You have just read a blog post written by Jason McIntosh.
Thank you kindly for your time and attention today.
This week I passed a kidney stone. The ordeal proved interesting at times but quite awful overall, involving a lot of pain, fear, and uncertainty. All told, it monopolized around four days of my time and attention. I hope I never have to do it again. But I got through it all right, and I learned a lot. I’d like to share my experience here, in part to help others who might find themselves facing a similar situation.
At around 7:20 AM Eastern time on Sunday, January 25, I woke up to a flowering of pain around the middle left side of my abdomen. (I would soon learn that medical professionals call this area the left flank, like on a horse.) It felt distinctly inside, deeper than a muscle cramp. Still half-asleep, I stumbled to the bathroom, vaguely thinking that perhaps I felt an unusually insistent urge to use the toilet. By the time I decided that didn’t work, I was both fully awake and in a great deal of intense pain.
I returned to bed, hoping that maybe I suffered something akin to a charlie horse that would just go away on its own after a minute. It didn’t. I woke up my partner to tell her about it, and what I’d tried so far, and she picked up on the growing fear in my voice even before I realized how afraid I felt. She got up to hit the web while I stayed in bed, in agony and starting to sweat clammily.
She suggested some likely sounding causes she had found, but I didn’t listen well; beyond my physical pain, I suffered under surety that I possessed something truly awful and surgery-demanding, an obstructed colon or a burst appendix. I twisted my body to experiment with positions that hurt a little less, while frantically wondering whether I wanted to reveal my passwords to my loved ones upon my death. So, I responded to her by calling out a request to see a doctor immediately.
We had lived in Newport, Rhode Island for only five months after many years together in Boston, and neither of us had a quick answer for the question of where one goes in a situation like this. (We had only recently — and thankfully! — set up insurance through Amy’s employer, but we hadn’t set up primary-care physicians for ourselves yet.) Amy started to search around for nearby urgent-care clinics, but nothing obvious came up.
We hesitated to call 911. It felt like crossing a very uncomfortable threshold. Make-believe people on TV called 911; tragic characters in news narratives called 911. But by this point we both started feeling slightly panicked, and we very literally didn’t know what else to do. “It’s OK,” I said, though no more sure about it than her, “it’s what it’s for. Please.” I made thumbs-up gestures after she dialed her phone and then said “Medical?” in answer to the question someone on the line immediately asked her.
She intended to ask where to take me, but of course they had begun to dispatch an ambulance as soon as she shared our address. That ambulance appeared within minutes, whooping its siren once, the way a taxi to the airport might honk when it reaches your house. We had just enough time to throw some clothes on by this time, and so went out to meet it. The two EMTs were both very kindly middle-aged guys; one gave Amy the lowdown on where they’d take me, so she could follow in our car, while the other started taking my vitals and asking about my pain. When I admitted I felt pretty nauseated, one of the EMTs produced a small plastic bin. “That’s for the nausea,” he said. “If you have to use it, please be careful, because I’m the one who has to clean up any messes in here.”
Soon enough, the EMTs finished variously prodding me and loaded me on board. I sat up in the back as we bounced down the road to the heretofore unknown-to-us Newport Hospital, only a few minutes’ drive from our apartment. The driver elected to blow through red lights, which I certainly appreciated on one level, as my pain had not abated through any of this, but I imagined Amy’s reaction as we casually left her in the dust. (We both had our phones, of course, and our phones knew the hospital’s location perfectly well — had we only thought to ask them before! — so this wouldn’t prove a serious issue.)
The EMT who sat in back with me, tapping into a mounted laptop and in voice communication with either the hospital or the dispatcher, asked me if I had any history with kidney stones. Oh: yes, I said, I’d passed one in the early aughts, minor enough that a phone-hotline nurse had diagnosed me through conversation, and it went away just by waiting a bit. I lived alone at the time, and didn’t record my experience anywhere other than memory, so found it all a bit dim.
However, I did recall then that Amy had suggested the same cause earlier that morning, while I ignored her in favor of fear and uncertainty. And for the first time in years, I very distinctly recalled the voice of that hotline nurse chastising me for reading scary web articles convincing me that my appendix had burst (with the suggestion that, were that truly my problem, I’d lack the means to pick up the phone at all). I hadn’t thought of that voice earlier that morning, even though I feared the same dreadful conclusion.
Presently we arrived at the hospital’s ambulance bay, and the EMTs led me inside. The moment I shuffled in, walking at old-man speed from the pain, I felt overcome with nausea, and said so. The driver hustled me to the nearest bathroom, and proceeded to hover by the door, soothingly repeating that I should take my time, and handing me paper towels when I needed them. I was glad to tell him that he didn’t need to clean up his ambulance, anyway.
Within a few minutes I lay in a bed in a small private room, nicer than I’d seen at other hospitals’ ERs; I don’t know if this poshness came from the hospital’s location in affluent Newport, or if I’d just gotten lucky by showing up before 8 AM. A bustle of nurses took more vitals, and soon enough one led never-lost Amy in while another hooked my right arm up to an IV system set to deliver hydration and anti-nausea medication.
I should pause here to note that, beginning with the call to 911, I had experienced many facets of modern medicine as a patient for the very first time, that morning. I had never before ridden as the primary passenger of an ambulance, nor been checked into an emergency room, to say nothing of finding myself the recipient of intravenous drugs. And I never before had the experience of seeing my spouse enter my hospital room for the first time while I lay there hurting and helpless. Even though we’d been apart for less than an hour, I still felt struck with sudden perspective on why this action in particular frequently comes up as an example of things denied to couples who can’t legally marry.
We didn’t wait long before a doctor appeared to examine me. Clearly already briefed, he confirmed that I rated my pain a nine on the one-to-ten scale (“where ten is the worst pain you’ve ever felt”, but reaching for that seemed gauche somehow) and that the pain didn’t worsen when he pressed on my side, and so yeah: almost certainly a kidney stone. He ordered me up some morphine as well as a CT scan, both to be administered right away.
I thought: Morphine! Prior to just then, I had somehow thought morphine a drug of last resort, brought to battlefields, or as comfort to the dying. Wikipedia would later correct me, when I asked, calling morphine the “gold standard” of pain-management medication in hospital contexts. And here a bagful of it began to drip into my arm. “You’ll feel a little flush,” warned the nurse, when she may as well have said you’ll feel like your blood has spontaneously transmuted into lead, because it did. But that feeling left in short order, taking the worst of my pain with it. I didn’t feel “high” or any other altered mental state, other than immediate, wholehearted relief.
Then a nurse wheeled me, bed and all, to the radiology lab for the CT scan, another first for me. After our return, she handed me a sample jar to fill while waiting for the results, and I ended up giving into sudden nausea once again as soon as I entered the bathroom with it. But I still fulfilled my mission, receiving more anti-nausea meds and morphine in my arm as my reward.
The doctor reappeared to confirm that the CT scan revealed a three millimeter stone jammed at the “choke point” between my left side’s kidney and ureter, the tube that leads to the bladder. (Coincidentally, Wikipedia has a CT scan image of this very situation, so my own irradiated meat-slice probably looked a lot like that.) At this size, a kidney stone is large enough to hurt like hell, but small enough to see itself out anyway, especially with the application of certain drugs to help it along. Thus I swallowed my first, hilariously named Flomax, one of which I’d eat daily until the stone passed. The doctor prescribed some take-home pain meds, and instructed me to follow up with a urologist after I left the hospital.
After this point, the process of leaving the hospital took a surprisingly long time. Between my unpleasantly early wake-up and the morphine, I found it easy to doze, and when I felt more awake I updated my friends on Twitter through my phone, glad to receive well-wishes from around the world quite quickly. Amy read a novel on her own phone, the gentle bleeps of her ebook app’s page-turning noise quite pleasantly relaxing. After a couple of hours, we began to feel unsure about the game plan, though. At one point another nurse checked in, but could only answer noncommittally about what would happen next. I could see and hear through my room’s open door that, as it moved into late morning, the hospital had swung into a busy day. I have to assume that, with my immediate pain neutralized and its source diagnosed, my position on the triage had sunk quite a bit. The hospital had plenty of things to do other than discharge me.
Eventually one of the health workers returned, bearing some documentation and a thing that looked like a paper coffee-filter cone, except with a fine plastic mesh at the apex. Handing it over, she advised me to try my best to capture the stone, once I passed it. Ah. If I succeeded, that would give the urologist a much better ability to analyze my situation and advise a course of action. Thus armed, we could finally go home.
The early morning’s unbearable pain had permanently left, thankfully, but my flank still ached significantly, and I requested that we stop at a CVS on the way home to fill my three prescriptions: one for more Flomax (tee hee), and a bottle each of Motrin and Percocet, both for the pain. When told at the pharmacy counter it would take 15 minutes to fill, I elected to let Amy wait while I walked the rest of the way home, through the bright, cold, windy day. Here I exploited some self-knowledge about the sorts of meteorological conditions that always brighten my outlook when I feel physically out of sorts. I began my walk at the same geriatric shuffle with which I entered the hospital, but by the time I got home, my lungs cycled with fresh, cold air, I stood straight and I walked fast. And I then went straight to bed, and the cat joined me, and I couldn’t have felt happier than when Amy arrived with three pill bottles and a paper bowl of hot lentil soup from the nearby health-food store.
Here began several days of uncertainty regarding the stone, coupled with varying levels of pain and fear, though neither ever more than half of what I felt that Sunday morning. The feeling in my flank ranged from a barely noticeable stitch to a strong ache, but taking the pills as directed would always dial it down. My whole body hated the continuing disturbance, though: I felt feverish at nights, my stomach angrily gurgled excess acids up my throat, my bowels went on strike. Multiple sources, including the papers I brought home, made the presence of a fever while stone-passing a harbinger of immediate deadly danger. But my fever didn’t feel that bad, and I exhibited no other scary symptoms. Meanwhile, southern New England lay paralyzed under a blizzard — how lucky the stone didn’t wait another day or two to pop up! — putting the urologist out of reach, and making me quite hesitant to call the hospital again. Through all this, I didn’t sleep well, and so neither did my partner.
I had no idea at first when or how I was supposed to use the strainer. I didn’t notice until the evening of the next day that the papers I took home included instructions. They directed me to start peeing into a jar instead of directly into the toilet, and if ever I saw anything odd, to pour it through the strainer as well. This seemed like a lot of work, so I decided to instead stay with my original plan to just do my business as usual and just keep an eye out for any anomalous output, at which point I’d deploy the strainer like a fishing net.
When I thought I saw a small shadow exit and vanish down the U-bend, though, I realized that my assumption the stone would float, ready for easy capture, had no foundation. A quick web search on the topic sank that notion handily. I allowed myself to believe that my problem had resolved itself, and attributed my continuing pain to abused organ-meat that would surely heal itself quickly.
On Wednesday morning, at around 5:30, I once again woke up to pain in my side. While only half as bad as that which I felt Sunday, it still got me on my feet, worried. I swallowed maximum doses of the pain pills, using a spoonful of oatmeal to fulfill the required “take with food” modifier; I felt too sick to eat any more. The pain seemed unusually stubborn. Amy pushed back against my low but rising panic, and my suggestions that I should return to the ER. By this time the sun had started to rise, and I chose (with Amy’s encouragement) to dose myself once again with a walk through the bright and the cold; I had, after all, spent most of the previous two days indoors, bunkered against the blizzard. Even though none of the sidewalks had been plowed yet, a brisk hike around one of the neighboring Newport mansions chased both the pain and the fear away once again, even if it didn’t explain why the pain arrived in the first place.
That afternoon, during an unrelated phone call, I felt what I must frankly describe as a pinching feeling, sharp but not very painful, in the middle of my penis. After wrapping up the call, I found that gently pressing down made the pinch sharper, suggesting that an interloper had indeed arrived from upstream. Well! With Amy’s permission, I chose a tupperware to sacrifice for science, and finally followed the instructions from those papers. Instantly, and without any unpleasant sensation, out came a dark object of just the right size. I’d caught it!
Or, as I type this, I think I caught it. The urologist would stay shuttered under the snow for the rest of that day, and by the time I finally connected with them I could make an appointment only as soon as next week. They assured me that leaving it in a baggie in the meantime is fine, and so this I do.
With the anomaly captured, I finished into the toilet as usual, surprised but not alarmed by the orange-brown hue of the urine; the literature had said this might accompany the stone’s passage. When I was done, I saw a lot of sediment at the bottom of the bowl, as well as something stranger: a larger, alien-looking red thing, a centimeter or two in length, its gooey tendrils waving in the water and looking like something alive. Horrible! Naturally, I had to collect it as well. Using a spoon we didn’t feel attached to, I fished it out, putting it into the strainer with the first rock, sealing the whole thing into a sandwich bag, and placing it my desk drawer for next week.
For a while I figured the red thing must have been the real stone, its ghastly shroud made of material scraped from its host ureter on the way down. I called it a “gnarly red devil-amoeba” on Twitter, to friends expressing gratitude for my not sharing photographs. But, days later, the object has dried to resemble a completely flat bloodstain, so while I may have been correct about its makeup — I’ll leave it for the urologist to decide — I now believe the first object I caught was the target after all.
I will update this post when I learn more from the lab. Otherwise, this experience apparently marks me as half again more likely than before to suffer another kidney stone within the next five years. Until I hear otherwise, I’ll assume that this came from chronic dehydration, and there’s little else to do besides knocking back far more water every day than I have been, taking special care to pair my favorite diuretic beverages with generous clear-water chasers. So: cheers.
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