Would You Walk Around with a Kidney Stone?

I awoke this morning to a kidney stone. You know
when it starts like this, it’s not gonna be a banner day.

I got up at four this morning and started the coffee. When I sat down to read I knew the pain in my back was familiar, and dreadful. I’ve had kidney stones before and this felt distressingly familiar.

By 4:30 we were on the road to the emergency room. Kidney stones hurt. There’s no way to sit, stand, or lie that gives comfort. I squirmed the whole trip.

I received great care in the emergency room at Vanderbilt Medical Center. The staff were professional, courteous and attentive. In this kind of pain, that helps.

They gave me pain meds in gradual doses, finally getting at what feels like a burning charcoal in my back. I was grateful.

But I was also nauseous. Extremely nauseous. I began to sweat. I was cold. I felt weak and flush. When I feel like this I just want relief. Fortunately, they understood and kept close watch. They treated my symptoms so I could get a cat scan.

I was wheeled to a nearby room and scanned, thinking how grateful I am that this didn’t happen while I was on a mountaintop in Ethiopia a days drive from a hospital and a plane ride away from Europe. I’ve been there and done that.

The cat scan confirmed my “diagnosis.” Not only that, I learned I have two stones, one on each side. Great, a twofer. One is descending, the other is embedded, awaiting the opportunity to descend, no doubt.

The attending physician called the urologists explaining they will tell me how Vanderbilt “manages” patients with kidney stones. Manages kidney stones? What does that mean? I want the suckers broken up and out. Having been in two other hospitals in the past for the same problem, that’s what has happened, almost immediately. His use of the word manage is disturbing. When pain is this intense you want it to stop and you want the cause to be dealt with if that is possible. Manage, ha!

The urologists are in surgery, we’re told, so it could take a couple of hours before we can talk with them. I’m barely awake now. The combination of medications for nausea and pain have not only zapped the pain and upset stomach, they’ve zapped my consciousness. I’m more asleep than awake. I doze off, but I’m happy.

Some time later I awaken to learn the urologists haven’t come yet. I get another dose of medications.

Six hours after arrival an intern enters and explains that I’m free to go home. What?

“The way we manage kidney stones here is to send the patient home with pain medication and ask them to call the clinic for an appointment,” the young doctor says.

My wife asks, with no little consternation in her voice, “You mean we have to go home and call back here and ask for an appointment? That will take a week or two, and then we’ll told he will be scheduled for a procedure a week after that?” (We’ve been through this system before and learned that it’s a bit less than expeditious.)

Sheepishly, the young doctor re-stated the procedure, patiently and quietly.

I’m thinking I’ll be walking around for three weeks trying to give speeches, lead meetings, drive, advocate for a variety of initiatives, convince donors to give, nurture relationships with partners and write, while drugged with pain and nausea medications, barely awake with two kidney stones, one descending. Now, tougher people than I may be doing this. But they’re tougher and more patient.

I tell him I don’t want to pass a kidney stone in an airplane or rental car thousands of miles from home, or late at night in a hotel room, or high above the ocean in an airplane, or in a meeting. It seems to register, but still Vanderbilt has its procedures, he says.

I feel as if I’ve got a red hot poker burning in my back and my inhibitions are relaxed by the drugs so I depart from type and say, “It sounds to me like this procedure is for the convenience of the urologists and not the patients.”

He’s taken aback but replies, “I’m sorry, it’s not my procedure, but this is what we do.” Polite but unyielding.

I decide on the spot we’re going somewhere else. I can’t walk around for two or three weeks with a descending kidney stone, and then go through recovery from a procedure at the start of the Council of Bishops meeting four weeks away. That won’t work. Thank goodness we’re insured and can explore options. Forty million uninsured people in this country are at the mercy of procedures, if they can get treatment at all. We need to fix this system.

At this point, a staff person says they’ll send me home with pain and nausea meds and give me a paper to carry in the car in case I’m pulled over. ?!

Pulled over? Even in my current drugged state it sounds to me like they know I’ll drive and crash into a light pole under the influence but I’ll have a “get out of jail free card!” Come on.

Those who know me know I can use eschatological language at times like this, but I didn’t. This isn’t worth a good curse. It’s time to get out of Dodge.

So my wife puts in a call to our excellent primary care physician and explains the situation. We hash things over with various staff for a few more minutes but it’s clear procedure reigns.

By the time we’re ready to leave an arrangement with another hospital and urologist has been made. The procedure to remove both stones is set for tomorrow. Thank goodness and our primary care physician.

Perhaps this is the way kidney stones are managed these days. I don’t know. But I’m reminded of the phrase Shoshona Zuboff and James Maxmin write in their book, The Deep Support Economy; institutional arrogance. When institutions make rules to make things convenient for themselves and not for their customers, they lose the support of customers and put themselves at risk. Somehow walking around with a couple of kidney stones while taking drugs doesn’t seem to me to be in my best interest.

So tomorrow morning if all goes as planned, I’ll be undergoing the removal of these stones.

And I forgot to mention. Tomorrow I was supposed to be speaking to a group of health advocates about the relationship between health in the U.S. and in places outside the borders of the U.S. Ironic, isn’t it?

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