Distraction, or “OMFG this hurts!”

I had to go to the ER on Wednesday night for severe back/kidney pain that I (and anyone I disclosed my symptoms to) thought was a kidney stone.

The pain started around 2pm while I was on my prep period at school, and I thought it was just from my lazy posture while sitting at my desk grading, so I got up to stretch and walk around. It didn’t help.

By 3:30pm (dismissal), the pain was coming in waves that spiked up to a 6 or 7 out of 10, accompanied by nausea that was enough to make me gag.

By 4:30pm (I was still at work, grading and planning since it’s the end of the semester and shit has to get done regardless of how I feel), the pain had elevated to the rank of “what fresh hell is this?” or 9 out of 10, and I began dry heaving and finally, before 5pm, vomited. The vomiting continued for some time, despite my stomach being fairly empty.

I then had to stay at work until nearly 6pm because I could not get the pain/nausea under control enough to feel safe to drive home during rush-hour traffic. When I finally left (just after 6pm), I took the side roads in case I needed to stop suddenly and did not arrive at my apartment until nearly 7pm.

At home, I sat on the couch, my two young children (ages 4yo and nearly 2yo) climbing all over me as I became more and more irritated – not at them, but at the fact that nothing I could do was making my pain any better. I was also extremely annoyed at the prospect of an ER visit, the likelihood of passing a kidney stone, and probably having to call off work (anyone who teaches knows what a pain-in-the-ass it is to be absent, even if you are TRULY ill and need the time off to recover). When my husband got in the door from work half an hour later, it was clear that I couldn’t continue to simply bear the pain and both he and my mother (who watches the children while we’re at work) encouraged me to go in and be seen.

My husband, despite not having eaten dinner, changed out of his work clothes and grabbed a phone charger as well as his Kindle Fire to drive me and keep me company. When I was apologetic for forcing him back out after he’d only gotten home he smiled, “Are you kidding? I’m bringing the Kindle, we’ll have a ‘date night’.” He knows that laughter puts me more at ease, and this was no exception.

The ER was terribly busy, as I knew it would be from my own past experiences as an ER tech during flu season. After a quick and dirty triage I was placed on a gurney in the hallway next to a mural of sea turtles and fish. I couldn’t even hold a conversation with my husband because I couldn’t concentrate beyond the pain and onslaught of nausea, so I attempted to distract myself with games on my own tablet.

People have compared the pain of a kidney stone to that of labor pains, but having gone through two births (induced with pitocin), I can honestly say that that hormonely fueled hell was worse than this…but it is a damn close second. On the drive to the hospital I remarked to my husband that I was at the point, pain-wise, where I begged for an epidural. Of course, it didn’t help that the road to the hospital was riddled with potholes from the snow plows and it felt like we were riding in a 1870 covered wagon vs. a 2004 VW Passat.

Regardless, the night in the ER passed rather uneventfully. Based on my symptoms the attending physician ordered the “kidney-stone protocol” and I had an IV placed, blood drawn, urine sampled, and CT scan. Because of the pain and my lack of ability to keep anything down from earlier that afternoon, it took a while for me to be able to provide a urine sample, and when I finally did, it was…gross, to say the least. And I should know, while pregnant with both of my children I had to give urine so often at my OB appointments that I am confident urine should never, ever, look like that.

When I came back to my bed in the hall I was instructed to place my sample on the back of the gurney on top of a plastic bag with my name on it. It was some time before a nurse returned to check on me, and it was a different nurse from the one who had checked me in and as she pulled up her computer cart beside me she exclaimed, “Oh! Is that your urine back there? Fantastic!”
I laughed out loud musing, “You know, I can honestly say I have never had anyone so excited to see my urine before.”

After that and the CT scan, it was just waiting: waiting, waiting, waiting.

As I said previously, I was not “good company” during this time. I didn’t feel like talking, and it was all I could do to play my silly little shape matching game on my tablet while breathing thorugh both pain and nausea. It took two doses of Zofran before I felt any relief from the nausea, and whatever they gave me for pain (liquid Motrin, I think) wasn’t touching it.

Diagnosis: “Flank pain – unspecified”

The CT scan showed no visible stones anywhere in my kidneys or urinary tract, and while there was a definite presense of blood in my urine (along with white blood cells and hyaline casts), there were no visible stones their either. So they talked me through “pain management” and following up with my PCP but that the diagnosis could not be specified beyond “possibly you had a stone and already passed it,” or “you may have a kidney infection…we’ll have to wait for cultured results to know more about that,” or “it may be something else entirely.” Isn’t modern science a marvel? /sarcasm

My husband took me home in the wee hours of the night and I went to bed, vowing to call off if the pain/nausea returned or if I was going to allow myself to recover and heal as I should. The pain lessened overnight, but I still felt bad enough to call in, which I did at 5:30, submitting my lesson plans from my phone before returning to bed. I slept in, rested and took things quite easy all day and aside from some residual achiness, was not having “pain” like I had the day before.

But I was up late last night because the nausea crept back along with the pain, and then woke up sometime between 3-4 with the same stabbing pain and nausea great enough to force me from my warm bed to sit by the toilet “just in case.”

I did make it to school this morning, but immediately put in a call to my PCP to be seen as soon as school is dismissed (Fridays are always early release days for PD, don’t ask, it’s a separate and equally stupid issue) and have been taking long, slow, deep breaths to keep the nausea at bay. I also logged onto my electronic chart and read through all of my medical reports and tests from Wednesday night. (For those who do not know my background, I was a certified Emergency Medical Technician in the early 2000s and was continuing my education to become a nurse, but ultimately I changed my trajectory to become a teacher instead of staying in medicine.) The chart confirms everything the medical professionals told me last night, but reading through my CT scan, I had a number of thoughts (bracketed words are mine):

History: Cholecystectomy. [My gall bladder was removed]
Flank pain. [duh]
FINDINGS: Without contrast, CT of the abdomen and pelvis was performed. The
lack of IV contrast limits the solid abdominal viscera. [We can’t see stuff as well without contrast, but we can see most of the stuff.]
Clear bases. [good] Significant pericardial or pleural effusion. [hmmm…fluid around my heart and/or lungs and no one mentioned to me that it was “significant?” likely means it is related to current infection/not to worry, but will ask anyway] Hepatic steatosis. [Fatty liver – pretty common in adults my age, likely caused by my being obese]
Spleen, adrenals, pancreas unremarkable. [as they should be] Gallbladder removed. 
No hydronephrosis. [no visible swelling/inflammation of the kidneys]
Appendix not seen with certainty. [huh…maybe cause I’m too fat? or it’s such a small organ…] Small bowel loops are not dilated. There is
no free intraperitoneal air significant free fluid. [both good] Uterus and ovaries grossly unremarkable. [Bitch, what do you mean, ‘Uterus and ovaries grossly unremarkable?’ Fuck you dude. My reproductive organs are the SHIT! Evidence: My kids.’ …ahhh…if I don’t laugh, then the pain has won]
IMPRESSION:
1. No obstructive uropathy. [no kidney stone or obstruction, i.e. no answers]
Having been through undiagnosed pain for years (2008-2015, ultimately turning out to be a bum gall bladder) and feeling ignored and misdiagnosed (likely on account of my being a woman who is medically obese), I am not about to sit on my hands while the pain continues.

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