A silly little blog for me to drop the excrement of my mind.
-or- the doctor becomes the patient
Published on March 8, 2008 By BlueDev In Life Journals

The time quickly approaches. I really only have a few months left as a General Surgery resident. Then I make the transition to Urology resident. To be quite honest, I am incredibly excited. Not only am I incredibly tired of General Surgery, I look forward to focusing my time and energy on what I will be practising for the rest of my life.

But yesterday I gained a whole new ability to empathize with my future patients.

It was about 8:45 in the morning. I was working on writing some transfer orders for one of our patients. Getting ready to move her out of the ICU, I sat down at the desk with a pile of forms (we can't seem to do anything without forms) and started to write. Then it hit me.

Pain. Pain like nothing I have ever experienced. In my right flank. It radiated down, around the side and to my left groin. Maybe that is too much information. Oh well, there it is. I couldn't sit still. Walking hurt, sitting hurt. Anything I did hurt. I knew exactly what it was. I had a kidney stone.

I paged the chief resident on our service and told him I thought I had a stone. After I told him my symptoms he agreed. Time to go to the ER. About 30-40 minutes had passed and it was just getting worse. I walked down to the ER, hobbling a bit, and went to the check in desk. They gave me a funny look, here I was, in my scrubs and white coat, embroidered with "Peter J Jones MD" right there on the front. The triage nurse called my name and immediately looked at me with a quizical look.

"What are you doing here?" she asked. Yeah, we know each other. See, the General Surgery resident is in the ER a lot. Seeing consults, running traumas, etc. They get to know us pretty well.

"I think I have a stone," I told her. I mentioned the symptoms and she took me right to a room. I won't lie, they took really good care of me. Sort of that "care for our own" attitude. The nurse was in immediately, and IV was in my arm along with 30 mg of Toradol. They even went and got me a mobile IV pole, since I just couldn't stand to sit still. A few minutes passed, things were getting worse and I called the nurse back in.

"I'm ready for the morphine," I said. He pulled the syringe out of his pocket and I had 4 mg of morphine on board. Holy crap, that is good stuff. I didn't get a buzz (I don't think you really can when you are in real pain), but I felt a lot better. All this happened before the ER doc had even seen me. Honestly, the nurses and aides were great. I gave them a urine sample, and within minutes I was on the table of the CT scanner. I walked back to my room (walking was still preferable to holding still) and grabbed a C.O.W. (computer on wheels), logged in to the medical record system, and pulled up my own CT scan. Maybe there is some HIPAA violation in there. Frankly, I didn't care. I just wanted to know if there truly was a stone or not.

As I scroll down the scan, I spot one. A little 2-3 mm white kidney stone. But there was one problem. This was in the upper pole of my left kidney, no the right, where the pain was. I look over at the right side and notice that the right renal pelvis is dilated. So is the right ureter. That means there is something further down the line. I keep scrolling through the scan and sure enough, there it is. Another 2-3 mm stone in the right junction of the ureter and the bladder. Great.

Well, at least I knew why I hurt so bad. At least I knew it was real. A few more doses of morphine, a prescription for ibuprofen (the 800 mg tablets) and some Percocet, and a couple of liters of IV fluid later and I was headed home. The pain continued, off and on the rest of the day and into the night. As it is right now, the pain is better, but I still haven't caught that little bugger in my strainer. I have puked a couple of times (first time since High School), and didn't really sleep at all last night. Hopefully tonight will be better.

At least I don't hurt nearly as bad.

Next time I have a patient with a kidney stone, now I can truly empathize with them. I suppose that is good. Right?


Comments
on Mar 08, 2008

That probably wasn't your first choice to learn that way.   I think we tend to think certain things are "minor" until we experience it ourselves.  I hope you feel better. 

on Mar 08, 2008
I've heard that kidney stones for men are akin to labor pains.

And its definitely nice to know that you're not crazy. I thought with my headaches I was going nuts. A $2500 clear MRI and MRA and a simple blood test later...it's diabetes. A year of hellacious headaches later, some fortamet, and the headaches are virtually gone, except when my sugars are too high. At least there's something really wrong.

I'm babbling, but I hope you feel better really soon, and the "passing" goes smoothly for you...
on Mar 08, 2008

I am sorry to hear about that. I watched my husband in pain one night because of those. I felt so helpless. I hope they are all gone.

on Mar 09, 2008
Good luck señor. Piss that sucker out!
on Mar 09, 2008

Whip:  You know, I can honestly say that your description isn't that far off from what happens in a lot of ERs.  The problem, as I see it, is that ERs are used to being abused.  With the current health care system, the number of people who use an ER as their "primary care" office, or sort of walk in Urgent Care clinic. 

What ends up happening is that the whole triage system ends up broken.  ER staff just get used to lots of people coming in that don't really belong in an Emergency Room.  I honestly think that next to every decent sized ER there needs to be an Urgent Care walk in clinic that is staffed by NPs and PAs.  Triage should happen immediately and then people either get fast-tracked to the Urgent Care side, or they quickly get in to the ER.  This would help ensure that the people going in to the ER actually should be in an ER. 

Unfortunately, this would require a significant amount of resources to get the ball rolling.  Once the system was in place, I think it would actually decrease health care costs, but it sure would be a bugger to get rolling. 

I'm sorry your ER experiences have been lousy.  Unfortunately, it doesn't really surprise me.

on Mar 10, 2008
Hey Peter, I responded on your 'I Passed' post but thought I'd just stop in and say 'poor bugger'... Those stones don't sound like much fun at all. At least you were in good hands, medically speaking.
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