Prologue:
Twenty-six years and more than five thousand cases of erectile dysfunction, and I have never had a more interesting and exciting patient than Jordan Marshall. His treatment will challenge all my pharmaceutical, physiological and psychological skills.
Before Jordan came to my office and told me his incredible story, I was seriously considering early retirement. My practice, which specializes in erectile dysfunction, was getting boring. It was becoming increasingly rare that I had a patient with a new problem worth telling my wife about. Jordan changed that. It has taken me a long time to establish exactly what happened to Jordan, but I enjoyed every minute I spent on his case. My wife and I spent many hours at the dinner table and in bed talking about Jordan, his penis, the rhino horn, his incredible sex-life, the murder and Jordan's role in solving it.
Erectile dysfunction affects the sex lives of 20 to 30 million American men. Obviously, I only see a very small fraction of these men. Most of the ones I see have an inability to get an erection when they want one, and these patients tend to be over sixty. Some of the men have priapism, a painful and long-lasting erection that is not caused by sexual arousal. It sounds like an amusing disorder, but it is not. Others have Peyronie's disease, which results in the curvature of the penis when it is erect. During the Clinton/Levinsky scandal some members of the press suggested that Monica would be able to pick out the president's member in a penile line-up. President Clinton reportedly had a distinctive kink, caused by Peyronie's disease, in his erection. I never found out if there was any truth to the rumor.
Since this is a story about murder and erections, I will have to give you some background information on erections. There is a tube called the urethra that runs down the length of the penis, it carries the urine and semen through the penis. Two cylindrical, sponge like structures run parallel to the urethra. The amount of blood in these cylinders increases to about seven times the normal amount when a man is sexually excited. The sponge like structures are expanded by the additional blood arriving in the penis and produce an erection by straightening and stiffening the penis. After ejaculation, or when sexual arousal is diminished, the excess blood drains out of the spongy tissue, and the penis returns to its flaccid state.
Erectile dysfunction most commonly has psychological and physiological causes. Physical causes such as men sticking their penises in places they should not, like in bottles, animals that bite, food or anything with an opening, are less common. Some men, but luckily not too many, have the desire to stick things down their urethra. This is not a good idea. In the past I have removed pencil leads, flower stems, crushed Viagra pills, toothpicks, and would you believe it, a small porcupine quill from infected and painful urethras.
There are five common ways of treating erectile dysfunction. The simplest and most common method is the use of medication. The Food and Drug Administration approved the use of Viagra in 1998, it was the first oral medication for erectile dysfunction. Alprostadil is an alternative to Viagra. It is either injected into the base of the penis with an incredibly thin needle or a disposable applicator can be used to insert a tiny suppository, about half the size of a grain of rice, 2 inches down the urethra, where it is absorbed by erectile tissue, increasing the blood flow to the penis that causes an erection.
When Mother Nature refuses to increase the blood flow into the penis even when pharmaceutically prodded, an external vacuum pump can be used to suck blood up into the appendage. Once an adequate erection is obtained a tension ring, or elastic band, is placed around the base of the penis to keep all the blood in the spongy tissue and maintain its turgidity. Using a pump is not a very satisfactory solution, but in some cases it is the only solution.
Surgery is usually reserved for men whose blood flow to the penis has been blocked by an injury to the penis or pelvic area.
Inflatable devices or semi rigid rods made from silicone or polyurethane can be implanted into the penis.
Finally, psychologists or psychiatrists treat ten to fifteen percent of erectile dysfunction cases.
None of these methods would be the appropriate treatment for Jordan Marshall. His problem was a little more complicated and more interesting than any one of the problems mentioned above. One could say that Jordan's erectile problems stem from the way he ate an ice cream, meringue and raspberry dessert. However, that would be a gross of oversimplification.
This is Jordan's story.
Part I
Jordan's Story
Chapter 1 Friday, April 8 1 day to erectile malfunction
When Jordan's problems started he was a month away from completing his MBA, and his future looked bright. He was a bit under six feet tall and weighed 170 pounds. There was nothing remarkable about him. Most people who saw him would not be able to say much about him, other than the fact that he looked like a friendly guy. He had a big smile, large nose and black hair.
For his twenty fifth birthday his parents, rich and ever indulgent, gave him a gas gobbling golden Lexus 4x4. With a life like this you might not expect Jordan to have erectile problems. Admittedly, his mother was a little pushy, but that is not really relevant, since she wasn't the cause of his erectile dysfunction.
Jordan had no penile problems before Friday, April 8th. His life preserver inflated on demand, his ice cream hadn't fallen off the stick yet. In fact he had a feisty red haired fiancée, Barbara Steward, who was a regular witness and benefactor of his well-functioning manhood.
A few freckles, red hair, a ready smile, small waist, succulent peachy buns and a wicked sense of humor were the first things men noticed when they met Barbara. A pity because there was so much more to her than that. Barbara was an MD/PhD student. Her work was top secret. Jordan wasn't quite sure what her research was all about, but he had managed to determine that the ultimate goal of the research was to use biomolecular methods to establish whether someone was lying or not, to find a more reliable lie detector. The Office of Naval Research paid her tuition and even a small salary. Genes, enzymes and proteins were not Jordan's cup of tea, he far preferred dollars, profits and IPO's. Perhaps I should also mention that Barbara was feisty, she wasn't about to let anyone bully or abuse her.
That's enough of an introduction to Jordan and Barbara; let's get to the root of Jordan's problem. April 8 was the day Jordan's redwood would start its eventual metamorphosis into a weeping willow. The Journal of Molecular Biology had just accepted Barbara's first article for publication with minor revisions. She had invited Dylan, her co-author, and his girl-friend Jackie for a celebratory dinner. It was the first time Jordan had met either of them. Barbara enjoyed cooking and had spent most of the afternoon in the kitchen. For appetizers she had prepared curried calamari tubes, mildly spiced with lemon mayonnaise. The main course was to be a succulent, slowly roasted shoulder of lamb served with mashed potatoes and vegetables.
Dylan and Jackie arrived a little late. After exchanging greetings Dylan immediately apologized for being late. They had gotten stuck at a local bar. It didn't take Jordan long before he could tell that he was a couple of giggles and stumbles behind the guests in alcohol consumption. He didn't mind there was plenty of time to catch up. Drinking was something he was good at.