After I began working in the ER, I quickly learned that emergency physicians are the doctors of last resort for some people. That is, if a person knew they needed to see a certain specialist but couldn't afford his services, the person would instead go to the ER. I've been called upon to be a step-in dentist, pharmacist, podiatrist, internist, psychiatrist, surgeon, pediatrician, obstetrician, plastic surgeon, gynecologist, neurologist, dermatologist, ophthalmologist, proctologist, and you-name-it-ologist. As long as the patient's problem wasn't wacky, I was happy to help them. I figured it was part of my job.

Perhaps we did too much in the ER, giving us a reputation for being a place for one-stop shopping, sort of like a medical Wal-Mart. Consequently, I was not easily surprised when patients presented with non-emergencies. On occasion, however, they would surprise me.

I found myself staring at an advertisement the patient had ripped out of the back of a men's magazine. Cleverly crafted, the ad depicted two side-by-side cylinders, one of which was noticeably larger. The urologist who placed this penile enlargement ad no doubt wished to convey the impression that his surgery could transform a minor-league member into something a man could proudly display in the gym shower or while auditioning for a lead role in a pornographic film.

“Can you do the surgery?” the patient asked in earnest.

There hadn't been much of a demand for penile enlargement surgery in the ER. “No, I've never done it before,” I answered.

“But can you do it?” he pleaded.

“I know how it is performed, but . . .”

“Well, will you do it on me?”

“It would be better for you to see a urologist about that,” I said.

“A urologist? A urologist? You know how much they charge for this surgery?”

“No.” When he told me, I suddenly wished I'd gone into urology instead of emergency medicine.

“I can't afford their fee, but I need it done. Please.”

I can see it now. A nurse calls out for me, “Doctor, we have a patient here with a gunshot wound to the chest and no pulse,” and I'd respond, “I'm sorry, I can't help him just yet. I'm in the middle of a penile enlargement operation.”

I refused, but my refusal wasn't based entirely on money or the priorities of an emergency room. While this event occurred a few years before penile enlargement surgery was getting a real black eye in the press, reports were already beginning to trickle in that this surgery often gave men a lumpy, dysfunctional penis. In fact, I heard that a famous Hollywood producer had killed himself after his penile enlargement surgery was botched.

I explained the drawbacks of the surgery to the patient. Although clearly disappointed, he said he understood.

“How about giving me some drug to make it bigger?” he asked.

I thought, sort of like a Miracle Grow for Men? Maybe some day, but not now. I said, “There isn't anything I can give you which will do that.”

“But I've heard that certain drugs can enlarge women's breasts.”

I was impressed by his research. “You're correct. However, that effect doesn't translate into the stimulation of penile growth.”

“Why not?”

“The penis is not the male counterpart of female breasts. It's different tissue, and it doesn't respond in the same way as would breast tissue.”

“So what can I do? How about a peter pump?”

A brief explanation for the uninitiated. A peter pump is a colloquial term for a vacuum chamber into which the penis is inserted. The vacuum draws in more blood and tissue fluid, thus enlarging the penis.

“It will work, at least temporarily. However, it might be risky, especially if you apply too much of a vacuum, or if you leave it on too long.”

“Anything else I can try, Doc?”

I'd heard of the remarkable success achieved in this regard by men in the Caramoja tribe of northern Uganda, but I felt it would be unseemly to pass along such a tip. Thankfully, the overhead speaker interrupted us, “Dr. Pezzi to the radio room, stat!” I was glad to get back to the real ER, but I'd enjoyed my brief stint as a urological consultant.

Update: This case occurred years before I discovered various ways to enlarge the penis that produce better (and quicker) results than what men can obtain from using peter pumps. I described these techniques in The Science of Sex and Advanced Enlargement.

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