Next time I get my hands on some “Intelligent design” whacko, I intend to ask him about the design of the urinary tract. That was dumb.

I just shook my head in wonder.

Thanks for your concern, bowser, especially in the midst of miseries of your own. I am touched.

Hurts, those kidney stones, don’t they? Everybody seems to “know” that the pain is equivalent to childbirth, but I possess just enough humility to know that I can’t claim to know what that means. For males, call it like being kicked in the balls repeatedly for 24 hours.

We now have a pain-equivalency calibration: 1 child_birth = 1 24_hr_ball_kicking.

Yay us.

He just shook his head.

It didn’t seem as painful as yours was, although it was the most intense pain I’ve ever felt. Fortunately, it was taken care of without complications with a laser fiberoptic forced up my urethra. Fortunately, I was knocked out, and other than the painful urinations during recovery, the most unpleasant part of the whole episode was the diagnostic procedure used to locate it, also involving a urethral camera. The imagery was vaguely astronomical in appearance.

Episodes of waking to pain or distress really stay with you. I have this memory of waking up, some time during Thursday’s operation, upright, choking and coughing and having a hard time breathing. I remember a surgeon in full scrubs standing in front of me, arms crossed, watching; and I believe I said aloud “what the hell just happened?” But then the memory ends. They confirmed later that it happened, and think maybe I aspirated something. It’s scary to imagine the consequences of suddenly spasming and jerking around during an operation. But I survived that one too.

There’s a pattern to things we’re all reporting; we seem to end up at the same place, by different routes. The laminectomy weakened your legs; peripheral vascular disease has weakened mine. And we’re all experience pain and learning its <bitter_irony>glorious diversity</bitter_irony>.

I’m permanently cautious about the strong painkillers, even after reading reassurances that sure, morphine is safe to take forever, at measured doses and with periodic testing and supervision. But I get a little cognitive dissonance trying to wrap my head around the proposition that the way to avoid addiction to a painkiller is to take it regularly. Uhhhh? It’s not an addiction if it happens under a doctor’s care?

In ’83 I spent two weeks in the hospital because of an infection during an appendectomy. They were generous with the demerol, and I remember that after I got out, I was nostalgic for it. But I didn’t crave it. Still, based on the fact that I smoked for 30 years, I know I’m not immune to addiction, so I’m not going to get cocky about the risks of painkillers.

I am not sure what different pain killers they gave me but I was out of it for a couple of days. My hospital stay was about 2 weeks including rehab to teach me how to walk again.

The pain I was in before the operation left me with little choice on the procedure. It successfully relieved the pain but it also resulted in some nerve damage that caused a weakening of my leg muscles.

Before it only hurt when I walked. Now, it doesn’t hurt when I walk but I can hardly walk anymore and it seems to be a degenerative thing.

Anyway, I intended to comment on oral pain meds. When they discharged me they had me on Oxycontin and Hydrocodone for break through. I stayed on that for about 6 months under the supervision of a pain specialist. Based on my relationship with the pain guy I had the impression that I could stay on the meds for life as long as I came in every 90 days for blood work and new scripts.

I decided that I had had enough of the oxy and I just quit going to the guy. They talk about pain killer addiction and I believe it is a problem, but for me, it just wasn’t. The shit makes you wake up feeling drugged and I hated that feeling. Yes I could feel some withdrawal but it wasn’t a big deal. I felt okay after 4-5 days and I have not been tempted since.

I didn’t post anything about how this started, so I have a little narrative catching up to do.

Back on the 23rd of January, a Thursday, I awoke at dawn to intense pain in my lower left abdomen. I hung in there, and it stopped in a few hours. I thought it likely that I’d passed a kidney stone, and I thought it was over.

But of course it wasn’t. The pain came back at midnight, and by 5am Friday I had to concede it wasn’t getting better. Drove myself to the ER, which fortunately for me wasn’t too crowded, and got seen in about ten minutes. Wired me up to a saline IV and started pumping in the morphine, and eventually I could relax my deathgrip on the bed railing and stop the convulsive panting. They did a CT scan, and reported (emphasis in the original) “you have a large kidney stone”. 6 millimeters, about the diameter of a dime. In a tube about 2 mm across. They got me into surgery by midday, but found that they couldn’t remove the stone without an unacceptable risk of blowing out the ureter and spewing infection around my abdomen. So they put in a stent that bypassed the stone and let my infected kidney drain. Scheduled me to come back in a month for a second try.

That was this last Thursday, and at first it looked good. I was first in line for takeoff, showed up at 5:30am, and by 7:30 was in surgery. They used a spinal tap for anesthesia, which was a trip, of sorts–I can relate to what a paraplegic experiences. They zapped the stone with a laser, and put in a new stent to help the fragments drain out. It seemed to go well, and they sent me home in midafternoon.

But by early evening I was starting to experience intense pain. Consulted the on-call urologist by phone, but she didn’t have anything useful to recommend. But at 9pm she called me, to suggest I should remove the new stent myself, at home. Sounds appalling, but actually wasn’t painful at all (but messy). There was a string attached to the stent to facilitate removal (yes, that’s right, think tampon string).

A “JJ stent”, so named for the loops at each end that hook into the kidney and the bladder to keep it in place. About 2/3 actual size. I think I’ll frame mine and hang it on the wall.

But that wasn’t the problem, and so around 10 I asked my neighbor to drive me to the ER. They were more crowded, and it took a while to be seen; and when eventually I got into the back, and after an infuriatingly long interval of taking medical history and asking dumb questions (everything shows up that way when you’re in pain), they started giving me morphine.

The morphine didn’t work at first. That’s pretty scary when you’re feeling intense pain. Looking back, on their ten point scale, I would rate a heart attack at 8, a kidney stone at 9, and what I experienced that night as a 10. I hate to admit it, but when the pain passed a certain threshold I lost it, and just started screaming. What I put those poor people through…nurses earn every penny they get.

They switched to dilaudin, turbo-charged morphine, and that finally reduced the pain. Again they scheduled me for surgery, and put in a new stent. They tried to kick me out in the afternoon, but I fought it, because I was still in pain, albeit coming in waves instead of continuously. I prevailed, and good thing–if I’d gone home with those useless acetominephen with a dash of real painkiller pills, I’d simply have had to come back to the ER for hospital-grade painkillers.

Weirdest night in the hospital I’ve ever experienced. My roommate was some kind of mental patient, a violent one who needed to be strapped down because he’d attacked a nurse when he first arrived. And he spent almost the entire night yelling incoherently. He eventually slept a couple of hours, and then I could. By Saturday morning the pain had improved enough that I felt I could go home without too much risk of having to come back. Sunday I woke up with almost no pain, and eight hours had elapsed since my last painkillers. Still took them, having no stomach by this point for any pain at all. And now it’s Monday, I’m starting to feel fairly functional. On Friday I go back one more time so a urologist can yank my string.

What did I learn? Well, for one, to not to try to tough it out. When you feel a sharp pain in your lower back in the approximate region of your kidneys, just go to the ER and get it over with. They might tell you to just wait to piss it out, but at least they’ll give you painkillers so you won’t rather die. And if it’s a tough stone, you won’t pass it yourself and you’ll need their help, their lasers and ultrasound and stents. An untreated difficult kidney stone can kill you.

The other thing is about painkillers. Objectively, the doctors are correct to resist giving strong painkillers because of the risk of addiction or habituation. It’s a negotiation, and you have to prove that you really need the painkillers, that you’re not just recreationally surfing the opioids. When you’re in pain and the doctors are refusing what you think you need, it’s easy to think that they’re just being cold-hearted bastards. But they have a point, however hard it is to be rational at the time.

A related point is to learn about painkillers. I read up on opioids, after the fact, and I think in the future I’d tell the docs that I don’t respond to morphine right away, that dilaudin is what does the trick; but I’m willing to try morphine first on the principle that you should always use the minimum painkiller to get by. It works psychologically, because there’s a known and dependable path for escalation from oxycodone, morphine, fentanyl, dilaudin (hydromorphone), etc. It’s easier when you have a plan to achieve relief from pain.

What else? Oh yeah, almost forget, that first time, my surgeon was Wesley Crusher. Or at least his doppelganger, Wesley at about 20. The second time I saw him, when he visited my room afterward, he was wearing a Stanford jogging suit that was way too much like a Starfleet uniform. It was one of those “I’m getting too old for this shit” moments.

That’s my story. I hope the act of writing it down will help put it behind me. I don’t have to keep remembering it now that I can come back here later and read up on it. And I hope those last few paragraphs might help any of you who get into the same situation.

Thanks for all your support and good wishes!

Last round! That’s great. It sucks, but you’ve rounded the corner, in the home stretch.

That’s the Tea Tree you’re tasting in the honey; and New Zealand.

Haven’t made oxtail soup in years, but damn it’s a wonderful stock. Warms the bones, it does.