parking lot if you want,” he said. “Just try to take it easy.” Then he gave me my take-home kit, which contained an empty sample jar I was to use to provide a, um, sample at my follow-up visit in a couple of months. (It can take several months for all the existing sperm to clear out.)

“There are instructions in the bag,” Dr. Poff said.

“Instructions?” I asked. “How about a magazine or a list of Web sites?”

“That’s up to you,” he said. Miss Wolf smiled but remained respectfully silent on the matter.

“You probably want to take it easy the rest of the day,” Dr. Poff said. “And put something cold on the incision to prevent swelling, like a bag of frozen vegetables.”

“You mean I need peas and quiet?” I quipped.

“Exactly.”

And that was that. Miss Wolf thanked me for letting her watch, and with a final good-bye I left.

Epilogue

My wife was waiting to drive me home, but I felt like it wouldn’t have been a problem to do it myself. I took some Tylenol just in case, then napped for a bit.

For the next couple of days I was a bit sore, but it was more uncomfortable than painful, as long as I took my Tylenol. There was no swelling, and by Monday I was back 99 percent.

I’ve got two return visits scheduled to do a sperm count and to make sure the stitch has healed properly. (I’m pretty sure it has.) And then… well, nothing. No pills for Karen to take, no latex for me to unwrap.

After my insurance kicked in its part, the whole thing cost me about $150. When you take into account our prescription co-pay or the cost of condoms, it really is a bargain. It’s also 100 percent effective, at least as long as I go back for those follow-ups; any reattachment is likely to happen in the first few months.

In fact, something like 80 percent of men don’t bother with the follow-ups. But I will, just to be sure. And then I’ll get Dr. Poffenberger’s go-ahead and be, in some small way, a free man.