The following is an account of an episode of Kidney Stones, which I had during the second week of June. Friday, June 8,2007. It is around 9:00pm. I feel tired and decide to go to bed before the kids; there is some dull pressure on my left lower back – I am not really concerned because I know I have some kidney stones in there. Three of them to be precise, last time I went to the urologist I was told they were all below 4 mm in size, too small to be smashed by ultrasound electrolithotrypsy. Saturday, June 9. I wake at 3:30am and immediately realize that the pain on the left side has gotten worse, much worse. I decide that the pain is bad enough to warrant a trip to the hospital; as an experienced kidney stone patient I know what to do. I take two tablets of Percocet, a pretty strong pain killer, and take one suppository of Endomethacine, and anti-inflammatory agent that works very well long term when faced with Kidney stone pain. Manya is still asleep – I decide that it is better to let her sleep; there is nothing she can do anyways. I write a quick note saying that I will be at the TEGH (Toronto East General Hospital) and that she won't be able to reach me on my cell phone. I only take my Health and hospital cards and leave on foot to the Hospital. My typical symptoms are there: pain on the left flank, nausea and unsettledness. While walking, the pain crystallizes in my left flank, radiating like light in the outside areas. Finally, I reach the hospital. It has been about 20 minutes since I have taken the Percocet pain medicine. With my metabolism, it takes about 40 minutes for the tablets to be effective. Its 4:10am as I enter the emergency. A security guard asks me to put on a mask, just in case I have SARS. There's one person ahead of me in the lineup of the triage nurse. A glance at the waiting room astounds me: the waiting room is completely empty! It's my turn now. I explain that I'm having a renal colic – the nurse understands, writes down my symptoms, takes a quick temperature and blood pressure and tells me to line up at the admitting. This also goes quickly – I have to show my health and hospital cards and get two ID bands, one that says I'm allergic to Quinine sulfate and the other one that has my name and other information. I'm given a chart and told to go to the station. There, I'm assigned a room with a bed, and have to wait. Fortunately, the pain medicine now has kicked in, and the pain is now quite manageable. What should I do if they offer me morphine? Thirty minutes later, an emergency physician, Dr. S. Sirna examines me. I'm careful to explain the symptoms that I have, and list them, stating that these correspond to what I have previously experienced as a renal colic. Some doctors really hate it if you go into their office with a diagnosis already made up. But in this case, I was pretty sure. He examines my abdomen, and listens to my breathing. He asks how many previous episodes of stones I have had. I answer that it is about fifteen or so, since 1992. He asks if I need pain medication, but I decline, since the pain has become manageable. A nurse comes to take some blood for an analysis and leaves; they wait for the shift change. At 6:00am, the shift changes, the doctors transfer the knowledge of what has happened with what patient and the nursing staff also changes. There is usually more buzz in the department. Around 7:00 a new physician comes to greet me. We agree that it is best to do a normal KUB, and abdominal X ray to see what is going on, after finding out that all of my previous stones were calcium based. Calcium based stones do show up in an X-ray, some of the other types do not. Around 8:00am, I go to the imaging department, where a nice young lady takes two pictures of my abdomen. I tell her to expect more than one stone in the X-ray. After the imaging is complete and developed, she tells me there are three stones. Want to see, she asks? I glance at the computer monitor, where she points out three lumps of gray, one going down the urethra, the other two still located inside the kidney. From the picture they look big. The technician makes some comment about there being some likely problems passing the stones and wishes me good luck. It's close to 10:00am, it takes time for the doctors to make the rounds of the emergency. The doctor tells me that the stones are there, and that I urgently need to see my urologist, Dr. Kell. He prescribes more Percocet and endocet suppositories and lets me go. I finally go home. The pain is almost completely gone. I now have to fill my prescriptions, as I know that I am sitting on a time bomb. By 1:30pm I am all done, and wind up talking to my sister all afternoon – her server's hard disk crashed and she needed some support. Saturday, June 9th, 9:30pm. The kids are finally in bed. My kidney pain comes back, all of a sudden with a vengeance. I feel sick to the stomach, but not enough to actually throw up. I take two more Percocet tablets, and another suppository. Around 10:00pm, I decide that the pain is such that I can't control it with Percocet anymore. I remind myself that Percocet has 500mg of Tylenol and that the maximum daily dosage of Acetaminophen is around 2000mg – after that you can poison yourself. I take another Percocet before leaving - thinking that it may take some time until I'm seen. The emergency physisican had told me: "If you can't control the pain with the Percocet, come back. Just tell them that they have confirmed that you have stones and they will take you in, and we will give your morphine". I then leave for the Hospital, one more one foot. I could have taken a cab, but it would not have been much faster. Around 10:25pm, I get to the emergency department of TEGH, and the waiting room is full. I am greeted by a elderly stern, thin nurse with a British accent. I tell her my story and that I'm in pain. Same routine, admission, bracelets are due. I'm told I will have to wait at least 1 hour as there are no beds. As my pain is getting worse I'm almost going crazy. Why can't they have morphine drips in the waiting room? I pace up and down the corridor, restless and miserable. At 11:45pm, I can't bear it anymore – I go to a pay phone and call Manya. I had made the critical mistake of not brining extra Percocet tablets with me. I told her to send the medicine per cab courier to the Hospital. Around midnight, I picked up the package with pills and a water bottle in front of the Hospital emergency. I immediately took two Percocet tablets – at this point I did not care anymore – I just wanted the pain to go away. Around 1:00am, I finally got my bed, and a morphine drip. The nurse in the ER was a bit careless however, the IV somehow was blocked and not dripping – I had to call her back two times to get the medicine to flow. This "not checking" if the IV was really working happened a few times at the hospital and as a patient shows to me a severe lack of professionalism. The rest of the evening was spent in the arms of Morpheus, the god of dreams in Greek mythology. Even with the morphine, the pain was still present, just dulled and made more bearable. Sunday, June 10, 8:00am. The emergency doctor comes in, and we agree that it is probably a good idea to do a CAT scan. He asks about previous CAT scans as he is concerned about the levels of radiation. Around 9:00am, the CAT scan happens; a friendly young blond woman is the technician. After the CAT scan, I'm moved to the CDU (Critical Decisions Unit), a small room with 6 beds. Here all the poor slobs that need procedures are gathered, and decisions regarding possible surgical interventions are made. Morphine keeps flowing, I just have to ask for it – I get a bag of 5mg every 2 hours or so. The morphine is diluted in 50 ml of 5% dextrose; they add gravol, and then drip it in slowly over a 10 min period. This prevents getting a rush or high – a good thing – because morphine is extremely addictive. I have been given morphine directly before, and the instant you're injected with it you feel like you have to throw up, and then you get a warm itchy relatively pain-free feeling. The drip is the better solution, for sure. They are careful – nurses always measure your blood pressure; if it is below 100, you cannot get pain killers, opiates including morphine depress the Central Nervous system. I am still under the care of Dr. Sam, the current emergency physician. Around 2:00pm, a Doctor comes in. He introduces himself as Dr. John Morell, the on-call Urologist. He has already spoken to my Urologist, Dr Kell and now we discuss the options. He offers to go in with a scope and to blast the two reachable stones with a laser, and then to put in a stent, a small flexible plastic tube into my urethra, the tube connecting the kidney and bladder. I have had stents before, and a similar procedure done by Dr. Kell about one and a half years ago. My questions were: have you ever done this before? And would Dr. Kell be OK with this? He assured me that this type of procedure is a "Bread and Butter type of urological procedure that all urologists can perform. I sign the consent form. Dr. Morell says he will try to schedule sometime in the Operating Room tonight, but that it may get bumped if a higher priority case comes in. Around 6:00pm, Manya comes with Anna. Just around then, I get sick to the stomach, and throw up right into a plastic container. I am a bit surprised, since I have not eaten anything in the last 24 hrs. Around 7:00pm, I am moved to the 5th floor to the surgical and Urological unit. It's a nice 2 person room, with another man in the bed next to the Window. The bed is considerably nicer than what they had before. I am anxious to know when the procedure will happen, and keep ordering morphine drips every two hours. At 9:30pm, I am informed that the procedure will not likely happen today (Sunday). At this point I have limited mobility; the IV's are hanging from a stand with wheels; I can get up, drag the stand into the washroom. Nurses are much nicer (more caring) than in the ER. The night is a disastrous one, not knowing how much longer I will have to suffer. Hours go by slowly, after each bag of morphine, I sleep for a bit, and then wake again. Sunday, June 11th. I have to wait the entire day until 6:30pm, when a familiar looking guy with a colourful OR cap comes to pick me up. They bring me to the sixth floor, to the operating room. I am greeted by a nurse who asks a number of questions – concerning if I have dentures etc.. Dr. Morell is also there, and tells me not to worry. I request to speak to the anastetheologist, who has not yet arrived. Finally, I enter the tech-filled OR room. I notice to huge plasma monitors arranged in portrait mode next to each other, with a keyboard suspended in mid air by a jig. Cool. They have lots of portable X-Ray equipment stored in the room, but everything is clean and tidy. The OR bed is very uncomfortable, and the nurse comes and brings a heated blanket which feels really wonderful as the OR is frigid. I speak to the anstetheologist and tell him that on previous occasions, I had problems getting back to normal breathing after the operation. I also ask him to consider the previous morphine that I got, but he's way ahead of me on that one. I'm starting the medication now is the last thing I remember. I wake up in a daze and listen to Dr. Morell telling me that he got two stones and that everything went OK. Next thing I know is that a nurse is telling me to breathe deeply – she is almost screaming. I don't know who she is, and I don't seem to care too much… I don't remember being wheeled back to my room. Monday Jun 12th. It is early in the morning. The pain is GONE! The OR staff have put in a catheter that drains my bladder, probably a good idea since I'm not in any condition to go anywhere. At the same time I feel trapped in the bed, I cannot go anywhere. It is about 3:00am. Slowly, the morning comes. Around 6:00am, the nurse comes and removes the catheter, and brings me something to drink. I notice a strange tingling in my left thumb, index and middle fingers, and the whole hand feels as though it was "asleep" and is just awakening. But the usual movement of muscles does nothing. The nurses and Dr. tell me not to worry, that this will go away by itself in a day or so. After doing some research on the Internet, I found that the cause was positioning on the Operating Room table, somehow my median nerve was compressed. The takeaway message is, be careful when you position yourself on the OR table. In fact, the compression was not very severe, now, after a few days everything is back to normal. I am informed that they will let me go some time in the morning, but that I have to pee a good quantity first before I go. I have to request breakfast, but finally get it. They bring some eggs that look like balls of ice cream with a weird texture, toast and some cereal with milk. The food is horrible, so I only eat the cereal with milk. Around 9:30 am, Manya arrives to pick me up. I am still shaky, but OK. We walk out of the hospital with discharge instructions and prescriptions for more meds as well as a follow up date with the Urologist to take out the stent in 2 weeks time. We take a cab home.
