Self-surgery

Self-surgery is the act of performing a surgical procedure on oneself. It can be a rare manifestation of a psychological disorder, an attempt to avoid embarrassment or legal action, or an act taken in extreme circumstances out of necessity.

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Genital

By far the most common type of self-surgery is orchiectomy, removal of one or both testicles. A small number of men resort to self-surgery in an attempt to control their sexual urges or due to gender identity disorder (Lowy & Kolivakis, 1971; Money & DePriest, 1976; Money, 1980).

Rarer still is the phenomenon of attempted repair of injury caused during masturbation or similar activity that would be embarrassing if revealed. One notable example of this is a case report by Morton (1991):

One morning I was called to the emergency room by the head ER nurse. She directed me to a patient who had refused to describe his problem other than to say 'he needed a doctor who took care of men's troubles'...the patient permitted me to remove his trousers, shorts, and two or three yards of foul-smelling stained gauze wrapped about his scrotum, which was swollen to twice the size of a grapefruit and extremely tender.

...Amid the matted hair, edematous skin, and various exudates, I saw some half-buried dark linear objects and asked the patient what they were. Several days earlier, he replied, he had injured himself in the machine shop where he worked, and had closed the laceration himself with a heavy-duty stapling gun...eight rusty staples were retrieved.

This patient had used a piece of machinery for stimulation on the lunch hour at his machine shop job, when the other employees had left the building. His left scrotum had been caught in the machine. He was thrown several feet away and when he awoke, he stapled the wound closed and resumed work.

Boston Corbett, the soldier who killed Abraham Lincoln's assassin John Wilkes Booth, had performed self-surgery earlier in life. He castrated himself with a pair of scissors in order to avoid the temptation of prostitutes. Afterwards he went to a prayer meeting and ate a meal before going for medical treatment.

Abdominal

Abdominal self-surgery is extremely rare. Two well-publicized cases have found their way into the medical literature.

The first, in 1979, involved a male student who had already performed a self-castration. He also attempted to reduce the activity of his adrenal glands with an injection of bovine serum albumin, luteinizing hormone-releasing hormone and Freund's adjuvant. When this produced an abscess at the injection site, he resorted to self-surgery. His psychiatrist, Dr. Ned Kalin, reports (Kalin, 1979):

At four o'clock on the morning of his surgery, he disinfected his dormitory room with spray disinfectant and alcohol and draped an area with sheets that he had previously sterilized. For anesthesia, he took oral barbiturates. He also took hydrocortisone and prepared a canister of vaporized adrenalin, readying himself for a possible shock syndrome. He performed the procedure wearing sterile gloves and a surgical mask.

Lying supine and looking into strategically placed mirrors to obtain an optimum view, he began by cleansing his abdomen with alcohol. The incision was made with a scalpel, exposure obtained by retractors, and the dissection carried out with surgical instruments. Lidocaine hydrochloride was injected into each successive tissue layer during the opening. He controlled hemostasis with locally applied gelatin powder, while sterilized cotton thread ligatures were used for the larger vessels. After eight hours he had had minimal blood loss but was unable to obtain adequate exposure to enter the retroperitoneal space because of the unexpected pain in retracting his liver. Exhausted, he bandaged his wound, cleaned up his room, and called the police for transport to the hospital because of a 'rupture'.

More recently, a Mexican woman was forced to resort to self-surgery (a Caesarean section) because of lack of medical assistance (Molina-Sosa et al., 2004):

She took 3 small glasses of hard liquor and, using a kitchen knife, sliced her abdomen in 3 attempts...cut the uterus itself longitudinally, and delivered a male infant.

Both mother and child reportedly survived and are now well.

Medically supervised

Dr. Jerri Nielsen was the sole physician on duty at the U.S. National Science Foundation Amundsen-Scott Antarctic research station in 1999 when she found a lump on her breast. She was forced to biopsy the lump herself. Her experience made international news and was the basis for her autobiography, Ice Bound. The lump was found to be cancerous, so she self-administered chemotherapeutic agents. She was cancer-free as of March 2006.

Self-trepanation

Main article: Trepanation#Self-trepanation

Trepanation involves drilling a hole in the skull. One of the most famous instances of self-trepanation is that of Amanda Feilding.

Extreme circumstances

Aron Ralston was a student in mechanical engineering and French at Carnegie Mellon University, as well as a member of Phi Beta Kappa. While on a canyoneering trip in Blue John Canyon (near Moab, Utah), a boulder fell and pinned his right forearm down, crushing it. After six days of trying to lift and break the boulder, a dehydrated and delirious Ralston bowed his arm against the chockstone and snapped the radius and ulna bones. Using the dull blade on his multiuse tool, he cut the soft tissue around the break. He then used the tool's pliers to tear at the tougher tendons.

References in popular culture

• In the 1984 film The Terminator, the android title character, played by Arnold Schwarzenegger, removes a defective eye using an X-acto knife in a gory scene at a bathroom sink.

• In the 1990 film Predator 2, the extraterrestrial Predator is injured in a shootout and breaks into an apartment, where it smashes a hole in the a wall and uses the crumbled plaster mixed with an advanced medical substance to heal an arm gash. This species's highly-developed ability to mend itself is mentioned in the original Predator, although briefly.

• In the 1991 film version of The_Story_of_Ricky, the protagonist ties toghether a tendon in his arm after it's cut by someone else with a knife.

• In 2000's Battle Royale (manga), the main antagonist Kazuo Kiriyama finds that he is unable to properly flex his trigger finger, and cuts his upper arm open to tape damaged muscles back into place.

• In the 2004 film Master and Commander: The Far Side of the World, Dr. Stephen Maturin (played by Paul Bettany) is forced to perform emergency surgery on himself to remove a bullet from his abdomen, as there are no other trained medical professionals onboard his ship.

• In The 2007 film Shooter, Bob Lee Swagger (played by Mark Wahlberg) is forced to use self surgery when shot two times by a cop. He makes a homemade IV solution by mixing salt and sugar with water, and injects it into his arm with a meat injector.

References

• Kalin NH (1979). Genital and abdominal self-surgery: a case report. JAMA 241(20):2188-2189.
  • (See also editorial: JAMA 241(20):2193.)
• Lowy FH and Kolivakis TL (1971). Autocastration by a male transsexual. Can Psychiatr Assoc J 16:399-405.
• Molina-Sosa A, Galvan-Espinosa H, Gabriel-Guzman J and Valle RF (2004). Self-inflicted cesarean section with maternal and fetal survival. Int J Gynecol Obstet 84:287-290.
• Money J and DePriest M (1976). Three cases of genital self-surgery and their relationship to transsexualism. J Sex Res 12:283-294.
• Money J (1980). Genital self-surgery. J Urol 124:210.
• Morton WA (1991). Scrotum self-repair. Med Aspects Human Sexuality Jul 1991:15.

Further reading

• Michell J (1984). Eccentric Lives & Peculiar Notions ISBN 0-15-127358-8. This book has been reprinted (2002, ISBN 0-15-127358-8) and apparently has the same information as the earlier edition.