True Tales of Medical School: The Foley
Filed under: Medicine
I was down in the operating suite helping the anesthesiologist prep a patient for surgery. It was the middle of my third year in medical school, and I was halfway through my general surgery rotation in the downtown VA Hospital. Just as we got the patient sedated, intubated, and hooked up the ventilator, two older nurses walked in.
VA nurses are a distinct breed; they are capable nurses who have chosen not to pursue the higher pay and higher acuity at better hospitals, but instead to reign in comfort in the federal system. Almost uniformly, they are old, big, and tough. You learn quickly not to cross a VA nurse.
I’m almost out the door as they walk up to the patient. They look at me, look at each other, then share a wicked smile. The anesthesiologist quickly leaves.
“Hold it there,” the older nurse says. “This patient needs a Foley catheter.” She hands me a Foley catheter kit. Foley catheters are soft rubber tubes that are placed up into the bladder to drain the urine during surgery. To place a Foley in women, it takes a little lube and a deft twist of the wrist. In men on the other hand, it takes a lot more lube, a firm grip, and some honest effort.
“I’ve never put one in before,” I said.
“We’ll tell you how,” she said as she handed me a pair of gloves. As I put them on, some other nurses came in the room to watch. The first nurse handed me the catheter, the tip dripping with lube.
“Hold the Foley in one hand,” she said. “Now, take that other hand and just choke that chicken, son. Just choke that chicken!” All the other nurses joined in, laughing, “Choke that chicken! Choke that chicken!”
I placed the catheter, made sure it was working, and left the OR as quickly as I could, the nurses still cackling behind me. I hoped nobody else been watching; I also prayed that for his sake, the patient was deeply asleep.
From that day on, I made sure I was out of the OR long before the nurses came in.
June 27th, 2007 at 4:56 pm
Gosh this is SCARY. I wonder if I ever go to a surgery after reading this.
July 21st, 2007 at 12:39 pm
Almost as embarrassing: when I learned how to place a male Foley, it was at the hands of the cute OR nurse (who we all secretly had a crush on) yelling at me to “c’mon, grab it like you own it!!”
October 14th, 2007 at 6:29 pm
As a guy, I can safely say that getting a Foley cath while wide awake is the single most painful thing I have ever experienced.
November 5th, 2007 at 5:15 pm
As a guy, being absolutly, totally unable to urinate after a hemorrhoid
operation (nobody warned me about this) let me say the Foley was a God-send.
And the (male) nurse inserted it quote skillfully and with no pain whatsoever.
December 5th, 2007 at 11:52 am
I am a VA RN (two years out of nursing school) and love my job. I have tried other hospitals but returned to the VA because I missed the veteran population and fast pace of the VA floor. I, too, have been on the receiving end of the behavior you described. Some of of my colleages fit your description. Unfortunately, some older nurses attempt to “eat their young” along with the occassional med student. However, I am not old, big, or tough and I always try to help the doctors in any way that I can. I work with a lot of other young women and several men (many former medics) who are efficient, respectful and excellent nurses. The population of VA nurses is changing.
December 16th, 2007 at 4:46 pm
I’m a med student and last year, we were in a group, guided by a nurse, and had to take care of one patient. The first thing he needed was a foley. Nobody wanted to do it and I volunteered. I had theoretical knowledge, but it was my first foley. Everything went just as it should be, I got it in and urine started to flow, we had a little cup to keep it so it was no big deal. But then, I had to inflate the little bag that the catheter has on the first two cm that prevents it from sliding out. Meanwhile, everyone in my group was very near, watching every move. I had to loose the grip to inflate the bag, it clashed into the cup, spilled the urine in it and started to act like a hose when you let go, moving upwards and sideways and covering my teammates in urine. They jumped backwards and I announced: “Calm down, urine is sterile” meaning that it can’t make you sick, like poop can
May 2nd, 2008 at 9:47 am
Um….where does it go? please don’t say it goes in the pee hole
May 2nd, 2008 at 10:12 am
Official Comment
Sorry, that’s just where it goes:
http://en.wikipedia.org/wiki/Foley_catheter
June 22nd, 2008 at 9:15 pm
Just want to add that Alabama had the luck to have a guy put that Foley in. Guys seem to know all about using lidocaine gel as a lube instead of the KY stuff. A urologist taught me that. Most other female nurses never give a thought to how far the cath has to go and the emotional aspect of having a strange woman grab your penis.
An old not VA nurse
October 31st, 2008 at 11:02 pm
choosing a urologists office as your first career move out of school is not really the most pleasant experience, i learned to put a foley caths using the old school methodology of ..” See one ,do one, teach one” that is the method of choice in our office. We have 3 urologists in our very busy practice and there is no room for being shy, just get in there and do it. Luckily i don’t embarrass easily although our older male patients do….
November 26th, 2008 at 5:49 pm
I’m a male Nursing Student. Last month I just placed two live foley catheters. It was a lot less nerve racking than on the dummies in class. One male and one female. You’re right about that upward flick of the wrist on females. On the male, it was ‘yup, there’s the prostate’. It required a firm, yet gentle grip. Never ‘choke that chicken’. Pushed a little harder and told my awake patient that the catheter was passing his prostate. He was fine, uncomfortable, but fine. I’m 53. The experienced RN’s so far realize that I can bite back, and when I’m around they don’t mess with my fellow Nursing Students. It makes for a better experience for the youngins.
December 6th, 2008 at 2:51 pm
Placing a foley in an 82 years old, ortho patient with Alzheimer’s was THE most painful thing I have ever done in my life. The stench, the weird fluids oozing out of EVERY orifice, the mushy feeling under my fingertips… I was just glad I hadn’t had time to eat in 14 hours or I’d puke all over the patient.
Good times, good times…
May 27th, 2009 at 2:10 pm
Hey Scott,
Loved your Foley catheter story!
My BF had his removed a couple of days ago (he has been in the hospital for 9 days after surgery to remove his stomach because of stomach cancer)
Even though I am female, it makes me squirm just to think of that catheter going up a guy’s urethra…OW!
I love to watch surgeries on Discovery Health and find all medicine fascinating. I read a lot of books by docs (esp. surgeons)
Although I also love House and Grey’s Anatomy, I am aware that the medicine is weak at best and fake/wrong at worst. If I had been better at math and science and better able to detach myself from patients, I might have become a doctor. I’m pretty good for a layperson at diagnosing mystery illnesses.
I love your blog–keep the stories coming! I am also a comics fan…
March 3rd, 2010 at 1:24 am
Nice story. The first time I ever placed a foley on a man was just a tinge worse. The patient had coded and we had him stable and on a vent. I grab the foley kit, get it set up, and start to insert it…and the patient gets an erection. Fully unconscious, on a vent…and the guy gets an erection. I ask my senior, who is doing his best not to burst out laughing, if this is normal. At this point he loses it and shakes his head furiously as he guffaws, “No way. I’ve never seen it before!”. He then discreetly grabs several interns and nurses to supervise the rest of the “procedure” one of the most mortifying moments of my life. Thank God by the end of my first year in that ER not a soul remembered lol.
April 24th, 2010 at 1:55 pm
Sometimes it feels like performing a TURP in the blind …
July 10th, 2010 at 8:32 pm
I know doing these procedures is embarrassing for both, inserter and insertee however I am appauled being in the nursing profession of the unprofessional behavior by so many. I try to treat all patients as I would want myself and family treated. There’s a reason I would never let my spouse or disabled, mentally challenged daughter be alone overnight in a hospital or have anything done to them unless I feel the person is professional. I have seen,heard and read too many of accounts of this type of behavior by so called professionals.Most lay people have no clue what truly goes on when they have to have surgery or stay in a hospital. I avoid them myself since I now work as an educator and not a practitioner.
September 22nd, 2010 at 5:08 pm
I recently performed my first foley on a paraplegic. I was mortified!! It wasn’t as bad as any of the others but for me, OMG !!
October 13th, 2010 at 4:12 pm
About two months ago I was in the hospital, awaiting surgery to remove a brain tumor. I had a catheter inserted (while I was anesthetized thankfully.) I have Buried Penis because of my weight. It’s embarassing, yes. But, does that fact change the procedure for insterting a cath? I would think it makes it more difficult.
Two days after surgery, I was cleared to be moved out of neuro intensive care and into a private room for futher recovery/observation. I didn’t need a catheter for the private room, so it was pulled out. All I can say is OUCH! It hurt like heck for a few seconds after being yanked out.
But that pain was nothing compared to the urinary tract infection I got two weeks later. Because I had recent brain surgery, I wasn’t allowed to drive. So I had to call an ambulance to take me into hospital emergency. (A different hospital than where I had the brain surgery.)
Five days after the surgery, I was discharged from the hospital, but then immediately admited to a rehabilitation facility. I needed some time to recover some of my mental capablilities. While in the rehab facility, an old retired man I shared a room with needed a catheter to releive his bladder. He wasn’t able to go to the bathroom on his own (for several days I overheard from the nurse.) So the nurse had to insert a certain kind of catheter than was used once (to immediately relieve the bladder) and then removed. The whole procedure took about 20 minutes or so. I didn’t watch, but I could hear. Oh man, that was horrible. The guy was crying – he was in his late 70s.
December 3rd, 2010 at 2:34 pm
As a medical student, I remember how uncomfortable putting in your first Foley catheter can be. Thanks for sharing your story!
February 17th, 2011 at 3:23 pm
I’m a doctor in the UK. Just found this site and love it – I’m a big House fan but always drive my (non-medical) sisters mad when watching it with them by constantly nit-picking the medical inaccuraries.
I have a catheterisation story… here in the UK it’s standard with male catheterisations to inject most of a pre-loaded 10ml syringe of lidocaine gel into the urethral meatus prior to cathing the patient, to serve as both lubrication and anaesthetic. You then wait a couple of minutes for the anaesthetic effect to kick in (unless the patient is in acute retention and is begging you just to hurry up and shove it in).
When I first learned how to cath a male when I was a third year med student, some of the more unkind doctors decided to teach their female med students that having injected the lidocaine, you then had to ‘massage it down’ with both hands around the penis… with predictable consequences in at least some of the younger patients. I wasn’t caught out by this myself, but a few of my more naive colleagues did it several times before they realised their mistake.
I’ll never forget my first male catheterisation, for different reasons. I’m not sure how much US doctors will be able to relate to this, as I know most US men are circumsised, but in the UK it’s relatively uncommon. So before you do a cath, in order to maintain sterility, you have to gently draw the foreskin back and clean the glans of the penis. It’s very dependent on the gentleman’s personal hygiene how unpleasant this task is, but I’ve never since encountered what I saw on my first ever attempt…. (look away now if you’re squeamish)…. great white plaques of dead skin and general gunk, the size of two pence pieces. He was an old guy with obvious signs of self-neglect and it was clear that no-one had been behind that foreskin for a very long time.
July 11th, 2011 at 8:12 am
The first time I saw a patient have a foley he screamed with pain and I passed out. When I came round I asked the gentleman ‘did it hurt’ he replied ‘no not really’ I was howling with laughter.
Lawyers Harrogate
January 25th, 2012 at 1:29 am
I’m in paramedic school, so any time someone needs a foley during my ER shifts, i am more than happy to inform the nurse that Foleys are not in my scope of practice and we could all get in a heap of trouble if I did one, but if there’s any OTHER way I can help them…
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