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A Botched Circumcision and Its Aftermath

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A Botched Circumcision and Its Aftermath

Dr. Funnyman took out a pair of forceps and in a matter of seconds had cut the hair tourniquet from the skin bridge. “I’m amazing!” he said. I was overcome with gratitude and relief. I took a photo of the offending hair to memorialize my liberation. Dr. Funnyman told me that the skin bridge had been strangled by the hair to such an extent that it would probably soon separate into two pieces hanging off the penis. If this happened, I could come back and he would give me local anesthesia and remove them with cauterization, a relatively simple procedure that he had performed before. That night, I drank vodka with friends on the Lower East Side, and when I got home to my apartment in the city I locked myself in the bathroom for an hour and wept without quite knowing why.

Within forty-eight hours, the skin bridge had broken into two parts, “a minimal stump distally with a larger stump proximally,” according to the doctor’s notes, the latter of which was an unsightly piece of skin flapping in the summer wind. I have always imagined that beyond its pleasurable utility the penis must be an incomprehensible thing to most heterosexual women, like a walrus wearing a cape that shows up every once in a while to perform a quick round of gardening. Neither my past lovers nor my wife had remarked on the condition of my phallus, but now my genital was truly unbound, as it had always been in my imagination, its freakishness undeniable. It was time to return to the city for my second circumcision of a lifetime, an unlikely double mitzvah, or good deed.

Early Newspaper

On September 8, 2020, my wife drove me to a pharmacy on Second Avenue, where Dr. Funnyman had left a scrip for Valium. Buzzed and dissociated, I floated into his office and put on a gown. The doctor, the nurse, and I were all wearing masks as a precaution against COVID, which reminded me of being seven again and having a mask placed on my face and being told to count in reverse in a language I barely knew as the general anesthesia took hold. I remembered the colors around me changing into a medley of greens and yellows as the world pulled away, like the impossible sensation of entering a tunnel backward. I remembered being scared even as I lost consciousness and needing my mother even more than I usually did. When I woke, I would be given the name of Abraham’s son Itzhak (a name I never used once I had made my exodus from Jewish day school), but on this day in 2020 I hoped to remain Gary. This is a minor procedure, I told myself.

My gown was lifted and a metal grounding pad was attached to my left thigh with a bandage. Dr. Funnyman said that this would keep me from being electrocuted while I was being cauterized. That sentence did not inspire confidence. I grabbed the nurse’s hand as lidocaine was injected into the shaft of my penis, and she gave me a squeeze ball to pulverize instead. (Later, Dr. Funnyman laughed and said I had been “a lightweight.” He also explained that he was joking about the electrocution.) I could not see what happened next or, mercifully, feel very much, although according to the notes “the distal stump was simply fulgurated using a pinpoint Bovie. The proximal end was resected and then fulgurated giving an excellent cosmetic result.” To “fulgurate,” in medical terms, is to destroy by means of the heat from an electrical current. From my supine perspective, I saw and smelled smoke, pieces of my penis being burned away. After it was over, I examined the result. The skin bridge was no more, which, speaking “cosmetically,” was positive. But parts of the remaining redundant foreskin were inflamed and, along with the termini of the erstwhile skin bridge, covered in what looked like a dense layer of Eastern European soot. Dr. Funnyman told me I would be able to resume normal activities soon, but in the meantime parts of my genital would swell and “look funny” for a week.

Four days later, when I was back in the Hudson Valley, my wife and I hosted a barbecue, and I found myself recounting the event. Two close friends who live upstate have cancer, and I hit the comedy notes of the story, as if trying to emphasize its ludicrous nature compared with what they were suffering, but also perhaps to show that I now also understood something about physical pain. In any case, my prognosis was a quick and complete recovery, and I imagined the skin-bridge excision as a brief interlude in a future work of fashionable autofiction.

The afflicted area improved slowly, but peeing was now painful. A part of the redundant foreskin that had always resembled two flaps was becoming more swollen. Two weeks after the surgery, as I was finishing an hour-long walk, it felt as if hot clothespins had been attached to the areas where the skin bridge had been excised and were pulling ever downward. Whenever any clothing came into contact with the affected area, a Klaxon of pain would sound across my central nervous system.

I wrote to Dr. Funnyman, who replied that, given my initial soreness, he was not surprised that it was taking me longer to heal than expected. “For slow learners like yourself, this could take six weeks,” he wrote. I assumed he meant “slow healers” instead of “slow learners,” but I came away with the feeling that the fault was somehow in my body and its inability to “learn” how to respond to a minor genital bonfire. In a later e-mail, the doctor surmised that “there’s something about your skin chemistry that’s just different from the average bear.” I took umbrage until my wife explained Yogi Bear to me. Perhaps the doctor was right. Something within me was wrong. I was not a very average or fast-learning bear.

My condition began to take over my daily life, like a game of Twister but with each wrong move resulting in a jolt of groin pain. To get out of my car without the affected organ scraping unduly against my underwear, I began to propel myself from the seat in one quick motion, until one day I hit my head hard on the doorframe, and spent weeks nursing a headache. Eventually, I quit driving. Lifting grocery bags became impossible. Sitting on a hard chair excruciating. Drying my groin with a towel unbearable. Wearing jeans unbelievable (only sweatpants would do). Playing hide-and-seek with my son out of the question. Even sleeping required a fort of pillows placed in strategic locations to keep my penis airborne through the night. I had been advised to use numbing lidocaine jelly, and to wear soothing Xeroform gauze held in place by an improvised bandage. My wife, upon seeing the shaft of my organ covered in bandage and gauze, sadly compared it to the Elizabethan collar worn by dogs (not that I was in danger of licking myself). Erections became dangerous, and at night I turned away from my wife so that I would not smell the deliciousness of her hair. I began to wonder: Was this the rest of my life?

I decided to expand my medical horizons. My primary doctor recommended a specialist in “minor outpatient urological procedures” whom I will call Dr. Neuroma. I visited the doctor’s aerie in the medicinal slab of the Weill Cornell tower on York Avenue. The doctor, younger than Funnyman but not as funny, could not give a full examination, because touching either of the termini of the former skin bridge produced intolerable pain. He ventured an opinion. In all likelihood, I was suffering from a penile neuroma. Some readers may be familiar with Morton’s neuroma, a highly painful malady that often manifests itself between the toes and may make walking difficult. This was that but in the penis. “A tiny nerve gets swollen,” the doctor said. “A nerve was snapped or cut during the surgery, and the proximal end is angry or inflamed or trying to reach for the other end, but there’s no other end to receive it and that may be felt as pain.” In this interpretation, my nerves were a bunch of ragtag troops stranded on a remote island who had not been informed by general staff that the war was over.

“That one guy from, you know, that thing.”
Cartoon by Paul Noth

The doctor left for what felt like twenty minutes to answer a pressing text message. When he returned, he said that my problem was a rare outcome, “one chance in a hundred, bad luck for you and bad luck for the doctor.” He also told me that he expected I would get about “eighty per cent better” and would learn to live with the rest of the pain. In the meantime, I should “keep it moist and lubricated down there,” and take gabapentin, a drug that was primarily used as an anti-seizure medication but that could also reduce nerve pain. I walked out of the hospital building into a surprisingly hot October day with the softly spoken but uncontestable words of the doctor ringing in my ears. “Penile neuroma.” “Bad luck for you.” “Live with the pain.”

My primary-care physician had recommended another doctor, whom I will call Dr. Cortisone. After the razzle-dazzle of Cornell, this doctor’s office felt more familiar in a urological context, smaller and lower ceilinged, its walls festooned with quotes from Maimonides and a waiting room populated with older Rothian Jews huddled over copies of the Post while waging a final battle with their prostates. The doctor examined my penis and pronounced it wonderful. He even thought the initial Lubavitcher-inspired circumcision had been done with care and did not speak ill of the clumps of redundant and now inflamed foreskin. Dr. Cortisone told me I did not have a neuroma. He recommended three hot baths per day and instructed me to apply a dab of one-per-cent cortisone cream to the stumps thrice a day to reduce inflammation. Additionally, he thought the anticonvulsant drug gabapentin was too strong to be deployed this early. “This is a minor issue that will heal given enough time,” he said. I was not a chronic-groin-pain patient hobbled for life. The key was to forget the pain and move on.

Back home, I stripped off my Elizabethan collar and applied the first dabs of cortisone. My penis stung, but with a sense of joy. Everything was going to get better. And yet Dr. Neuroma was a highly respected Cornellian urologist, and when not responding to text messages he conveyed an air of deep institutional knowledge. So was it a neuroma or not? Would I heal up to eighty per cent and no more, or would I get to live a normal life? Why did everyone have a completely different approach to the issue? And what was the issue?

Dr. Neuroma had told me that, when it came to the male genital, MRIs and other modern tools were “low yield,” and that any further surgery might only make matters worse. When I talked to my friend Mary Karr, the poet and memoirist, she was surprised by how few diagnostic tools were available for the penis. “Why can’t they slap it between two pieces of glass?” she asked. “As fond as people are of dick, that I can’t believe.” She was right. It startled me how little literacy my otherwise literate male friends had about the organ. When I mentioned the glans, some responded with a version of “You mean the mushroom part?”

Things got worse. The cortisone had dried out the affected areas, and my pain was easing to some degree, but my wounds were now covered with long unsightly scabs. Dr. Cortisone thought this was a sign of progress and assured me that the scabs would fall off during one of the long hot baths. “You’re ninety-five per cent of the way there,” he told me. Not completely convinced by the doctor’s excitement, I took some photos of my penis and sent them to my primary-care doctor. “That’s just horrible!” he cried. He told me to return to the city and seek further care.

After consulting with a dermatologist and receiving yet another prescription for lidocaine, I visited a highly recommended and very handsome surgeon who happened to work down the street from the dermatologist. He was a good listener and did not dismiss my concerns. Dr. Handsome agreed with my primary doctor. The scabs were a problem and their very presence kept me from healing. He made an analogy between my penis and the hot molten magma building within a volcano. (Dr. Handsome doesn’t remember this, but I recall at least one of us drawing a volcano on a pad.) “If you want,” he said, “I can get rid of the scabs with just some Q-tips and some saline solution.” True to his word, he removed the thick scabs very gently and with a minimum of pain. For the first time since the initial surgery, I felt that I was being cared for and looked after. Is this it? I thought. Is this my liberation? “In seven to ten days,” the doctor said, “the new skin will grow in and I expect you’ll feel great.”

In seven to ten days, I was in the worst pain of my life. There were some improvements. My penis was no longer covered with scabs, and yet walking for more than ten minutes was impossible. I was losing my mind. I had finally tried gabapentin, but it brought about a mild psychosis during which I wasn’t sure what was real and what was not. The penis is an outcropping of privilege in the male of the species, but it is also a pleasure palace constantly sending signals to the brain. Having pain in the region amounts to a never-ending genital tinnitus. It is impossible to think of anything else.

I’ve always had a rational fear of dying, but when I imagined a life without being able to walk or swim or have sex or travel or do anything without pain or an Elizabethan collar, I wondered what it would be like to kill myself. I looked out the window and onto the fresh snow gathered below and considered the coldness of its eternal compress. Shortly thereafter, I read a BBC article about Alex Hardy, a British man who had committed suicide in 2017 after being circumcised in Canada as a young adult. He did not share his travails with anyone after his operation, but in a long farewell note to his mother he wrote that “these ever-present stimulated sensations from clothing friction are torture within themselves; they have not subsided/normalised from years of exposure. . . . Imagine what would happen to an eyeball if the eyelid was amputated?” That analogy perfectly articulated my own experience.

Male circumcision is an important part of Islam—two-thirds of circumcised men are Muslim—as well as Judaism, though I can speak with a modicum of knowledge only of the faith in which I was brought up. My friend David Fine, the rabbi, has a progressive outlook on many issues, but he is staunch on this subject. He tells me that a man need not be circumcised to be Jewish; in the matrilineal tradition of the religion, a boy born to a Jewish mother is automatically Jewish, and yet, to Fine, circumcision means that “we are God’s partners in creation.”

The Talmud specifies that, if a child’s older brothers die of complications from the procedure, the child should be spared circumcision. In “Why Aren’t Jewish Women Circumcised?,” Shaye Cohen, quoting Rabbenu Tam, the well-known twelfth-century Talmudist, writes that even “a man who was left uncircumcised out of ‘fear of the pain of circumcision’ . . . is not to be considered an apostate since his ‘heart is directed at heaven.’ ” If adult men may be excused from the procedure because of their fear, what are we to say of an infant about to experience what is likely the greatest pain of his young life? Or of a seven-year-old who wants only to please his father?

The Jewish religion generally seeks to ameliorate unnecessary suffering among its faithful. And, outside orthodoxy, large swaths of the Torah are subject to interpretation. Is a practice born of ancient Egyptian feats of endurance indispensable enough for us to continue cutting one of the most sensitive parts of the male anatomy, where any miscalculation may lead to tragedy?

“I thought they’d be less scared of me, but boy let me tell you . . .”
Cartoon by Pia Guerra and Ian Boothby

Yet, even for highly assimilated Jews, circumcision, according to Diane Wolf, a sociologist at the University of California at Davis, “is really the last ritual to go.” In such families, she singles out fathers as the main drivers of the practice. “What is the connection there, between masculinity and circumcision?” she asked me. When it came to her own son, she opted for the brit-shalom naming ceremony (a version of which, sometimes called the brit bat, is also performed for girls). When her son asked her why he wasn’t circumcised, she told him, “You are a Jew in your head and your heart, not your penis.”

The question of whom circumcision is for becomes even more fraught for Soviet Jews in North America and Israel. Sasha Senderovich, who teaches at the University of Washington, and was born in the Russian city of Ufa, said of the post-Soviet foreskin, “It could be seen as a Jewish bodily mark all its own—a mark, for example, of a circumcision that could not have been performed because it might have invited the unwanted attention of suspicious neighbors or the state.” For Senderovich, “the uncircumcised Jewish penis is not a problem that needs to be fixed.”

In the nineteenth century, circumcision expanded beyond a religious custom. The squeamish Victorians believed that the procedure would lead to better hygiene (and discourage masturbation). American physicians reasoned that Jews had far fewer sexually transmitted diseases such as syphilis because of their missing foreskins. In truth, Jews may have suffered from lower rates of these diseases by having less sex outside their communities. Today, some doctors support circumcision because certain studies show that it may lower the risk of H.I.V. transmission and infant urinary-tract infections.

On the other side of the ledger, though, two out of every million boys circumcised in the United States die from the procedure, according to the American Academy of Family Physicians; other studies place the death toll higher. Estimates of complications vary from around 0.2 per cent of surgeries to as much as ten per cent. Most are relatively minor, but some have resulted in amputation of the glans or the entire organ. Among ultra-Orthodox Jewish communities, the centuries-old practice of the mohel, or ritual circumciser, suctioning the blood from the penis by mouth has resulted in several infants being infected with herpes; in 2011, a boy died. The belief that babies don’t fully experience pain during circumcision because their central nervous systems aren’t developed has been shown to be false. A 1997 circumcision study at the University of Alberta ended enrollment early because doctors found the procedure too traumatic for babies who were not anesthetized, while even a form of injected anesthetic, the dorsal penile nerve block, did not eliminate all pain.

Many people around the world, from parents to legislators, are reconsidering the practice. The parliaments of both Denmark and Iceland have debated banning the procedure, and the proportion of infant boys circumcised in the United States between 1979 and 2010 dropped from sixty-five per cent to fifty-eight, according to the C.D.C. It is possible to envision a near future in which the majority of male American infants begin their lives with their genitalia intact.

Outside the snow-glazed window of my New York apartment, the pandemic was raging and the President had declared that he had won an election he had just lost. As a former citizen of a failed superpower, I was always looking for signs of irrevocable collapse, ready to whisk my family to the airport and then to whichever half-decent country would take us (Ireland, by that point). But how would I propel myself to the airport in my Elizabethan penis collar? How would I leave behind the nearly dozen doctors (and one excellent hypnotist) who were now taking an active interest in my situation?

My seven-year-old son knew that something was wrong. During our brief walks in the country, one of my hands held on to his little one, while the other hunted through the pocket of my sweatpants, trying to keep my collar in place. He made me a daily menu where I could mark off which dishes I wanted for lunch and dinner. I was the child now, dependent on my son’s and my wife’s hugs and soothing words.

On the advice of my psychologist, I began to keep a journal tracking my pain level on a scale of zero to five. Peeing was the most painful (I could now urinate only sitting down). The relatively pain-free moments almost always accompanied the presence of family and friends:

11: 00 [a.m.] pain level at about 3

12: 02 [p.m.] after talking to tony bass [my psychologist] and paul [my friend Paul La Farge]: down to 1.5

12: 05 after pee back to 3 right away

12: 15 hot shower down to 2

12: 20 down to 1 happier thinking of family

By 1: 30 back up to 3

2: 30 pee then shower, down to 2

2: 50 lidocaine cream up to 3 depressed

3: 15 down to 2 working in bed underwear off, feeling sad

3: 29 finished writing for the day feeling panicky

3: 40 pee 3 put on bandage going for walk

4: 15 walk 3 but a little happier to be outside

4: 46 return home after 50 min walk about a 3

5: 20 after bath and about 20 minutes 1 or even .5

6: 30 dinner sitting in chair 1-2. Happy time with family mind not in pain

6: 45 after pee back to 3 [my son’s] first episode of the Simpsons

8: 20 down to 2 after hot shower

9: 14 up to 3 lidocaine cream applied

9: 35 still pain taking Ativan to sleep

2: 54 [a.m.] wake up to pee. Painful 3 or 4

Source:
A Botched Circumcision and Its Aftermath