Hard News by Russell Brown

433

Another entry in the Public Address Medical Journal

Friday had been such a nice day. I wrote a blog, popped around for a cup of tea and a yarn with Davd Herkt (I gave him some presents on your behalf, for that remarkable essay). And I'd made really good pizzas for the family, with the fresh mozzarella and flatbreads I got at different places out on Lincoln Road.

There was a nice chardonnay, an open fire, plenty of stored television and the company of my darling. But a dull, gnawing pain in my left lower back started up. Quickly, the muscles on that side went hard into spasm. I was in deep, deep discomfort.

I knew what it was. I'd been diagnosed the week before with kidney stones. Since late summer, I'd had recurrent and increasingly severe lower back pain. One time, walking into the supermarket, I'd felt like someone had suddenly socked me in the kidney so hard I couldn't breathe.

My osteopath, Roydon, told me he shouldn't be treating me so often. Go to the doctor, he said. I did, taking the usual tests first, and the diagnosis was pretty quick. (I did wonder if more might have been made of what I'd said at my previous visit about urinary frequency, back pain and gouty symptoms, but I know I didn't exactly press the issue then. You just want to get in and out, right?)

It'll be sweet, said the doctor. Drink lots of these Ural sachets and we'll dissolve the stones. See you in three months. My symptoms seemed to ease immediately. Nice to have that fixed.

Hardly.

I went to lie down in the dark, but it just got worse.

I think what makes kidney stone pain so special is that it's a power-trio of pain -- like, say, Motorhead in their heyday. Fast Eddie is tearing off licks around your abdomen; Lemmy is strumming furiously on one testicle; and Phil Taylor's double kick-drums are hammering sickeningly into the small of your back.

It was really, really bad. I thought I couldn't bear this much longer: but what happens when you can't bear it any longer? I genuinely felt scared.

I got up: "I think this is ambulance-grade," I said to Fiona. She was sceptical. ("I was thinking, y'know, man flu," she explained later, by way of apology.)

I lay down again. Then got up. Went to the toilet. Another wave of pain forced its way up from my abdomen. And again. Even on its way out, it occurred to me that it the pizza tasted pretty good. What a waste.

I stumbled around repeating "I don't know what to do." This couldn't go on. We agreed about 10pm that Fiona would drive me in to A&E at Auckland Hospital.

We beat the Friday night rush there and got served fairly quickly. I was asked, for the first of many times, to rate my pain out of 10. Compared to what? "It was a nine before, but now it's a … seven," I ventured. (A nine? Was the single decile above that sufficient for all the bodily trauma, the terminal patients, the women in childbirth?)

I told them I'd been diagnosed with a kidney stone the week before, and described my present symptoms. The triage nurse agreed. I still didn't actually expect to be admitted, but we were shown through and, after a brief wait, taken to a bed.

We agreed that Fiona should go home. After again being asked to rate-my-pain, I was given paracetamol, Brufen (ibuprofen) -- and intravenous morphine, along with an antispasmodic and an antinauseant. Wow, I thought, they're taking this seriously. We did rate-my-pain again:

"It's actually not as bad now as it was before I came in," I mumbled.

"It's alright," said the nurse. "It does come and go. You don't need to feel like a fraud."

This turned out to be the "unlikely to cause trouble" room of the emergency ward: the old, the slightly-too-old for Starship, and me, the glum and enfeebled. I saw no Friday night fireworks, although their presence elsewhere would be periodically signalled throughout the small hours on the intercom: a businesslike voice saying Security to triage, please, men shouting in the background, then radio silence again.

But part of being in an ED ward is the small-scale intensity of what's going on immediately around you. And it was intense. An older woman across from me with little English but her daughter there to translate was puzzling the doctors and nurses.

Things unfolded. She had come in with diarrhoea, but it was established that she hadn't walked for two weeks. The two weeks she said she'd been back in the country turned out to be more like four and a half -- they knew, because she'd had a blood test in her first week back. They quizzed the woman and her daughter about medication she might be taking.

It got a lot worse when her tests came back. A lot. Somebody said "creatinine" and then a number. A little later, "I need you to understand that a lot of things are going to happen tonight," said one voice.

"We regard this as very serious," said a male doctor, who explained what they'd found. One of her liver enzymes was "off the scale" -- they couldn't even measure it. That enzyme was now shutting down her kidneys.

This is what they realised had happened. The woman had suffered muscle pain as a side-effect of a prescribed medication. To treat that, tragically, she had been taking high doses of two different anti-inflammatories -- ibuprofen and diclofenac. That had been too much for her liver, which flooded her kidneys with its waste.

She could die, I thought.

(And, shamefully in my head, this is like House, I thought.)

The woman was moved out to another room where there would be more nurses near her. I assume a lot happened after that.

In the midst of this all, I was wheeled off for an ultrasound scan. I'd had a bag of saline sluicing into me and I was busting for a pee throughout. Some time later, one of the doctors came back with the results. There was a stone -- a big one, 10mm x 5mm -- now partially blocking my ureter. It was at the very limit of stones they'd let pass of their own accord, but I don't think that was ever likely. The other option -- the stone would be removed with a telescopic device introduced via my penis -- was always going to be the one.

---

There was a lot of downtime that night and the next morning. I had nothing to read, but I did have my iPhone, freshly updated to iPhone OS 3.0. It was much faster. I browsed some websites, but settled on Twitter, to see what news Tze Ming was re-tweeting from Iran. One of the drugs was making it really hard to focus, but I persisted.

Unfortunately, I only had an old client -- Twitterific -- on my phone, and every time a new tweet came in, it posted the one I was still laboriously typing. Hence, the first news was:

In A&e

A flood of concerned replies came back (what was everyone doing awake at this time? Although I'm not sure what time "this time" was. The times on my Twitter log are hours out.) My next effort got as far as:

In AE on a bed reading tweets from Itan. Mor

Then:

Morphine slows down one's typing. Apart from that, fine.

And:

Kidney stone, probably. Mind-blowing pain earlier.

I don't think I tweeted in search of comfort -- I'm not sure why I tweeted, to be honest -- but the responses were comforting. @brucehoult said "oh man, I've been there. After this don't let any woman tell you she knows what pain is just because she had kids.," and when I broke the news of the size of the stone @tzemingdynasty flashed back "My god, that is huge. Al Swearengen would give you props." Yes, I saw that episode …

Even brands seemed concerned for my welfare. @powershop said "hope the surgery goes well. take care" and @vodafoneNZ enquired as to my welfare, as did @TheWineVault (buddy, I had a glass of your wine in my hand when it went down. Just sayin').

---


I had another severe bout at around 4am. I asked for more morphine. The nurse gave me some, and said she'd come back in two minutes to see how I was faring. More, I said, when she returned. And again. Third time, she brought tablets too and said "we're giving you as much morphine as we gave you when you came in -- this means you can't walk to the toilet." Fine, I said. Just do it.

The next morning, I downloaded Tweetie directly from the App Store, which fixed my Twitter problem, and waited for a surgery call. Fiona arrived with magazines and (this is someone who has been in hospital before) two boxes of muesli bars. I was not, of course, allowed to eat or drink. We were nearing the cut-off time for surgery, but the call came while she was there.

The surgical team were all groovy and conversational. I chatted to one about Jetmaster fireplaces and the rugby. They figured I'd be in a fit state to watch the game that evening. I must have answered the same set of questions about allergies, any other drugs I might be on, etc, five times before we got to theatre.

In there, the anaesthetist looked dubiously at the cannula in my right hand, which had been knocked about a bit by my iPhone typing.

"Here's one I prepared earlier," I chirped, laying out my left arm, where Grant, the impressive senior nurse from the emergency ward had inserted another one, just in case.

"Excellent!" said the anaesthetist.

--

I immediately knew where I was when I woke up in the recovery room. I felt drowsy but quite okay. Indeed, as soon as I had satisfied a bursting urge to pee, I'd quite probably be on my way. I informed the nurses of this.

"You might feel like you need to pee, but it's actually the catheter," said one.

She pulled back the blanket to reveal a tube emerging. From my penis. It turns out that having a tube stuck up your penis feels a lot like really needing to pee.

At this point, I regret to inform you that I was not my usual reasonable and polite self. I think I demanded that it be removed. I was convinced it was leaking ("that's blood," a nurse pointed out). Just relax, they said. I was not relaxed. At all. The other patients looked at me nervously.

("He seemed quite annoyed to be there," nurse Patricia told Fiona over the phone.)

At some point, they showed me the largest shard of the stone, in a bottle. It was a black, ugly little thing.

They offered two Panadol, a Tramadol and oxygen. Yes, I said. At least, I think it was oxygen. I wouldn't have blamed them if they'd given me nitrous to shut me up.

---

By the time I woke up in the urology ward, I was more rational. The catheter was still there, connected to a bag hanging off the bed. I tried to be rational about that. I waved weakly at the bloke across the way. He waved back. He'd just had his catheter out, after bladder surgery, but had not yet been able to pee. He was a bit worried about that. It'll happen, said the nurses.

We did watch the rugby, delayed, on Prime. We fulminated about the ads (an ad break between the haka and the kick-off? WTF?), and then found a room with a better television. There was guy there in his 20s, carrying what I thought must be a portable dialysis device (he said he'd had an operation on his back) who was so full of bullshit that I decided he must be really, really scared inside. Poor bugger. I was glad when he left me to it, the last one there at the final whistle.

It apparently took Patricia a while to find me there. She was clocking off. She gave me some more tablets. I found my way back, toting my plastic bladder in a pillowcase.

---

It seemed a long day on Sunday, punctuated by the blessed removal of the catheter. I set about pissing blood. Perfectly normal. Fiona came to collect me in the afternoon. Home at last, I thought.

---

"I think we're going to have to go back in," I said to Fiona at 6.30am Monday. My pain was an eight.

If I'd been in the hands of the A Team on Friday night, this time the place seemed to have a touch of Mondayitis. It took an hour to get the pain relief, and the urology ward didn't have a bed, so I'd be spending the day in emergency. My nurse, kind and experienced, went to insert a cannula in my hand and put it right through the vein. Mondays.

By chance, my surgeon came past, having visited another poor bastard with kidney stones.

"Mr Brown!" he exclaimed.

It appeared that not every fragment of the stone had been removed. The others would have to pass. I had two doses of morphine, each procuring a two-hour fever-dream in which I sporadically heard what was going on around me. It was largely depressing. The man next to me had multiple problems -- ulcers on his remaining foot, terrible catheter problems and unexplained rheumatic pain in his hand. I heard him explain to his niece, in a calm, deep, sad voice, that he might die of all this.

I kept my curtains drawn in the emergency ward. I found it difficult and embarrassing walking past people having a bad time. I didn't want people to see me. I wanted to be in a bubble. And eventually, I just wanted to go. The surgeon's promised return at 4.30 ("we'll either get you in front of an x-ray or send you home") didn't eventuate. By 5.30, I pointed out to the new nurse:

"Look, I don't need to be here. The only issue is pain relief if I get another bout, and Panadol and Brufen don't cut it. If you can give me some Tramadol, I'll just go home."

She couldn't do that. Only a doctor could, and the doctor was, presumably, elsewhere, with someone in greater need. But -- bless this young woman's heart -- she went away and came back with a script for Tramadol that we were able to fill at the White Cross on the way home.

It's an interesting drug, Tramadol. No one actually knows exactly how it works. It hits some of the same receptors as the opioids, but also has actions on the noradrenergic and serotonergic systems. It seems that it delivers a quick serotonin hit that helps alleviate the perception of pain. It's a little short-acting happy pill as well as a painkiller. And it works fast.

The prescription said three times a day, but that would be silly. I had four in three days, when it seemed the severe pain was threatening. The last time was on Wednesday night, just before serving dinner. Totally nailed it.

I seem to be done with pissing blood, but I've also had the odd, clear moment of being in no pain at all. It has brought home to me that for most of the year I was carrying around low-level pain without even thinking about it, with the back pain, and with high uric acid levels (I haven't had an acute gout attack in a couple of years, but low-level symptoms had become almost constant).

This had got in the way of exercise (I'd been pretty fit through summer), been self-medicated with alcohol, and generally become an illustration of how a man in his 40s can quite quickly risk getting in a hole with his health. I couldn't be happier in my work, but that, in a way, makes it easier to let things slide.

I may have a glass of wine tonight, the first in a week, but I'll watch it. In the longer term, I'm finally on allopurinol for uric acid and I need to cut down on protein intake to help prevent future stones and uric acid buildup. I think my languishing eat-less-meat-and-drink-less-alcohol project is now officially out of beta.

I'm still feeling shell-shocked by what happened. Not just by what happened to my body -- and, really, however unpleasant it was, my well-being was never in serious danger -- but also by simply spending time in an emergency ward. It's intense.

What I'm left with is a very strong feeling for the professionalism of the people who work in hospitals. I was looked after, monitored and always made to feel that people cared what happened to me. Not for nothing are these called the caring professions. Thanks.

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