Every journey starts with an external paradigm and then the inner journey slowly discloses itself. In contradistinction, this last week my outside reality was defined by my innards.
Last Sunday, now 8 days ago, I was awakened by left sided back pain. Weird, to be awakened by back pain, which I don’t suffer. But I have been exercising more and Sharon has led me back into bike riding and I had played golf two days in a row. I spent 24 hours lying on the floor with ice on my back and lovingly applied tissue massage from Sharon. It hurt – it was unfamiliar and I thought little of taking some Percocet for relief. After 24 hours of no improvement I figured that the Percocet had “clogged” me up and was getting in the way of colonic function (a Simay male off his colonic function is by definition pathology). So for 24 hours I just rolled around moaning and occasionally screaming - resolutely refusing to take a pain pill.
The last thing that I wanted was to see a doctor and subject myself to that travail. Finally on Tuesday morning I was scared enough and hurting mightily and Sharon took me to UCSD’s Thornton Hospital. Worried I wouldn’t be able to pee on demand I took a urine sample in with me. An hour later, after a bit of oxidation, the sample turned brown. I knew then that it wasn’t back strain or a bowel obstruction – I must be passing a kidney stone.
Some IV Dilaudid took away my acute pain and the CAT scan showed a 2 mm stone at the junction of where the left ureter joins the bladder. Not much distance left to be rid of the harpoon in my urinary tract. I went home, drank at least 8 ounces of water each hour, and took a Percocet every two hours on the dot. I kept a written time journal so as not to use too much – afraid of acetaminophen toxicity; not of taking too much narcotic. After 2 solid days getting 40 minutes of pain relief out of each 2 hour period I became hostage to pain. I could not think, could not listen to music, could not watch TV. I could only sleep for those 40 minutes and then wait for the spasms of pain to crescendo again. The only intellectual control I could exert was to spend hours with the stethoscope listening to my bowel sounds and trying to map the parts of my colon that were still functioning. Its function went away. I got so distended that tapping my finger on my belly sounded like a Caribbean bongo drum. So in addition to the spastic pain in my ureter there was now the expansive pain of my whole abdomen. I cannot understate how severely I hurt.
Back we went to Thornton for another 12 hours in the ER. There was more IV Dilaudid (at a total dose that would kill by respiratory depression most mortals) and then a wallop of IV morphine. Now that is weird drug. It doesn’t take away the knowledge of pain. It separates the brain from the body. So while the body still hurts, I could choose to get into my “head” and dissociate from the corpus. My body still spastically hurt but inside my head I was at least protected as if in a padded cell. The second CAT scan showed that in two days the stone had not budged – still lodged just a millimeter from freedom.
Finally that millimeter was traversed at close to midnight on Thursday.
Over the course of two ER visits there were 5 doctors and probably 5 nurses. Of that cadre there were 2 doctors and one nurse who extended any real compassion. Fortunately, one of the good doctors and the one good nurse were taking care of me on the first visit. They made me feel that my problem was their charge to help. They included me in their thoughts and actions – more importantly they had a plan which they shared.
Compare that to the young, second visit ER doc who came in made his diagnosis and pronouncements without introducing himself or even touching me.
The urology resident who saw me late in the evening of Thursday was the best. He extended his hand for mine and introduced himself. He listened for me to answer the questions he asked before positing the next question. He included me in his reasoning process. We looked at my CAT scan together. He, alone of all the physicians, raised the problem of a colon impacted by 5 solid days of quiescence. Every physician had access to the same data but only this one looked beyond the obvious kidney stone to see what else might be a problem. Then after consultation with his attending he came back to my room to share “the plan”, let me know a contact point for follow-up and then finally shook my hand and wished me well.
I have always said that a physician who does not touch their patient has not examined them. And the first form of touch is as simple as the courtesy of an introductory handshake. A physician who does not examine the patient and ALL the data has a fool for a patient.
After the stone passed I was ecstatic. After five days of only catnaps for 40 minutes out of every 120 – I felt like I had amphetamines in my veins. Just had to overcome my abdominal distention and obstipation. Magnesium citrate was to fix that. The bottle says that it should work in under 6 hours. I got home at 3 am Friday morning and got about 2 hours of ?sleep? before rising to the day. My innards felt filled with a bubbling caustic brew that after 10 hours had had little real effect. But I was free of the kidney stone spasms and reduced to only a gut that might pop at any moment. I had stopped all pain medicines to help my colon wake up. I kept my yoga session with Arturo. We treated me like a fragile, weak egg. After days curling up like a pill bug it seemed correct to try to open me up dorsally. It may have been the opening of the spine and the out-folding that finally allowed the mag-citrate to flower. I spent three solid hours running to the toilet every 3 minutes. In between I listened to the music of my colon’s pops and wheezes and grand rushes of foul waters. I smiled and heard that my colon was not yet dead.
Still too soon to think I was free. It was another 20 hours before the distention and constant expansile pain subsided. Saturday night I asked Sharon if I could write a simple will, sign it and have it be valid. She thought I was joking. I thought after passing a stone that all would be normal again and we could all celebrate with a glass of Chardonnay. It took two solid days – until Sunday morning at 2 am until I finally was reassured that pain was leaving and wasn’t going to return. I won’t even share my dark visions of causation and outcome.
My loved Sharon has been my loving companion through this. She has been brave to stand by when there was naught else she could offer than rubbing my hands and my feet, and wrapping my long legs that extended far beyond the short gurney with blankets to stay warm. She did not laugh at me when my paranoia dictated me seriously considering dying, if not naturally at least by my own hand. Her loving compassion was my only tether allowing that there was still a future and it wasn’t going to be maimed and wracked by pain. It continues to amaze me that compassion is increasingly not to be found in medicine. The patient must not only pay for medical service – but bring their own compassion companion to the process. When I was young… but that was long ago and far away.
Kensington Avenue 6 -2008
