Cognosco

Sooooo…

After seeing the general pediatric surgeon who first pointed out that Albie has hypospadias we asked our family doc for a referral to another surgeon for a second opinion.

He sent us to a pediatric urologist. There is a specialty for everything.

We went to see said specialized urologist surgeon person last week. The first person who talked to us was the physician assistant. I had a list of questions. She placated me with answers.

Then the wonderboy (more like wonderman, but I like the demeaning connotations of calling him a boy) surgeon came in, acting rushed, making us feel like we were sapping his precious time.

At the time, we didn’t quite view it like that. We decided to have the surgery done, and I went ahead and made the appointment.

And then we had a few days to sleep on it. And both admitted we hated the physician assistant and hated the surgeon. Hyrum was especially annoyed by the fact that when I inquired about food restrictions prior to surgery, the P.A. only referred to formula, instead of "breastmilk or formula" and continued to refer to said liquid nourishment as formula even after I made it clear that I breastfeed exclusively. And that is reason 1,748 why I love my husband. Because I think it pissed him off more than it pissed me off.

Once we came to our senses, we also resented the fact that both of them spoke in terms that implied the surgery was absolutely necessary, it needed to be done, it should be done, etc.

Which we may not have noticed had it not been for the first surgeon we had talked to. Who was an older man. Who had sons of his own. Who perhaps had more perspective and respect for us as parents. Because when we had talked to him, he never said it was necessary. He didn’t say it needed to be done, or should be done, or anything else that would leave us feeling like inadequate parents if we chose not to have the surgery. He said he recommended it. And acknowledged that of course we would need time to think things over. And told us that if we wanted to come talk to him again before making a decision, we could make another appointment at any time.

That older surgeon talked to us himself for over 20 minutes. And never made us feel rushed. He was not a warm man. Surgeons are not typically warm people. But he took the time to be a doctor, not just a scalpel monkey.

After realizing that we hated the second surgeon, we asked for another referral. They referred us to another doctor in the same practice. We went to see him today.

By this time, we had made the decision to have the surgery because I have spent hours reading about the condition and there is the possibility that he will have to aim at the ceiling to pee, that his penis may develop more curvature as he ages, etc. And sure, I could let him make that decision some day, but there are so many more risks as he ages for this type of surgery.

So, back to this third surgeon. He came into the room shadowed by a resident. He actually picked up Albert (!), talked to him, and generally engaged with my son as a whole, rather than just examining his penis. Even the first surgeon (who we were planning to go back to if today was nonproductive) didn’t really engage with Albert. Which I understand. I don’t think I could cut people for a living and feel comfortable getting to know them either.

This gentleman said it was really mild and wasn’t likely to cause serious complications, but that if it was his son, he would do the surgery. He acknowledged that there is an ethical dilema over making this decision on Albert’s behalf, at which point I almost fell out of my chair. A doctor acknowledging ambiguity of any kind is rare. Especially about something as silly as ethics. But he pointed out that if further problems develop as a toddler, the healing process would be a real challenge and it could all be a very scary experience for the Dude. And of course, there is the whole hooded foreskin thing that makes his penis look neither circumcized nor uncircumsized. It really does look different. And not the kind of different you have to look for–it’s pretty obvious. Obvious enough that when I really tried to put myself in Albert’s place, I realized that I would want my parents to go ahead with the surgery.

This surgeon also acknowledged that this is a parenting decision. It doesn’t HAVE TO be done–Albert could still have sex and make babies and urinate and his penis would function just fine. That was really what sold me on this surgeon–the fact that he didn’t try to hard sell us.

I think the thing that is the hardest for me about the surgery is that he will be circumsized afterwards because they have to use some of that tissue for the reconstruction and the only other option would be to re-un-circumsize him which just gets into the realm of weird. But I resent the fact that we chose not to circumsize him, and now when people see his penis they will assume that his parents chose to essentially perform genital mutilation. Which is sort of selfish and perhaps shallow to be so concerned with the opinions of others, but it really bugs me nonetheless.

So, the surgery is scheduled for August 31. I have spent many nights laying awake obsessing about this decision, but I feel good about it now. Which doesn’t mean I won’t be an absolute wreck as the date approaches because it is surgery and there could be complications. But I feel at peace with our decision to go ahead with the surgery.

The moral of the story is to always get a second, or perhaps even a third opinion.

The second moral is to talk to an older doctor because they are less intervention-oriented (which is exactly what my midwife said).

Although I must say that I am rather fond of my family doc residency practice. Because I know a little secret about residents–they’re just grad students, like me. Which makes me unafraid to ask or say pretty much anything. And at this point in their lives, they still like their jobs…