- Education and Science
The Doctor As Patient
The pain of self-importance
The first twinge of pain and I know immediately that I was about to have another attack of renal colic--- a clinical, rather non-descriptive, almost noncholant term a doctor uses to indicate the act of passing a kidney stone. This, to belabor the point, is an apt example of a doctor's glossy if not totally convincing habit of applying a benign sounding name to a most excruciatingly painful malady; or on a similar tact, using a catch-all-label like Fanconi's syndrome to imply a slowly fatal disease related to total bone marrow failure.
Going back to renal colic. The first time ever I experienced the severe, colicky, mid to low back pain was four years ago, on a Saturday morning, one day before a friend and his family were due to arrive to spend part of the weekend with mine. At first I thought it was just a simple case of muscle spasm, having strained my back one day earlier at the gym. The pain was not agonizing, initially, but it lingered on for the next several hours and got stronger as the day progressed. I took twice the usual dose of Advil and then it only eased slightly. I soon realized I was passing a kidney stone, when my urine turned a faint pink then burgundy-red several hours later.
The pain persisted for the next 24 hours, controlled to some extent by Tylenol with Codeine. The relief afforded by this analgesic was more than outweighed by the nausea and lightheadedness I felt, especially when I tried to close my eyes in a futile attempt to get some sleep. It was the same sick sensation I remembered feeling way back my younger days when, during friendly reveries with classmates, I would imbibe a little bit more beer than my then 105 pounds frame could tolerate. But I digress.
I was getting concerned that the pain would not subside, but by the time my guests arrived, the pain was gone. They left the next evening impressed that, as usual, I played the role of the perfect host to the hilt. I slept better that night too and without taking the analgesic, thus freeing myself of its unwanted side-effects. During the next two days the pain did come and go, but gradually subsiding so that by the time I had the Intravenous pyelogram (IVP), the pain was essentially gone. The x-ray did show tell-tale signs of a kidney stone on the left side.
Again, and now for years later on a Monday morning, while I was dressing up to go to work, I feel an almost identical mid to low back pain, but this time on the right side. There is something different about this pain aside from its site, and it is its greater intensity within so short a time. I take the usual dose of Tylenol with Codeine, but the pain only ceases a notch. After making a slow and labored hospital rounds on my own patients, I arrive at the office looking pale and gaunt; I try to see patients but give up after only the fourth one. An internist colleague gives me an injection of Demerol/Phenergan and within 15 minutes the pain subside perceptibly. He orders a kidney and abdominal ultrasound; it shows an enlarged kidney and a dilated ureter on the right side indicating a stone obstructing the distal ureter. It incidentally also reveals the presence of three small gall bladder stones.
I take the next several days off because the pain, despite oral analgesics, continues unabated in varying intensity at different times of the day. On the second day, I wake up with the most intense pain yet that sends me staggering towards the emergency room. After 5 short minutes-- an eternity when one is in severe pain-- the ER doctor orders the nurse to give me a dose of Toradol. In another 5 minutes I am totally pain-free so much so that I try to convince the doctor to send me home. Before agreeing to this, he orders several more tests including an IVP and a hepato-biliary scan. Both tests confirm the fndings of the ultrasound done three days earlier. After conferring with the ER doctor, my attending physician decides to admit me to the hospital for hydration (IV fluids) and for more pain medication should the need arise.
After getting this bit of unwelcome news, I ask myself what next? My usual sense of self-assurance dissipates quickly, having been always on the other side of the equation where, as the attending physician, I am in control of the whole situation, from the time I admit a patient and write my admitting orders, to the time the patient's hospital course mandates a change in therapy and he/she gets well and is ready for discharge. I start to sweat the instant I change my street clothes to the loose hospital gown the nurse provides me. I lie down on the cold gurney and stare at the bright flourescent lights above. The feeling of not being in control sinks in like a two-ton brick on quicksand. My discomfort is compounded by the ER staff hovering over me all at once; my claustrophobia intensifies when the nurse takes my blood pressure, while the lab technician inserts an IV line in, and the surly nurse's aide draws the curtain shut.
I heave a sigh of relief afer they finish their respective tasks. During the lull, I try to sleep only to be awakened abruptly when the gurney starts to move, pushed in a hurried manner by the now suddenly burly nurse's aide. From my supine position looking up, the ceiling lights look like distant stars zipping by Captain Piccard's window on the USS Enterprise while it is traveling on warp speed. After a quick trip though the worm-hole, the aide deposits me on the third floor in the VIP suite.
The VIP suite, so called because it is where sick doctors who have lost their obtrusive sense of self-importance are sent to recover, becomes my home for the next three days. I try to convince myself that I am ensconced in one of the luxurious suites of the Rits-Carlton Hotel across town, but the steady interrupton--- the nurse coming in and out of my room, the hospital pager at full blast, the lab tech drawing another 20 cc of blood for yet another test--- reminds me that my stay is not going to be pleasant. By the third day, I am ready to jump off the third floor balcony. Happily my doctor decides to send me home after making sure that I am pain-free for at least 18 hours.
I finally leave the hospial late in the afternoon. I pass through one of the side exits; with the cold hospital air still tugging at my neck, I feel a tingling sensation run down my spine when the sun, which I have not seen for three days, stikes and zings my face with its searing heat. I dive quickly into the cool comfort of the purring Jaguar.
My wife drives me home; along the way we pass by a golf course, its palm trees casting long and thin shadows on brown grass. The golf course itself is strangely empty except for a solitary cart being driven by an old man in orange plaid. He drives between sand traps that, in the pale yellow glow of the setting sun look like moon craters, Suddenly from parts unseen, the sprinklers spray jets of jaundiced water.
Finally I'm home. After a long cool shower, I lie down on my bed. I do not wake up until the next evening, when the moon is full and the night is bathed in golden yellow.