The Case of the Creole Urethra

A year or two ago, I was working a special event and was called to the men’s restroom at the venue. I was vaguely irritated. I will let you in on a secret, one that you probably already know: No “good” call ever began in a public bathroom. Nothing good starts in any bathroom, generally. Public restrooms offer even lower odds. I’ve run cardiac arrests and shootings in public bathrooms; they were not good calls. So my initial mindset was not the most… productive.

As expected, I found nobody in the restroom who was obviously in need of my help. It is not a good spot to be in, walking into the can and asking the fifteen or twenty guys with handfuls of themselves whether they needed some assistance. It is a set up for amateur comedians to really shine. But because I am a consummate professional, with very little pride remaining, I loudly announced my presence and asked if anyone had called for the paramedics. A well-appearing man walking out of one of the stalls told me that I was there to help him, and that he was almost done. He beat me to the suggestion that he wash his hands and meet me outside. Working outside of the bathroom sounded like a good idea to me.

We went outside and the man began our relationship by demanding an ambulance: “I need an ambulance to take me to the hospital.” It was seriously the first thing he said to me. No introduction. No exchange of names or handshakes. Just a statement of needing an ambulance. I shrugged, smiled, and called for a transport unit to start heading my way.

While waiting I decided I should attempt to do some paramedic-type stuff. I introduced myself, asked what was going on, took a set of vital signs, and performed a quick exam. This is what I found:

The patient was a 48-year-old male who was complaining of severe inferior abdominal/groin pain associated with urinary retention. His last normal urination was approximately 18 hours previous, and he felt a strong need to urinate. Any attempt only produced a few pathetic drops of non-bloody urine. He had no flank pain, and wasn't presenting in a way consistent with renal colic. At this point, the patient was in distress and apparently knew that I didn’t have a way to cath him. His vital signs were normal, his exam was as expected, and his appearance was consistent with a man in pain due to a bladder fit to burst.

The patient had a theory of why he was unable to urinate. He hadn’t urinated in about 18 hours, right? Well, about 18½ hours ago, he was eating Creole food. Either the Creole food or the spices in said Creole food had apparently caused a reaction in his urethra that had swelled it shut.

I had never heard of such a thing. I was excited to learn something new. I asked if he had experienced similar reactions to Creole food in the past. Nope. Were there other signs of allergic reaction, such as itching? Nope. Was he allergic to shellfish or a specific spice in Creole cooking? Not that he knew of. Did he know of anyone else who had had Creole problems like this? Nope.

Why did he think it was the Creole food? It was the only thing it could be.

None of this was making sense to me, but I needed to get ready to handoff the patient to the transport unit. I collected and wrote down the patient’s name, birthday, medical history (none), allergies (none), and vital signs. I asked about the patient’s medications.

“I’m prescribed Flomax, but I haven’t needed it. So I quit taking it five days ago.”

I laughed out loud.

For those who don’t know off the top of their heads, Flomax (tamsulosin) is an Alpha-1 blocker used for benign prostatic hypertrophy and bladder outlet obstruction, among other things. This guy quit taking the med that helped him pee!

I have a wild theory as to the cause of your pee issues...

“Well, there’s your problem,” I told him. “Not taking the Flomax is allowing your prostate to impede things.”

The patient did not appreciate my laughter. (Most patients don’t enjoy laughter, especially when you throw your head back and point. Not that I did here. I'm just saying.) He disagreed with my diagnosis. Truth be told, he was mad at my insane diagnostic skills. He explained how it couldn’t be the absence of Flomax that was causing urinary retention. See, he stopped taking it five days ago. The peeing problem started yesterday night. If it was the Flomax, the peeing stuff would have been a problem four or five days ago. I was bring a jerk for even questioning that. Logic.

For my part, I was worried that I was on a hidden camera show. But it wasn’t worth fighting about. I was actually sympathetic for the guy – not being able to piss has to suck when your bladder is full. I remember when I was an EMT, we were roughhousing around the ambulance bay and a medic’s leg was broken. Between the near-overdose of narcotics we generously poured into him and the anesthesia he got during surgery, the medic woke the next day unable to pee. He was begging for a Foley. Begging. With tears in his eyes. The nurse said she didn’t have orders for urinary catheterization, so would have to call his physician. I’m still frightened of any process that would cause an adult male to loudly threaten violence upon a nurse if she didn’t hurry the hell up and shove a tube up into his junk. That has to be urinary urgency beyond anything I have ever felt. And I’ve had to pee pretty bad in my life. So I was sympathetic to this guy and his bladder pain.

The transport bus showed up. I helped the patient into the care compartment and onto the bench-X. I stepped away from the side door with the attending transport medic and began my report like a comedian begins a joke: “Get this…” After explaining the situation in a subtle and quiet way out of earshot (I thought), I heard the patient’s irritated voice from inside the ambulance.

“It’s not the damn Flomax! It is that Creole food!”

I smiled a knowing smile at the transporting medic and returned to service. I still think it was dude’s noncompliance with the Flomax that caused his problem. But I’m no doctor. So I have been avoiding Creole food since that call, just in case.