It all began with dark brown urine, something I’d never experienced or even heard of before. That was late Monday afternoon. I made a trip to the library that evening to look up dark brown urine causes on the internet and found a long list of options ranging from a few foods to cancer and liver failure, and suggesting a doctor be contacted, especially if it lasted more than a day. Unfortunately, I hadn’t eaten any of the foods.
Back home, I collected some urine, found dark solid flecks in the liquid and decided I’d be calling a doctor in the morning. The next day, everything was back to normal so, being a man, I put it off but the color returned Wednesday evening and I again planned a morning call. Shortly before midnight, I was woken by the pain of a kidney stone, a familiar pain which was oddly somewhat of a relief but since I’d never had this urine color before I still wondered if something more serious was happening. I thought back to the most recent stone pain in the middle of the night about five years ago while working in Yellowstone which occasioned a sixty mile ambulance ride at 3 AM while avoiding elk on the road.
I made it through a long night of pain-induced shivering and vomiting, catching brief moments of sleep while tightly clutching a stuffed animal between trips to the bathroom. By Thursday morning I was worn out and decided I’d make the ten block bus ride to medical treatment. I called and found out that the urgent care center didn’t open until ten, later than I wanted to wait. I called internal medicine to try to see someone sooner but was told they had no available appointments so I was off to the emergency room where I traded a urine sample for a blue plastic bag to vomit in and began to wait.
After longer than I’d expected (I’d begun pacing against the discomfort), I got past the waiting room to a private room, changed into a robe, and said yes when asked if I wanted a blanket. Time passed, pain increased leading to more shivering but no blanket appeared so I eventually had to ring for one. More time passed and a couple people came in with equipment and I said this was what I was waiting for, thinking I was about to get pain relief but they were only there to take blood. More time passed and I was wheeled off to be scanned, still with no fluids or medicine being put into me, shivering and hiccupping, and accumulated more blankets–I was up to five. After the technician managed to get a scan just before another hiccup, I asked if he was a baseball fan, trying to get an update since it had been days since I’d used the internet or heard scores, but he had no info for me.
Back to my room where I finally got an IV and some dope which induced another round of vomiting and, losing the pain and in a bed for the first time in months, fell asleep for a couple hours. When I woke, pain was starting to return, I skimmed through the television and got some baseball news, a doctor came in for the first time, I had to make a couple requests to get to a bathroom (not good treatment for an old guy with a kidney stone and big prostate). I’m not a pushy guy and my assumption was that they were busy, so my second requests for a blanket and a bathroom had allowed them plenty of time to get to me. When I later told someone about my plan to write about my seven hours in the emergency room as low man on the triage totem pole, he wondered if that was due to medical reasons or insurance reasons (I have Medicaid coverage). The second possibility hadn’t even occurred to me, but maybe I’m just not cynical enough. Nah, that can’t be it.
When the orderly finally arrived to point me to a bathroom, he carried the empty IV bag attached to me. When the doctor came in, I asked for more pain medication and he requested it. He told me I had a large kidney stone and he had called a urologist for advice about whether I would need a stent inserted but hadn’t had a response yet. Forty minutes later, I still hadn’t received more drugs and only did when the doctor passed by again and told someone specifically to do it.
Next I was moved to a different room which doubled as a supply closet so I had many visitors. By this time I finally had a new IV bag and more dope so I didn’t mind and was trying to amuse myself with the television. I’d had enough sleep and pain relief that I was more aware of my situation so I requested that the doctor stop by when possible. When he did and verified that the urine color was due to blood from the stone and there was not a more serious issue showing up in test results, I said I’d prefer trying to pass the stone rather than have surgery. After he talked to a urologist who set an appointment for me in the morning, I was on my way home with prescriptions for pain, nausea, and infection.
That evening a sharp pain near my hip and a spurt of fresh blood in my urine told me that the stone had moved and I thought the worst was over. Friday morning when the urologist showed up, we looked at the scan and he said that rather than one large stone, I had two. So surgery wasn’t needed but more pain lay ahead. I spoke a bit about my emergency room experience and though we both expressed understanding for their busyness, even he shook his head when hearing that fluids hadn’t been pumped in nonstop.
The two-stone theory was verified Saturday afternoon when I was in excruciating back pain at home for about an hour and experienced the most impressive vomiting I’d seen since The Exorcist. I considered options for getting back to the hospital—ambulance, bus, cab, neighbor—and packed a small bag while pacing and gasping and sweating and shivering and practicing my speech to the imaginary medical staff—just keep filling me with fluid and dope. Ultimately, I decided there was no point in going back since I couldn’t count on prompt or quality care so I just rode it out.
Several waves of less serious pain followed Sunday as the stone began to move, and I think there is still more to come.
As I mentioned, I’ve been through this before, and emergency room treatment of kidney stones should be simple and has followed the same basic pattern in all my past experiences—put the patient in a corner with a pot to piss in, pump full of fluids and medication to push the stone and kill the pain until it gets past the narrow spots, then send home pain-free. This time I was failed on all counts and have had additional pain and lost days of work as a result.