I’m most ashamed of myself today. Absolutely.

Home nursing trips this morning were truly depressing. We followed a home nursing nurse to houses of dependent patients, most being bedridden patients as a result of stroke and spinal cord diseases or injuries. Besides pain and suffering, I see desolation and hopelessness in their eyes. They were no longer embarrassed to have their private parts exposed in the presence of strangers during urinary catheterization procedures - be them doctors, nurses, medical attendants, medical students or relatives.

The first patient left the strongest impression in me. She was a 40-year-old stroke lady confined to bed following bilateral middle cerebral artery infarcts (stroke) with a nasogastric tube sticking out of her left nostril for feeding purposes and a urinary catheter draining urine into a plastic bag attached to the bed side. Her lips were parched and she had a large gaping pressure sore at her lower back. Her eyes teared when the nurse inserted a new nasogastric tube into her. She winced in pain. She would have used all her strength to push us away but she couldn’t move a muscle. She was paralysed from the neck downwards. She would have screamed at us yet she couldn’t even utter a word of protest throughout the agonising procedure. Her elderly mother stood by the door and looked on. There were 5 young children playing by themselves on the floor beside the bed. I looked around and thought if things could have been worse… the small house stank, the floor certainly needed some hard scrubbing, the wooden walls seemed to be eaten away by termites, ventilation and lighting were poor. Suddenly there’s a lot to be done for the patient and her family yet it just didnt seem to be enough. Depression, coping abilities, financial difficulties, responsibility of care for the young and dependent, the poor health of the caregiver, etc began clouding my head. I thought I was fainting. Then I saw the patient looking at my direction. For once I didn’t know what to say. I just smiled. And she continued to look on. After the necessary work was done, we left with heavy hearts. I felt so helpless.

The next patient was an old lady who was also bedridden as a result of a stroke attack several years ago. I was instructed to insert the urinary catheter into her. After cleaning her genitalia and preparing the necessary equipment, I was ready for action. I separated the labia and thrusted the lubricated tube into what I thought was the urethral opening. It wouldn’t go in. I asked aloud for help, “I’m inserting this into the correct orrifice right? This is the urethral opening right?”.

A male coursemate said from my side, “Yeah, that’s the right one.” It must be. The clitoris hood was over it. The “vaginal opening” was right down - huge and looking like what it is - a vaginal opening. When I was about to give up, the nurse finally came nearer and peered. “That’s the clitoris, my dear”. That instant I was… horrified. Yes, horrified. What?! That’s the clitoris? Can a clitoris actually be that huge it almost look like a hole?! My coursemate who was equally horrified couldn’t control himself and blurted, “Oh my god, that’s the clitoris?!”

Yeah, I tried inserting a urinary catheter into a clitoris, mistakening it for the urethral opening.

I looked up to the patient’s face and apologised frantically, changed position and finally eased the tube into her vaginal opening urethra just beneath the clitoris. And the nurse was grinning, “Better brush up your anatomy”.

Yes, I’m truly, honestly ashamed of myself. Will go read my anatomy books right away lest I get confused again with the many openings at a female’s genitalia which don’t look the same at all in every patient. A lesson learnt the unusual way. Enough for today.