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J R Soc Med. 2004 November; 97(11): 547–548.
PMCID: PMC1079654

Assessment

Arthur Baskerville, DVSc FRCPath

Dad didn’t seem to comprehend the term ‘urinary incontinence’, I suppose because of his mental confusion. However, after weeks of struggling with nappy-pads and of daily washing sackfuls of sheets, pyjamas and trousers, it was clear to us that this could not go on.

We had heard that salvation lay in the fitting of a sheath and bottle strapped to his leg, or even an indwelling catheter being rigged up. On the telephone his general practitioner was understanding. No, the practice didn’t handle this sort of thing now, because, for reasons of efficiency, incontinence services for the area were centralized in a special unit working out of the hospital. Leave it with him, he would fix it and the unit would get in touch with us directly.

It was a fortnight before we heard any more—two weeks of mounting tension and strain, of crisis after crisis, with Mum breaking down in despair one day and threatening to kill Dad the next. At last a home visit was arranged and our spirits soared—this would be the end of our troubles. I explained it all to Mum and Dad, she so deaf that even after endless repetition I was not sure she had understood, and poor Dad nodding and smiling vaguely; it didn’t concern him anyway.

When the incontinence nurse came I outlined the urgency of the situation, and our hopes rose that some more serious appliances might be fitted to Dad’s private parts. She was a middle-aged lady of severe mien, who reminded me of a Sunday school teacher who used to hit my bare legs with a ruler. Having established that the pad system was hopelessly inadequate for the challenge Dad posed it day and night, I asked if she had brought the magic sheath and bottle. ‘Oh! Good Heavens, no’ she spluttered. ‘I’m only Incontinence (Pads)’.

‘But we’ve already had all that! Why didn’t they send the right person? Can’t you just fit one on him?’

‘Oh, no, it’s far too specialized.’ She glared at me witheringly. ‘You may not realize it, but not all penises are the same.’

Our eyes met. It crossed my mind to suggest that she would know better than me, but I decided against. She did bear an uncanny resemblance to the Sunday school teacher. I changed tack.

‘How do you mean, specialized? It can’t be all that difficult, if it’s only like a condom. I mean, most people...’. I couldn’t go on to the practicalities in face of that glare.

‘In fact, it’s quite complicated. He would need proper evaluation by a Penis Assessor. They then arrange for the correct size of appliance.’

In the silence that followed I struggled to keep a straight face. ‘A Penis Assessor?’ I said, in a tone as matter-of-fact as I could muster, to confirm that I’d heard aright. ‘So, there’s actually somebody who goes about the country doing that as their job? Assessing penises?’

‘Certainly. It’s important work.’

‘Well, what’s the next step for us, because life’s getting critical? If there’s much more wet clothing and aggro, I’m afraid Mum might just hit him with something heavy. She keeps threatening to. Can you send your Assessor as soon as possible?’

‘Our Unit doesn’t do it now, I’m afraid—it’s been contracted out to another organization.’

‘I thought the Incontinence Unit undertook everything to do with incontinence?’

‘Unfortunately not. And, incidentally, we’re officially the Continence Advisory Unit, not Incontinence.’

She handed me her card, tastefully embossed with red and blue lettering. Continence instead of Incontinence; was this another tentacle of political correctness? Incontinence (Pads) wrote down the’phone number of the Penis Assessor, snapped shut her handbag, stood up and walked through the front door and out of our lives.

‘Has she gone?’ bleated Mum. ‘Isn’t she going to do anything to him?’

I tried to explain, but how do you rationalize the workings of the National Health Service to a 92-year-old?

When I rang the Penis Assessor she was bright, cheery and helpful. Perhaps it’s the sort of job that attracts cheery young women, or possibly anticipation of the day’s work sets their hearts singing. It was a pity, she said, but she was just about to go on a week’s holiday, and the week after she was already booked up. Sorry about that. She only worked three days a week anyway, and one of those days was study leave.

Resignedly, I settled for a visit in three weeks’ time. I prowled round the room in a fury: we had a major crisis but there was only one Assessor, she covers a big area, only works three days a week, and one of those days is study leave. Study leave? What is there to know about penises that takes a day every week to learn? Was she doing a higher degree? An MSc (Penises)? I pictured charts, plastic models, eel-like specimens in formalin, written exams. And how did she measure them, anyway? Callipers (warmed in winter)? A giant peg-board with different-sized holes? ‘Just see if you can pop it through this, my dear.’

It was a stressful time. Every night Mum had to get up to change Dad’s bedding. He would then go back to sleep, leaving her tearful and exhausted. They were not coping, and argued and bickered with increasing bitterness. A happy marriage of 67 years was disintegrating before my eyes. At last the day of the Penis Assessor’s visit dawned. Five weeks had passed, four tiers of bureaucracy had been negotiated; Dad’s problem was to be solved. The Assessor was not as I had expected, though I was not sure what a typical exponent would look like. She was late 30-ish, solid, and more the type you see behind the counter in a building society.

We sat in a circle; Dad in his armchair, looking distant, Mum straining to hear. The Assessor explained her mission, then examined him. She recoiled, aghast. Apparently he had such a rampant skin infection of his nether regions that she could not possibly fit a sheath. Instead, she advised us to call the doctor immediately. It was a pity, she said, that she had not been brought in earlier. She closed the case with the shutting of her handbag, gave me her card, and left the sinking ship.

His general practitioner came and arranged to get him into hospital, and, after a four-hour wait for an ambulance, poor old Dad was whisked off to start the long-drawn-out admission procedure in the emergency department. I sat with him in the cubicle for three hours, during which he repeatedly announced that he was off home and struggled to jump off the trolley. Just before midnight a girl in a black dress put her head round the curtain and informed us that she was a doctor, and would do a cognitive assessment.

Ten questions. The first two Dad got right with prompt certainty—his name and date of birth. Thereafter he floundered. What month was it? Blank. What day was it? No idea. What town was he in? Vacant. Reigning monarch? Not a clue. Last question; what’s the name of the current prime minister? Dad pondered for a moment and frowned, then, with feeling, ‘I can’t remember his name, but I hate the bugger!’

What that said about his cognitive state I’m not sure, but they admitted him. He never came out.


Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press