Thursday, February 07, 2008

From the other side of the sheets

As my readers know, I generally don’t blog about local issues or patients. I’m going to take exception today and blog about a patient. I recently became one.

A week ago Sunday at about 3 AM, my on call shift nearing completion, things were finally “quiet” enough for me to head for the hospitalist sleeping quarters to crash for an hour or two. Settling into the arms of Morpheus and thinking “I’ve survived another call night” I began to notice an uneasy but familiar sensation in my left flank. I had had kidney stones before, several of which I had passed easily. But as the sensation intensified to actual pain I was reminded of my episode of a few years ago, a very large stone stuck in my left ureteropelvic junction (UPJ) that ultimately required lithotripsy. Initial thoughts of “I don’t have time for this” soon gave way to “wow, this really hurts, I hope I can make it through the rest of my shift.” I paced the floor wondering what to do. An entrance to the ER was just across the hall. It would be easy enough to walk over there and get help of some sort, but no. I had to finish my shift. I was about to have a week off; then I could do something. The pain waxed and waned in typical colicky fashion before dulling down to a merely annoying level and I finished my shift.

Denial began to take over once I arrived home feeling much better. Maybe the stone had dropped into my bladder. Spirits lifted, I resolved then and there not to ruin my week off fiddling with this problem and (so I rationalized) consuming those precious medical resources. I made it through the week fairly well, subsisting on nothing more than a few Tylenol, but with just enough pain to convince me, toward the end of the week, to call my PCP (yes, I actually have one) who ordered a CT scan. This revealed a 5mm stone just below the UPJ (hmmm, UpToDate says that’s almost small enough to pass with the help of forced fluids and a little Flomax, I thought).

A KUB several days later showing no signs of passage convinced the urologist it was time to intervene, so I went in for extracorporeal shock wave lithotripsy (ESWL) yesterday. By that time, though virtually pain free, constitutional symptoms, gradual dehydration and fatigue had taken their toll. I was glad to be doing something, finally.

The nursing and anesthesia staff (even those I had occasionally snapped at in past moments of frustration) were professional and courteous, and I tried my best not to fall into the VIP syndrome. Despite my repeated protestations that I was pain free I was asked multiple times to “rate my pain” on a scale of 1 to 10.

All went well. The procedure was successful and, as a bonus, there were no laboratory surprises. The malaise was gone and I returned home yesterday afternoon feeling rejuvenated, expansive and inspired to write this post. I think there are lessons here for me to ponder---lessons about being a better steward of my health and being a better doctor.

Disclaimer and disclosure: the use of Flomax described in this posting is off-label. I would have posted an image of my stone fragments, but the dog ate them.


rlbates said...

Why does the dog always get blamed? Still, glad you are better. Any storm damages?

R. W. Donnell said...

No storm damage here. The really bad stuff seems to skip Northwest Arkansas. Wasn't kidding about the dog. Laborador retrievers will try to eat just about anything.

Anonymous said...

"Laborador retrievers will try to eat just about anything." So THAT's what's going on! My granddaughter's year-old chocolate lab/border collie cleans the floors meticulously, finding bits you'd need a microscope to see, and she's left swathes of the dining room table legs in splinters.

It is so reassuring to read about a doctor's reactions to a medical need all the way through to resolution. Actually, this sort of doctor post encourages me more to seek medical care when needed than almost anything else. Odd.

DrWes said...

Glad you're doing better. Here's to staying healthy and happy!

And at least your dogs won't get osteoporosis...