 |
| Lorena Bobbitt |
A STITCH IN TIME
It arrived in a Ziploc bag, inside a brown paper lunch sack.
"It was an intact penis, very cleanly cut," recalls Jim Sehn, the urological surgeon. "It was not crushed. It was not visibly soiled."
He had feared the worst. Gravel. Dirt. Run over by car. Chewed by animal. Instead he was amazed by the excellent condition of the organ.
Even so he found the situation extremely disturbing. He could not help but react both as a skilled urologist and as a man -- the doctor compelled to act, to proceed in an orderly fashion, washing the member with Hibiclens surgical scrub and then submerging it in a stainless steel bowl of saline ice, even as the man is wincing, squeamishly handling the ghastly object, a human organ that he had touched countless times but never while detached.
"I felt sick to my stomach. I had kind of an out-of-body experience at that point," Sehn says.
"I would have been very happy to have a seat in the corner, just to get my gut back."
Improbably, the tale of Lorena and John Wayne Bobbitt of Manassas has gone global. A penis story! The male organ had always been an unmentionable, the word too graphic and specific, simultaneously clinical and lurid. With the Bobbitt case, the penis now gambols freely along the avenues of public discourse, a precocious intruder into polite conversation, and there may be no way to make it go back whence it came. (The vagina, however, remains shrouded in silence.)
Reporters from around the world have made phone calls to the principals in Northern Virginia. Bill and Hillary Clinton and Vice President Gore have joked about the case. The New York Times, which a few years ago struggled to put together a diagram of President Reagan's prostate operation that would give no hint that Mr. Reagan had a penis, decided this summer that it would be okay to put the word in a headline.
Lorena Bobbitt has told her story on "20/20." "Lord!" exclaimed Hugh Downs after the report. Vanity Fair imminently will have its version of events and Gay Talese is finding the deeper meaning of the story for The New Yorker. John Wayne Bobbitt has remained silent so far -- "My lawyers don't want me saying anything to anyone at this point. ... I gotta go," he said from his new home in Niagara Falls, N.Y., during a very brief phone conversation this week -- but his sutured anatomy is celebrated, a medical miracle.
The Bobbitt case gained such unlikely notoriety for several reasons. The obvious one is that it has allegorical utility in any discussion about relations between the sexes, and rape within marriage. The public may be additionally intrigued because the Bobbitts are, at least superficially, attractive. But the replantation of the penis is also a key piece of the narrative. Without that astonishing surgical feat at Prince William Hospital in Manassas, the Bobbitt tale is far grislier, less amusing, trashy, even a tad banal. As long as John Wayne Bobbitt is put back together the amputation can be viewed as a powerful message rather than a mere mutilation.
And a good story needs heroes. The Bobbitts, each facing criminal charges, are not particularly heroic, unless one wants to concoct heroism out of victimhood and spontaneous violence. The role of hero in this case is filled by the two doctors: Jim Sehn, 48, the urologist, and David Berman, a boyish 36-year-old plastic surgeon who just last year moved to Northern Virginia from Canada. Sehn and Berman, strangers to one another, and novices at the operation they were compelled to perform, labored over Bobbitt's body for nearly 10 hours and succeeded magnificently.
"It looks great," Berman marvels.
Still, it's too early to know if Bobbitt will fully heal. The press, in tacking on the happy ending, has overplayed the rehabilitation of Bobbitt's organ, the doctors say. The penis has different levels of function and not every level has been reached. Bobbitt can urinate normally. He can have erections. But the penis is mostly numb.
Bobbitt can feel a pinprick and he has spontaneous "pins and needles" sensations that indicate that the nerves are regenerating as hoped, Berman says. "He has some return of sexual function," Sehn says. It will be many months before the doctors know if he'll regain normal sensation. If he doesn't, an erection might be difficult to sustain during sexual intercourse.
"If it feels like a block of wood -- that's probably not a good expression -- if he has no feeling down there, that's going to be a significant problem," says Berman.
At the Body Wall
Who wronged whom at the Bobbitt home early in the morning of June 23 will be decided in court. John Wayne Bobbitt has been charged with spousal sexual assault, and his wife, Lorena, has been charged with malicious wounding. She has said her husband repeatedly beat and raped her during their marriage. "You get beat up enough, you finally break," says her attorney, James Lowe.
Both cases go to trial in November.
The medical aftermath is not a matter of contention. Lorena Bobbitt, driving hysterically from the scene, had trouble steering the car. "I remember I couldn't make a turn, because I -- my hands were -- were -- with something on it and so I -- I try to turn, but then I -- I saw that I have it in my hand," she told "20/20." She threw the penis out the window, on the roadside near a 7-Eleven where Maplewood Drive meets Old Centreville Road. She drove to the home of a friend, who called the police and told them what had happened and where the penis could be found.
John Bobbitt, meanwhile, woke up a friend who was staying with the couple and asked for a ride to the hospital. At the emergency room he saw a friend who had been in an accident. They talked. Bobbitt, who had been bar-hopping before the alleged sexual assault, seemed calm. He held a bloody sheet over his lap. The ER doctor, Steve Sharpe, walked up and asked to look at the cut on his hand.
It's not my hand that's cut, Bobbitt said.
He pulled back the sheet and showed the wound. Sharpe, stunned, phoned the urologist on call, James Sehn.
Sehn is a man with a toothy grin and a relentlessly upbeat disposition. He lives in a lovely old stone house on 30 acres on the west side of the Bull Run Mountains, near Middleburg. He could easily have gone an entire career in relative anonymity, performing vasectomies and cystoscopies, treating urinary tract infections, then going home to his wife and two kids and his views of the forested hills, his sheep, his lambing barn, the fields of grass, the garden that smells of lavender.
"I have a gentleman here who has had his penis amputated," Sharpe said that morning.
Sehn gasped. The drive to the hospital took half an hour. When he got there he saw police officers standing around covering their groins.
He walked into a private room in the ER and found Bobbitt, stoic, lucid.
"My wife cut me," said the former Marine.
Sehn looked.
There was nothing there -- nothing at all -- but a clot of blood, right at the body wall.
"It looked like it was a forceful, clean cut," Sehn says.
"Doc, can't you put me back together?" Bobbitt asked.
"We don't have the penis," Sehn said.
Then came an especially difficult moment. Sehn knew that police were searching the roadside, but he had to prepare for the possibility that it wouldn't be found. To do any surgery at all required the patient's consent.
"John," he recalls saying, "if we're not able to find the missing part, we're going to have to close over the stump." He explained that Bobbitt would have to sit down to urinate and would never have sex again as he had known it.
Do your best, Bobbitt said. He gave Sehn a high-five.
The anesthesiologist put him under.
A Precedent
Severed penises are almost always the result of self-mutilation by psychotics, or accidental trauma. Mutilations by wives are extremely rare. The medical literature does include one curious outbreak: In Thailand in the 1970s it became fashionable for wives to punish adulterous husbands by cutting off the offending instrument.
An article by a group of Thai surgeons, "Surgical Management of an Epidemic of Penile Amputations in Siam," published in the American Journal of Surgery in 1983, reported that there were at least 100 such incidents between 1973 and 1980. Graphic press accounts, including interviews with women endorsing the method of retribution, apparently inspired and sustained the epidemic.
"Angry wives seemed to favor the kitchen knife as an instrument for amputation," the article said. It also noted that the traditional Thai home is situated on pilings, with the family's pigs, chickens and ducks living underneath; the amputated organs were typically tossed out the window. Thai men developed a common saying: "I better get home or the ducks will have something to eat."
The Thai doctors used a common replantation technique of that time, reattaching the penis by burying it temporarily in scrotal tissue. The technique has a number of disadvantages, aesthetically and sexually, including the fact that the penis remains numb.
Since then, reattachment surgery has made a great leap forward thanks to the advent of microsurgical techniques. No longer are penises crudely sewn back on; instead, individual nerves and blood vessels are sutured with nylon thread and tiny needles the size of a lower-lid eyelash. There have been only about 10 penile replantations in the United States since the 1970s.
Sehn needed someone who knew how to do microsurgery. He recalled that he had met a plastic surgeon, David Berman, who was new to Northern Virginia. Sehn figured that a young doctor would be able to drop everything and turn away a day's worth of patients more easily than someone more established.
Berman's bedside phone rang at 6:15 a.m. Sehn identified himself.
Berman wasn't on call, and had every right to turn down the request for help. But he likes a good surgical challenge, and this was highly unusual.
"I knew it was a once-in-a-lifetime chance."
So he let out his dogs, brushed his teeth, and drove 30 minutes to the hospital in Manassas, all the while envisioning how he'd perform the surgery. He walked in, saw the patient and, a few feet away, the penis in the bowl of ice. It had arrived just in time, as Sehn was pushing Bobbitt on a gurney into the operating room.
The situation didn't bother Berman in the slightest. Berman and Sehn are different types.
"I shut off my emotions when I operate," Berman says. "Having done so much surgery, very little fazes me."
But he adds: "In fairness, had it been mine in there, it would have fazed me."
Nerves of the Patient
The first few hours in the operating room were spent just identifying things -- figuring out what they were looking at, where the nerves and arteries and veins were on the body and on the severed organ -- an easy task if you are looking at a diagram in a textbook, much tougher if you are staring at a bloody mess.
"It's pretty fussy work," Berman says. It also follows the rule that close is only good enough in horseshoes and hand grenades: "This surgery is either all or not."
Neither doctor had done such an operation before. They had a general notion of what they had to do, but actually doing it was a challenge, they had to make no mistakes, think two steps ahead. The key thing was figuring out what had to be reattached and in what order. Sehn kept thinking to himself: I'm doing what I have to do. What do I have to do next?
"I had never done anything like this before," Sehn says. "I knew the anatomy real well. That was my end of it. Berman has done some fingers."
Berman had the clever idea of putting a tiny stitch in the end of the nerves and vessels they wanted to connect -- an identifying mark.
The nerves have the thickness of a hair. The blood vessels are larger, two to three millimeters. Microsurgery, as the name implies, requires a microscope.
They had to worry about the deep dorsal vein. Blood flows into the penis through multiple channels, but it exits only through that one tiny tube. Unless the blood could get out of the penis after an erection there would be venous congestion: The organ would turn blue, circulation would stop and oxygen would no longer flow to the tissues. They talked about the possibility of calling an 800 number to get sterile leeches to help extract blood should the deep dorsal vein become blocked.
"We are plumbers, but there is something artistic about surgery when things are really clicking along," Sehn says.
They clicked along. At one point Berman said to Sehn, "Jim, does this guy have insurance?"
"I've been afraid to even look," Sehn said.
Three different shifts of nurses assisted them. The overnight shift left at 7:30 a.m., and the day shift at 3:30 p.m.; with the evening shift nurses they wrapped up the surgery around 4 p.m. They never paused to eat.
At the end they released the tourniquet and watched the head of the penis immediately pink up. Using a Doppler probe they listened to the blood flow and could discern that everything was movely nicely, including the flow through the deep dorsal vein.
"Great news," Sehn recalls telling Bobbitt when he woke up. "The police were able to find your penis and we were able to sew it back on."
Both doctors say Bobbitt has been an ideal patient. He agreed to lie on his back for a week with his organ propped vertically in a foam collar to prevent blood congestion.
"John's the most calm guy I've ever met in my life," says Berman.
No Insurance
A week later John Wayne Bobbitt walked out of the hospital, but the doctors have continued to see him regularly. They say he doesn't seem bitter or angry. He doesn't curse his wife, they say. Sehn says Bobbitt appears still to have mixed feelings about her.
"He still had lingering affection for her," he says. One day soon after the operation, the doctor says, "He showed me her picture in his wallet. Talked about the good times they had had together."
For Jim Sehn and David Berman the case brought instant renown. The morning after the surgery Sehn got a call at home from a Las Vegas drive-time radio personality. He suddenly found himself fielding calls from radio listeners. He tried to answer questions as any medical professional would, in clinical terms, but the people on the other end were laughing hysterically. His masterly surgery was a big hoot!
Berman got a call from "Geraldo." What the heck, he figured. He went on the show, fatigued, as it turned out, because he had gotten no sleep whatsoever the night before, spent carefully reconnecting the veins and nerves in the wrist of a 19-year-old girl who had tried to kill herself.
Amid the ruckus, old friends called. People at dinner parties suddenly wanted to talk to the urologist and the plastic surgeon, and not just about prostates and boob jobs. For Jim Sehn, the most heartening thing was getting a call from his dad. The elder Sehn had come off the golf course and gone to his favorite bar, and the bartender said, I heard about what your son did. Dad was so proud.
It is only fitting that the most celebrated surgery of 1993 was not covered by health insurance; Bobbitt had none. He's also filed for bankruptcy. The doctors never got a dime. And they say they haven't even had any increase in business in their private practices. It's too weird an operation.
Says Berman: "You don't say, 'Gee, I'm going to put this guy's name on my fridge in case my penis gets cut off.' "
Joel Achenbach covers science and politics for the National desk. He has been a staff writer for The Post since 1990.
He writes about science and politics for The Washington Post's National desk. He has been a staff writer for The Post since 1990. He started the newsroom’s first online column, Rough Draft, in 1999, and started washingtonpost.com’s first blog, Achenblog, in 2005. He has been a regular contributor to National Geographic since 1998, writing on such topics as dinosaurs, particle physics, earthquakes, extraterrestrial life, megafauna extinction and the electrical grid. A 1982 graduate of Princeton University, he has taught journalism at Princeton and at Georgetown University.
No comments:
Post a Comment