Paul's Internet Landfill/ 2011/ The Snip

The Snip

NOTE: I am still not sure whether to mark this entry as NSFW. This is not a "family-friendly" entry (it is about birth control, after all), but I will try to keep the salacious details minimal. Still, you should probably skip this entry if you are Catholic, if you are my mom, or if you dislike long boring entries.

  1. The Snip
    1. Backstory
    2. Pre-Surgical Appointments
    3. The Leadup
    4. Surgery Day
    5. Post-Surgery Recovery
    6. Thinking About Health Care
    7. Regrets and Reflections
  2. Sidebar!


I guess this story starts in the mid-90s, when I was in second-year university. At the time I had never been in an intimate relationship, but I knew that I did not want to have children. So I went to Campus Health Services and asked for a vasectomy. The doctor reluctantly referred me to to a urologist, but warned me that my request would likely be refused. "We don't want you coming back in ten years asking for the vasectomy to be reversed," she said.

I remember that conversation to this day. At the time I was pretty upset that my life decisions were not being taken seriously, and I held onto that resentment. I also held on to the referral note; I did not follow through on the appointment. That note reads "20 y.o. student requesting vasectomy". I resented that wording too. I thought it was condescending.

In addition to strengthening my resolve against having children, I decided that I would wait ten years and then get the procedure done. Surely by the time I was 30 I would be able to demonstrate that I was serious?

Well, 30 came and went. It was not until last November that I decided to get this chore out of the way. Thus began the journey.

Pre-Surgical Appointments

I started by calling Planned Parenthood. They told me that I would need a referral from my family doctor. I don't have a family doctor, so I went to the walk-in clinic I turn to for medical attention. It took a few tries before I was able to see a doctor -- my walk-in clinic is notorious for filling up its slots early in the day, and refusing patients by the early afternoon, and I kept turning up after they had stopped accepting patients. But finally I showed up early enough to get an appointment.

The doctor at the walk-in clinic asked me the usual questions. Did I have kids? Did I have a girlfriend or wife? Once I admitted that I was childless and single, I worried that I would be turned away.

Fortunately, the doctor simply verified that I did not want children, and then gave me a referral to a urologist. He told me that family doctors no longer performed vasectomies in the office.

I thought this appointment went relatively smoothly. I had been prepared to argue my case, but I did not need to. Apparently being old has advantages.

It took a few weeks for the walk-in clinic to call me back. They had booked a referral for me -- but it would not until May, nearly six months away. I did not know whether this long delay was because of backlogs in our inefficient health care system, or because I was being tested to see whether I was serious. It was probably the former, but I suspected the latter.

Time passed. As May approached I occasionally thought about the appointment and its implications, but mostly I let time pass on its own. I did not know whether the urologist would perform the procedure during that first appointment or whether the trip would just be a consultation, so I booked some time off. The week before the appointment I biked to the urologist's office in the suburbs so that I would not get loston the big day. I also scoped out bus stops to determine whether I would be able to take transit back home, or whether I would need a cab.

The appointment day was sunny and dry, and to my surprise I arrived a few minutes early. There were other people in the waiting room when I arrived, but for some reason the doctor called me out of order (so I was "that guy").

The urologist asked me the same questions that I had answered at the walk-in clinic. Once again I was worried that I would have to argue my case, but once again my assent was accepted without pushback. The urologist told me that he performed vasectomies at Grand River Hospital once (or twice?) a month. He emphasized that the procedure was a permanent form of sterilization, and that reversal would be expensive and risky. He also told me the side effects of the procedure.

The urologist then took a physical examination. He had trouble finding my tubes, so he recommended that instead of local anaesthetic I go under full anesthesia. I did not feel totally comfortable with this, but I agreed to his recommendation.

Towards the end of the appointment I asked whether I could pay for this process out of pocket, rather than having OHIP cover the costs. The urologist told me this would not be possible -- that it was illegal for him to accept out-of-pocket payment if the patient qualified for the procedure under OHIP.

The urologist then wrote me some prescriptions -- an antibiotic and some pain medication -- and sent me to the receptionist to book an appointment at the hospital. There was an appointment available in three weeks. I did not think that would be enough time to get my affairs in order and arrange time off, so I requested the next available date. That turned out to be August. My appointment would be at 9:00am, so I would have to be at the hospital for 7:00am.

The Leadup

When booking the surgery the receptionist had handed me a big stack of papers: forms to sign and papers to read. Fortunately I did not have to go through the material then and there, but I remember feeling overwhelmed as she rattled off task after task I needed to carry out to prepare for the operation.

Upon glancing through the documentation, I noticed immediately was that I would be required to have somebody else drive me home after the operation. That annoyed me. I don't like getting in cars, and I resented that I would have to depend on one. More importantly, by arranging a ride I would have to get somebody else involved in the process. I wanted to get this done on my own. Fortunately a kind friend offered to give me a ride home, but arranging that ride could have gotten awkward.

About a month before the procedure I started going through the paperwork in detail. I would have to get the prescriptions filled the week before the operation, taking my first dose the morning of the procedure. I would have to get bloodwork done. I would have to fill out forms for hospital admission and for the anesthesiologist. There were also instructions to read about surgery, and about what to expect from the procedure. Four months after the surgery I would have to get a post-vasectomy semen analysis. The urologist listed two medical labs where I could get this analysis done, but one of them has apparently stopped offering this service. Although not strictly necessary, I decided to get my bloodwork done at the other lab so that I would know where the lab was.

While I got the bloodwork done I filled out the prescriptions. The drugs were not super-expensive -- about $20 a prescription -- but $12 of that consisted of pharmacy fees. I debated whether I really wanted to fill out the painkiller prescription -- it was just Tylenol 3 with codeine -- but I decided to follow the doctor's recommendation.

As the day grew closer I thought about the operation more. I decided not to tell anybody that I was getting a vasectomy, and to reveal my reasons for taking time off to as few people as possible. Partially I did not want people fussing over me for a fairly minor procedure, and partially I did not want to be serenaded with all kinds of horror stories about vasectomies gone wrong: "My friend's husband got a vasectomy, and it got infected and he wasn't able to walk for three months!!!" I also did not want to get into tiresome debates over whether getting a vasectomy was a good idea. Sometimes I felt guilty for keeping the procedure confidential, but I think it helped dampen my anxiety before the operation.

Although they never changed the date, the urologist's office kept changing the time of the procedure. First I was going to have the procedure at 9am. About a month before the procedure they sent me a letter changing the time to 2pm. Then they left a voicemail on my coworker's voicemail (!) telling me the time was now 10am. Then about a week before the surgery received a second letter which changed the time to 12pm. As with the original six-month delay for my appointment, I am sure they did not reschedule the surgery maliciously, but that's not how it felt. Fortunately, I had taken the entire day off, and even more fortunately the person driving me home also had a flexible schedule that day.

One worrying aspect of the surgery was that I was not supposed to take any valuables to the operation, since the hospital would not be responsible for lost items. But I knew I needed my health card and my housekey, at the very least. I also wanted to take enough money that I would not be stranded at the hospital. The night before the surgery I put together a little packet with these items, in the hope that I would be able to keep them with me throughout the day. I also packed a bag of necessities -- a few spare clothes, a book to read, some paper to write on, my stack of paperwork, and a pen.

I was not supposed to eat on midnight the day before the procedure. I scarfed down a tomato at 11:45pm and then went to sleep.

Surgery Day

The day started off fairly disastrously. I got up on time, but I did not shower immediately after getting up, and then the bathroom got busy. By the time I finally was ready to leave I had 25 minutes left to make a 40 minute walk. I considered taking my bike to the hospital, but thought that would be too awkward. I considered taking the bus to the hospital, but I did not know the timetable of a direct route. So I grabbed my bag (thank goodness I had prepacked it) and started jogging.

It was stressful, but I got to the hospital on time. When I hit King Street I saw some buses, but instead of being smart and taking a bus for three blocks I decided to risk my luck and hoof it. The gamble paid off.

Upon reaching the hospital I first had to check in at registration. There were several people waiting to check in, but I only had to wait 20 minutes or so before a nurse saw me. The nurse took my paperwork, asked me whether I had a ride home, put my paper identification bracelet on and sent me to Day Surgery. There I sat in another waiting room (which felt like only another 20 minutes, although it was probably longer) until I was ushered to a small examination room. First a nurse asked me to change into hospital pajamas, which I put on backwards (naturally). Then she and a companion nurse went through the pre-operative procedures. To my relief, they offered me an envelope for my valuables so they could be stored in a safe. They gave me a small plastic bag for my glasses (which I would not be allowed to wear during surgery) and put the rest of my belongings into a plastic bag. They took my height and weight, asked me some medical questions, and again made sure I had a ride home. They told me that I would have to wait two hours after the surgery to go home -- one hour in the surgery recovery room, and one hour in a day surgery recovery room.

I noticed that the nurses struggled with their computer systems. They were having trouble remoting into a desktop that would allow them to access their medical records system. One nurse told the other that the workaround was to give their computer a hard reboot (although she did not use those words). I got the impression that the nurses did not think very highly of the support they got from their IT staff, but maybe I was just projecting the way employees at my workplace feel about me. It was interesting to see the situation from the other side, though.

The nurses said that the urologist was running ahead of schedule, and they sent me to yet another waiting room. This one was staffed by a volunteer (I think), who took my name and had me sit down. There was a woman on a stretcher in the hall, who may have been sleeping. She did not look well. I also saw data jacks in the wall. Throughout the day, I kept noticing the kind of computer infrastructure used at the hospital, and I kept comparing it to what I do at work.

Finally a surgical assistant took me to the operating room. The staff had me lie down on a stretcher. I found the big mirror-lights above me intimidating, even though those lights were off. Weirdly, a local rock radio station was playing in the background. The surgical assistants hooked me up to oxygen and blood pressure monitors, and stuck an intervenous tube into my arm. The urologist introduced himself, but I did not recognise him behind his surgical mask. He asked me to give my name, and to state the reason I was in the surgical room. (The right answer was "to get a vasectomy.") He asked me whether I had filled the prescriptions, and reminded me that I would need a post-surgery followup in four months.

The anaesthesiologist also introduced himself, and then proceeded to administer drugs through the IV. First he injected a drug which was supposed to relax me, and then he injected the drug to put me to sleep. I remember getting drowsy and thinking some thoughts totally unrelated to the surgery. Then I don't remember anything at all.

When I woke up my kidney wa I had been moved to another room, although I did not realize this at first. A nurse told me that the surgery was done. I asked whether it had gone smoothly, and she told me it had. She then wheeled me into a recovery room, which I guess was the day surgery recovery room. I felt reasonably alert, although I was clearly still feeling the effects of the anesthesia. A nurse came to visit me. She offered some apple juice, gave me back my belongings, and handed me a sheet with post-surgery instructions. Some of this information differed from the sheet of instructions I got at the urologist's office. I clarified some of the details and asked some additional questions. The nurse showed me the stitches and told me what to expect. Then the nurse had me shuffle-walk across the room so that I would know what to expect while the anaesthesia wore off. She gave me a phone so I could call in my ride.

The hour passed fairly quickly. When it was over I was allowed to get dressed. Then the nurse called a volunteer to take me to the front lobby in a wheelchair (!) to meet the person who would be driving me home. Getting wheeled upstairs felt weird and unnecessary, but I did not protest. My ride had not yet arrived, but the volunteer let me go anyways. Then I went to Tim Horton's to buy fattening pastries, met my ride, and went home.

Post-Surgery Recovery

The information sheets from the urologist advised three days of bed rest. I had taken some time off work for this, so once my ride dropped me off I proceeded to lie around a lot. I slept most of the first day. I had few problems lying around the second day (being lazy is easy for me), but I did get antsy enough to take a short walk. I spent much of the third day lying around too, although I could not resist walking to the store and cooking a little at home. I noticed that I was moving much more slowly and carefully than usual, and I worried about my ability to function at work the next day.

I took my antibiotics faithfully. I did not take a single pain pill. Occasionally I noticed some discomfort, but overall I was not in pain.

After the operation the doctor had used a pad of surgical gauze to support my scrotum. I continued to use that over the next few days, and when that got gross I bought some new gauze (which was surprisingly expensive).

Within a week I was able to move more-or-less normally. As of this writing it is about two weeks after the surgery. Lately I have been getting worried because the incisions don't seem to be healing that quickly. I was warned that there might be some discomfort and discharge as the stitches dissolved, and that has been the case for me. Although I am worried, I am not going to freak out unless things are obviously getting infected, or unless I have gone weeks and weeks without healing. As embarrassing as it is to say in public, I admit that I have been paying more attention to my scrotum than usual. I really hope that this surgery foolishness does not flare up into a big health problem.

The story is not over yet. Assuming the incisions heal properly, I still need to do the followup analysis with the medical lab. After that I need to go to the urologist's office to confirm that the procedure was successful. None of this will happen any earlier than November, which means that from start to end this process will run at least a year.

Thinking About Health Care

Although I vaguely remember going to the hospital for surgery as a young child, this is (thankfully) my first experience with surgery in adulthood. Even this relatively minor experience opened my eyes to a lot of things.

I found the long process to get the procedure arranged frustrating, but I should not complain. The surgery was not pressing -- it was practically cosmetic -- so it seems fair that it would take a while to schedule. I would hope that if I had an acute condition it would be taken care of more promptly, but I should know better than to harbour that hope.

On surgery day, my experiences were smooth, and for the most part the staff was helpful and friendly. Sometimes they asked me information that I had answered on forms or to individuals previously in the day, but I did not find the repetition too aggravating.

The staff were good about answering my questions, but I personally would have benefited from getting an overview of the process earlier in my stay. It was not until I was being prepped in day surgery that I was told how the rest of the day would proceed. Logistics surely plays a role here: the admissions nurse does not necessarily know every step I should expect as a day surgery patient. Nonetheless I felt that I was being taken from department to department without understanding what was going to happen two steps in the future.

I was intimidated by the stack of documentation I got when the appointment was booked, but reading that documentation helped me feel less intimidated overall. There were a few places (especially with respect to storage of valuables) where the documentation conflicted with established practice. If I had known that there would be an envelope for my valuables, I would have been less stressed out about bringing my housekey to the hospital.

I continue to feel uneasy about the requirement to have a ride home ready after surgery. I can see why the hospital makes this a requirement, but it makes me wonder whether those who have poor social connections get surgery at all. I also resent the dominance of car culture in our society; it is assumed that not only do I have social connections to ask favours of, but that those social connections have access to cars.

I am surprised at how calm I felt throughout the day. I did not fret about the consequences of the decision I had made. I did not feel nervous or shy medical staff seeing my nakedness. In real life I am fairly prudish, but for some reason I am okay in medical situations.

I totally felt out of place at the hospital, though. Here I was, a relatively healthy person getting a cosmetic procedure, and all around me were people who were genuinely sick. I felt this especially strongly when I was in the recovery room. Beside me an older man and his wife were getting information about catheters after his surgery. He clearly had a number of medical issues, and clearly needed the health care system much more than I did.

I count 14 people who were somehow involved in my day surgery:

That's a lot! Hospitals really are intricate, and paying all (or most) of those people cannot be cheap.

That raises my biggest objection with this procedure: it was too elaborate. Vasectomies are simple procedures. They can (and in many places are) performed at a doctor's office in fifteen minutes. Somehow (I am guessing for liability reasons) this got blown up into a procedure that must be performed by a specialist (the urologist) in an expensive multi-hour process. I am not sure that I needed such an elaborate procedure, and I am sure that if I had to pay for this procedure out of pocket I would have balked at the cost.

Regrets and Reflections

On that note, my biggest regret about getting this done has to do with cost. Anyone who knows me knows that I am in no danger of fathering children anytime soon, and that for me a vasectomy is probably more like getting a tattoo than a medical necessity. So why did the Ontario taxpayer have to foot the bill?

I am especially unhappy that I agreed to full anesthesia. Using a local anesthetic would have been much cheaper. Although the process might have been more uncomfortable for me it would have been bearable. But because the cost to me for full vs local anesthesia was the same -- zero dollars -- I did not think much about the implications of my choices. This is what happens when patients are separated from the costs of their choices, and this could well be why health care is bankrupting the province. I like my socialized health care as much as the next red-blooded Canadian, but I don't need deluxe treatment for minor surgery. That money could have been better spent elsewhere.

I think the best strategy might have been to refuse to give my health card at the urologist's office. Then I could have paid for the procedure out of pocket. As it stands I will probably contribute whatever tax refund I get next year to the Ontario Opportunities Fund, but I doubt even that will cover the cost of the procedure, and that money does not go towards health care anyways.

The only situation in which I could see this cosmetic procedure being good value for the Ontario taxpayer is exceedingly unlikely: I avoid getting somebody pregnant because I had a vasectomy. The consequences of me having a child -- particularly an unwanted child -- would be disastrous, and would cost the taxpayer a bundle in Children's Aid, social workers, and maybe even the criminal justice system. Avoiding those expenses by rendering me sterile would be wise financially, but my chances of having kids (wanted or otherwise) even without the surgery were slim to begin with.

Other than the expense to taxpayers, I do not feel many regrets over having the vasectomy done. I do wonder whether my insistence on getting this cosmetic surgery stems from that comment at Campus Health Services, whether my need to prove that I was serious drove this decision. But there is little question in my mind about living a childless life. I don't actively hate children, but I can't deal with prolonged exposure to them -- they are too self-centred and I am too self-centred, and the combination is toxic. When I am in the presence of a child, it does not take long for me to thank my lucky stars that I am not a parent.

In principle, I could have been capable of fathering children for many many years -- Pierre Elliott Trudeau fathered his youngest child when he was 70 years old. In practical terms my window of opportunity for having a kid is small, and shrinking rapidly. In order to be an effective parent I would have to fix my brokenness, which would take years of effort I apparently don't want to devote. Then I would have to find a (fertile, female) mate, establish a relationship, and possibly get married before having kids. During that process I would have to overcome my brokenness around employment and get a job that paid me a lot of money, because children are an expensive hobby that I cannot currently afford. None of this happens quickly, and by the time I jumped through all these hoops I could easily be in my forties or fifties. So children are already infeasible for me.

All the same, in the days leading up to surgery I did feel some remorse. Getting the vasectomy represents another life milestone I will miss, and that makes me feel even more alienated and alone than I am now. I thought this remorse would intensify post-surgery, but surprisingly it hasn't. Maybe that is because I am a bad decision-maker; I worry endlessly when faced with even the simplest choice. But when a choice has been made, all I have to do is live with the consequences.

I do feel bad for my mother. I have not told her about this yet and I am not sure I will, but if/when she finds out I bet she will be hurt. She wants grandchildren so badly, and although I have told her time and time again that I would not be giving her grandbabies, I don't think she believes me. I think she still hopes that I will stop being such a disappointment, that I will live out the life she wants me to live. But if I was to give her grandbabies I would have to raise them, and I am both unwilling and unable to do that.

Given that the socially accepted purpose of life is to survive long enough to reproduce, I guess my genes are mad at me too. It sucks to be them, I guess. It is glaringly apparent that I am not well-suited to my environment, so in a Darwinian sense it is appropriate that my genetic line die out. If nothing else, I am in good company -- almost all genetic lines die out. Given that I am not going to reproduce, it is worth asking whether I should be surviving, but that's a topic for another time.

I doubt I will change my mind about children, but even if I did turn my life around and suddenly decide to be a father I don't think the vasectomy would concern me that much. Putting children into the world would mean that I thought that my children would have a good future, which would mean we somehow avoid the Calamity. In that case (Utopialand?) I would expect that medical technology would continue to improve, and reverse vasectomies (which have a 60% success rate already, I think?) would become more effective. A reverse vasectomy would be expensive, but in this glorious fictional future I would have the money to afford a child, which would mean I would have the money to pay for the surgery.

Overall, I am glad that I got the surgery when I was young enough to heal quickly. I am not healing as quickly as I would like, however. I have been frustrated at not being able to bike. For obvious reasons I should not be biking too heavily until the wounds have healed completely, but it is hard -- we are running out of summer, and I am running out of opportunities to be outside.

So why did I do it? To some extent I wanted to prove I was serious about wanting a vasectomy when I was younger. To some extent I hoped it would be a relief to know I would not be having kids regardless of what happens, and that remaining childless is non-negotiable for me.

I am certain that stupid ideology had something to do with this as well. If I had my druthers there would exist cheap and effective reversible permanent sterilization, and we would encourage (or force?) all people to be sterilized at puberty. Then when couples wanted kids they could get the sterilization reversed, and there would be no unwanted babies. There are many, many reasons why this dream is stupid (and we will discover some of them in dealing with our current demographic crash) but nonetheless I hold on to it. Getting a vasectomy was the one step I could take towards making this dream real.

Lately I have been thinking a lot about that original conversation at Campus Health Services. Was that doctor wrong to warn me against having the vasectomy at 20? I used to think so. Now I am not certain. 20-year-olds have a lot of stupid ideas in their heads -- it is an ideal age for extremes, which is why so many soldiers, terrorists, looters, and anarchists tend to be in their early 20s. Certainly I have dropped or moderated some of the strong beliefs I had at 20, and certainly some of those beliefs were indeed stupid (just look through the archives of this website...). My antipathy towards having children may also be stupid, but it has stuck with me to old age. I am not sure how the doctor could have known that, though.

I am also tempted to play what-if games about following through with the vasectomy when I was younger. I would have healed more quickly, but it is hard to say how my life would have been different otherwise. I suspect there are certain people in my life I would have hurt less if I had been less obsessed with not getting pregnant. Maybe my life would be better now, but I could also see it being much worse. There are many consequences to sexual activity, and only some of them have to do with pregnancy.