In light of my usually relentless blogging, I’d guess that my absence for much of the past week came as a surprise. Here’s what happened….
Last Wednesday night, I had no sleep. The kidney stone that I thought I’d passed (with evidence to show for it) seemed to still be plaguing me. So I called the doctor, who thought that a piece of it was still in there, and causing me continued pain. Oh, guess what….he had a cancellation for surgery the next day (Friday), and told me that “this had been going on long enough.” He wanted to go in and get the rest of it.
So, while millions of others were packing cars, coolers and kids for the Labor Day weekend, I was presenting myself for surgery at Pennsylvania Hospital. The process begins with a “welcome-to-prisoner-of-war” series of escalating depredations: surrender your valuables; strip completely and put on two back-and-front, graying gowns that you can’t tie up; wait in a large room with other saps who have nothing to do but lie there nervously.
My doctor appeared briefly, initially anonymous and unrecognizable in his surgical cap. I began by telling him that the rest of the stone might by now have passed, since I was no longer feeling any pain, or even discomfort. This didn’t daunt him: “Let’s go take a look,” he cheerfully suggested, as though he were a kid about to look through a telescope. By this point, I was increasingly convinced that this wasn’t a good idea, but the combination of my ambivalence and the weight of circumstance led me to agree (by saying nothing). I did manage to ask about the risks, to which he matter-of-factly replied with these two disconcerting possibilities. (1) “Sometimes the stone gets pushed back into the kidney, because we have to irrigate the ureter and the water can drive it back up there.” OK, I guess. (2) “Sometimes the ureter gets punctured, but that hasn’t happened in years.” Wait. How many years? What happens if it does get punctured? What are the chances? All questions I didn’t ask. Would you have?
So of course they found exactly no (zero, none, the null set) kidney stones after burrowing through my ureter all the way to the kidney. Couldn’t they have checked before going in? Because the procedure isn’t exactly inconsequential. Shortly after I woke up, I was seized by the same stabbing pain I’ve now grown to know and detest as kidney stone agony. It turns out that dilating the ureter often leads to violent spasms that call to mind, in a searing burst of unwanted nostalgia, the pain of the stone itself. And since the bladder is swollen to Hindenberg size, the pressure one feels brings its own deep discomfort.
As the nurse in the Recovery Room said to me: “Well, they don’t tell you about this part. Oh, it’s just a procedure. A piece of cake.” Well, today is Tuesday — almost four full days after this l’il “procedure” and it’s the first that I’ve been coherent enough to do much of anything. Friday through Monday are lost to a narcotic haze that left me unable to do much of anything — even blog!
There were, and are, so many things wrong here. First, and most centrally, the surgery itself turned out to be completely unnecessary. Especially given the strong possibility that the stone had passed, wouldn’t a quick scan for it have made sense? Personally, I like to avoid needless surgery and the risks (not the least of which is general anesthesia).
Then there’s what they do, and don’t tell you — and when. It was only after I insisted three times that they summoned one of the surgical team’s doctors to my hospital bed to explain what was going on. Well, that’s not completely right, because apparently there was a doctor talking to me shortly after the surgery, but I was in such a state that I didn’t even remember the event. Is this what’s passing for bedside manner: a physician so clueless that he doesn’t bother noticing that the patient isn’t coherent enough to understand what is being said?
And about the pain: Yesterday, when none of the drugs I was taking would mitigate the latest bout of pain, my doctor suggested that I repair to the ER and ask to be admitted (at his direction). But once I got there, the resident urologist turned out to be the one who actually performed the surgery (that I thought my doctor was performing, by the way). Disagreeing with the other doc (likely without knowing it), he said that there was no need for me to enter the hospital, that the pain I was continuing to feel was normal, and that I could get even better pain-killing drugs, as needed. Oh, and the ER doc said that simple anti-inflammatory drugs, like ibuprofen, could really help. First time I’d heard that.
Lessons? First, although I won’t necessarily refuse surgery in the future, perhaps this sorry episode will get me to be more skeptical and to practice what I preach: Surgery is to be avoided, and there should be a presumption against it. Your MD’s livelihood may depend, in large part, on the number of surgeries he or she does, so your interests may not coincide perfectly. I’m not suggesting that surgery in my case wasn’t indicated, just that it was only one of a few options. And not even necessary, as it turned out.
Second, one must insist, constantly, that one’s medical team lay out the whole picture — including pain to be expected, possible complications, risks and alternatives. As things stand, “informed consent” is more a legal doctrine than a practical reality.
This post was originally published on September 8, 2009.