Kidney stoner: Two trips to the ER

I'm writing about my two trips to ER over the last two days, mostly as a way of processing for myself, but also because some things came up that were interesting to me. This story is very detailed medically, which may be gross to some people.

Many years ago when I lived in Chicago, I had a few weeks of life that were utter hell. I would be in constant lower right flank and abdominal pain. I would feel hot and cold flashes. I began drinking water constantly, but would throw up everything until I could vomit was bile. The pain would be so intense that I would have to take scalding hot showers to distract from it for a little relief.

After several weeks, I was convinced that I was dying somehow. Maybe something had ruptured? I didn't know. As a student, I had some insurance. But I had no friends or family at all in Chicago. Finally, one day I walked the three miles to the ER and was seen. They did a sonograph of my groin and said nothing was wrong. They asked me, "Have you been under a lot of stress lately?"

I had been, and they attributed it to that. This event forced me to move back in with mom (I was 19 at the time), back in a rural part of the state. I began the long and tiresome process of working on stress management as a religion, and strong boundaries as a lifestyle. Since then, my patience has grown, and I am able to stay calm even when being physically assaulted or threatened with death (something that happens often in the acute psychiatric setting in which I work).

I never really bought this diagnosis, though. It seemed like a diagnosis of exclusion.

Years later in the current day, I began having some similar symptoms. At work one night, I started having trouble focusing because of pain in my lower flank. I attributed this to stress and went through my steps to see what might be bothering me, but I couldn't find anything. I then thought about what I'd been drinking and realized that I had drunk nothing but coffee, tea, and Mello Yello for the last two days. I went out to my car where I keep 24 packs of water and started drinking some more. Pain went away, no big deal.

On Sunday morning, about 8:30 AM, I awoke in tremendous pain. The same place, I recognized it. I drank more water, the pain wouldn't go away. I took two Naproxen, no relief. I went to the shower to douse my back in scalding hot water - relief. Temporary, until the water stopped.

Then I tried urinating, and it didn't go very well. I couldn't get out more than a few drops, and they were brown. Having worked in medical settings for most of my adult life, I knew this was no bueno.

I hate going to ER, but I hate it more when I have to give a vague complaint like "Lower Back Pain." When I worked in the ER, this phrase was often coding for, "I'm here for my Norco." But I went anyway.

The ER was huge, and I was seen by a doctor very quickly. They did a CT which showed a <5mm kidney stone still in my kidney. They told me it would pass in a few days. They took a urine sample, which I was able to provide, and it was the darkest sample I've ever seen. They came back and told me that there was so much blood in it that they had to "swab it manually," because their machine wouldn't work fast enough (I assume this is common, but have no idea).

They gave me Norco 5 and a medicine to help dilate the ureters to encourage the stone to pass. I had never had Norco, and was intent on going to work that afternoon. The ER Nurse strongly discouraged this, so I called my boss (who is also a nurse) to see what her suggestion was. Per her, I took the evening off - and I am so glad that I did.

I got home and the first dose of Norco was hitting in. I really dislike pain medicine, and I usually don't take it even if prescribed because of a family hx of addictive behavior, not to mention my experience working on the front lines of treatment in the opioid epidemic. The stuff demands respect. I slept for a few hours, then woke up in minor pain. I waited for the 6 hours to have passed, took my next dose.

Except, nothing change. The pain got worse. I would not take more Norco outside of the prescription guidelines, so I went to Walgreens and got a heating pad, icy-hot, and Ibuprofen that the MD told me I could stack on top. Nothing helped. Around 10, I started vomiting. I hadn't eaten much, so I was vomiting up my medicine and all the water I'd been drinking. The pain was so bad that I ran a scalding bath and just laid in it. I had to do this over and over again all night, vomit, shower, bath. That hot water is what let me get a few 10-15 minutes of sleep here and there.

Finally, after suffering through to 6:30 when my next dose of Norco was up, I took that and the Flomax. I waited another hour, nothing. I vomited again and realized it'd be a big waste of time to keep taking the meds if all I was going to do was vomit them up. I called the ER to get their advice, and they told me to come in.

When I got there, about 24 hours after I'd been the first time, they put me in a different room and did their assessments. The pain was much worse, and I was holding back tears. They told me they were going to give me an IV painkiller and some other medicines. The MD came in within me having been in the room for about 10 minutes and told me about my CT again. He explained that a lot of "kidney stoners" are able to pass <5mm without a problem, but a small percentage become very symptomatic and experience a lot of pain. He said they were going to consult with Urology and try to get me into surgery today to have it removed if possible or at least put a stent in.

The nurse came back with a syringe, "This is fentanyl, it's going to help with your pain." I was astounded that they were giving me fentynal for this. Yes, I think it was appropriate, but I have never had a painkiller like that. Working in the field that I do, I hear many stories about accidental overdose often involving fentynal. We talked about dosage, half-life, and expectations before she gave it to me.

The feeling was... Strange. My whole body became a little numb. The pain went away about three minutes after the shot. My head felt warm, then the rest of my body did. I felt like I was floating. I now understand why the stuff is addictive. I was very tired, so I nodded in and out of sleep while watching CNN on the hospital TV.

A Urology PA came in to consult with me and explain the surgery, she was super nice and clear. I got moved up to Same Day Surgery and nurses there explained everything to me. They asked, "Who is picking you up today?"

"What do you mean?" I asked.

"You're going to be under general anesthesia, so we can't let you sign yourself out. Someone has to come up to provide care for you."

"I don't have anyone that fits that description within 100 miles." (I moved here about 6 months ago, and while I have friends from work, I wouldn't really put them in this category[1]).

The nurse got a facial expression that I've seen many nurses put on, I call it, "Well, that sucks, but too bad." She said that if no one could come, I'd have to stay in Observation overnight. Too rich for my blood. I put in a call to mom who started on the way up.

The surgeon came in and spoke to me, saying that the stone was probably too high up to try and get without damaging the kidney, so they would put a stent in if they couldn't get it out safely. I was okay with that. Went into surgery, it lasted less than an hour and woke up 20 minutes afterward in the recovery section.

I have a lot of experience coming out of anesthesia because of a birth defect that required a lot of surgery when young. Sometimes I came out combative, sometimes over emotional with a sense of the world ending. I came out of this anesthesia fully functional, running some of my own assessments and talking to the nurses about the surgery. My perception of time was wonky, as far as how long these were taking, but nothing too serious.

They had to put a stent in. Has anyone ever had a stent running from their kidney to their urethra? It's not fun. I constantly feel like I need to urinate a little, and there is a severe burning sensation when doing so. My first urine sample was straight blood, which didn't surprise me.

My mom got there around this time. I spoke to the nurse and discharged a bit later. We went to get some lunch, then the grocery store, and she dropped me off at my house before going home. I was very appreciative that she came up, but I don't feel like I need someone with me for the 24 hours they suggested.

I took a nap, and just now woke up.

I write this mostly to process in my head and help facilitate memory storage. But some themes came up:

1. I have insurance, and yet still waited as long as possible, because I have a $2000 deductible (this is lower than my old one, which was $4k.

2. I made a statement, "Not friends that I'm going to involve in this."
   This one, for me, highlights some old behavior. I used to have a very rigid social classification. Work friends, school friends, and that's it. I disliked when the boundaries crossed. This got me into serious trouble in Chicago, because I had gone out of my way not to make friends, and found myself in a bad way medically without help. Do other people do this? I find it to be a little unhealthy and will be trying to work on it as time goes on.

3. I think that I got better treatment once I started talking about working in ERs in the past and doing psych care now. I'm not sure, but medical culture loves the Patient Story or scary tales of practice. I exchanged some with the nurses and doctors and a sense of camaraderie develops quickly.

I'm also just writing for myself because I think it's super helpful to debrief. If you made it this far, hope you enjoyed!