A remembrance of things passed

Hemingway once remarked that every man's life is a novel if written down truly. In my experience as a health care practitioner, every patient has a short story to tell. Here is one of my own.

The dull ache in my right lower back is all that's left of the searing pain that landed me in the emergency department at one of the local hospitals yesterday. The pain has faded, but the memory of the incident remains sharply etched in my mind.

What began as a backache exploded into flank pain that reached down as far as my right testicle, throwing me into a foggy delirium for most of the morning.

I stagger into the ED, clutching a plastic shopping bag in one hand, unable to stop shaking from what I now recognize as a sustained epinephrine release. Someone seated in the waiting area—a friend—recognizes me. She tells the triage personnel that I am a physician assistant and that if I say I think I have a kidney stone, I probably know what I am talking about.

There is nothing like intense pain to bring the present moment into focus. Even so, it seems like an eternity as I rock back and forth in the wheelchair, babbling to myself.

I later learn that the ED staff was busy attempting to stabilize three critically ill patients at the time. One, the man in the bay next to me, succumbs shortly after they pull the curtain around the gurney where I lie.

In the fog that is now my memory, I can hear voices calling—calling for oxygen, calling to start CPR, calling for “anesthesia stat to the emergency department,” calling for an ET tube, and then for epinephrine.

And then the tension that has been palpable on the other side of the curtain dissipates. I can feel it slip away, along with the soul of a patient I will never see.

Finally a nurse comes to attach the ECG leads to my chest, slip the rubber pulse-oximetry cot on my finger, and wrap the BP cuff around my right upper arm.

She gets the IV on the first stick. Soon fluid is running into my vein, along with welcome opiates that press out the last wrinkle of searing pain in minutes.

“So, you have pain in your back, yes?” The doctor speaks with an accent that I peg as Slavic. “How long?”

“Five-thirty this morning.”

“Sit up.” I wince as she taps my right lower back.

“Deep breath now.” She listens with her stethoscope.

How well I know that she is checking for evidence of a lower-lobe pneumonia. I could tell her that isn't the diagnosis, but that's fine, I think; let her do her job.

“You passing blood in the urine?”

“Haven't been able to pee,” I say.

“You have kidney stone before, yes?”

“Three—last one years ago.”

“We send you for CT scan soon.” She disappears behind the curtain.

It's cold on the table in the scanner room. The technician gives me a warmed blanket when she sees how badly I am shaking.

“Arms over your head. Now—hold your breath.

Good, you can breathe now.”

She repeats the process twice.

“Did you see anything on the film?” I ask her.

“I just take ‘em, I don't read ‘em. Good luck!”

Shortly I am back in my bay in the ED. Someone new has taken up residence in the bed next door. I can tell from the constant wet cough—it sounds bronchitic.

“You have a 3-mm stone lodged at the junction of the right ureter and the bladder,” the Slavic voice announces.

“How you feeling now—better?”

I nod my head.

“Good. You can go home. I give you medicine to take for the pain. You need to drink a lot of water and see your urologist in two days.”

I have to wait another hour for a nurse to pull out the IV line and hand me the discharge papers to sign. My wife walks me out to the car on her arm.

I look at the dashboard clock—four hours have elapsed. Looking back, it may well have been an eternity. JAAPA