The last couple weeks have been difficult, not least because I passed a kidney stone (I have history with the buggers, and I could feel the pop and pressure release) over a week ago. That one took 2 days to pass. But then my kidney kept on being very, very sore (though mostly not quite as sore as before passing the stone). When the pain crept up to the excruciating level, I ended up in the ER. The doctor was not sympathetic, and appeared to doubt what I was saying about my kidney pain. I was worried that there might be bruising or some other lingering damage. Painful infection (these can actually be life-threatening) is also a possible complication, though as my temp hadn’t spiked, I was pretty certain it wasn’t that.
For weird reasons, I was at a hospital about 50 km away from home. It was a smaller hospital, and the CT machine there doesn’t operate overnight. So I had to wait for morning, in raucous pain the whole time, in a chair in the lobby. (Beds were apparently only available for priority patients.) The CT team had a couple patients higher in priority than me for first pics, but they got to me around 9am. Low! And Behold! The pics showed numerous stones in my kidneys. Most weren’t placed low enough to block fluid flow and create the painful pressure famously associated with them. One, however, was located low enough to cause pain, but not all the way down near the exit yet. Imagine my surprise! It was “large-ish” in the words of the physician, who suddenly became much more solicitous than my overnight doctor. I received good care from that moment on.
What seems terrible to say, however, is that both at the time and after analyzing the events of that night in far more detail than I’ve laid out here, it seems that the primary reason for the ungenerous care upon being admitted was that I was able to tell people almost exactly what was going on with me. I described the pain. I spoke of passing a kidney stone and a specific feeling associated. I told them that I couldn’t be sure that this was another stone or whether it might be lingering damage, but that it was sure as heck kidney pain. Finally, I told them that there was no way that this pain could be treated with over the counter meds (I had already tried).
There really isn’t a lot of wiggle room in there for the doc. Metabolic and physiological signs of infection were absent. There was no blood in my urine when I first showed up at the ER (normal for an early-stage kidney stone, and any small bleeding from the stone I passed might have been long over). In truth, if I were a drug addict actively seeking to score narcotics, kidney pain and a professed history of kidney stones (that, in this case, hadn’t been imaged since I entered the Canadian health system) would be an almost perfect story. The one weakness: real kidney stones large enough to cause pain would almost certainly show up on a CT scan.
Now, it’s nice to have images on file showing I have a history of stones, and showing that my left kidney has one of problematic size (though innocent position) and my right kidney has several (only one dropping now). Maybe the next doc can see those files in the system and treat my story more credibly. However, I can’t help but think that if I had been less helpfully informative of everything I knew about my kidney pain and its history, I might have been treated better.
I don’t know for a fact (maybe there’s research out there) that being able to speak with great specificity about one’s problems is or is not characteristic of drug seeking behavior. Maybe it is.
But it sure as hell sucks to be penalized for knowing your body and your medical history and for being able to articulate both plainly and clearly to your provider.
At this point, I think I’d rather know a little less and be able to pass on my kidney stones to a deserving Trump or Trump Cabinet member, rather than keep my knowledge and my stones. If anyone knows anything about donating kidney stones, do let me know in the comments.
You have my sympathy. I glad your outcome is … OK.
My experiences as informant in ERs has been sort of similar. The more information one can provide seems to provoke a response like, “Yes, dear. We’re medical professionals, we’ll get your mother/SO/friend sorted. You just go sit over there and be quiet.”
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Another friend just went through about a month of kidney stone madness, including infection, a stent and, finally, ultra-sounding it. Good outcome there, too.
Glad to hear your friend had a good outcome, sorry about the month of madness.
It’s hard to know exactly how much information to give to be as useful as possible. Obviously giving too much can trigger a fairly human defensiveness: but not all doctors will respond that way. (There are a lot of doctors, after all, so the number who won’t respond defensively has to be non-zero, right?) What is the optimal amount of information? And should it be doled out in a particular way? It’s a very weird and distinctly human problem.
I’m sorry you ended up with such shit treatment. A lot of doctors are taken aback by knowledgeable people, and too many of them seem to operate on an assumption of “addict” if you don’t act the drooling idiot.
I keep having various medical asking me if I am/was a nurse. Even my oncologist asked me, after I said I had dealt with nausea by taking a dramamine every day, as if this was some sort of genius on my part.
“Raucous pain.” I could not have put it better myself. I passed my stone almost a decade ago. It was the start of a dreadful year of ill-health for me. The night I passed the stone wasn’t even in the top ten most painful days that I had in my future, although I did not know that at the time. I sorry your doctor was a tool. They might have started with IV or IM Toradol, a non-narcotic and extremely effective for renal colic. Effectively treating pain starts with believing your patient. Every patient deserves as much.
I always find knowledgeable patients a relief. It means I don’t have to re-invent the wheel.
Oh! By the way, to answer your question: NOOOOOOOO!!! I do not want another kidney stone.
Actually I did get Toradol – so they weren’t completely neglectful. But my kidney pain was still pretty terrible. It was a bit lessened, sure, but not down to a level where OTC meds could have dropped the pain down to something tolerable. It was going to require Toradol + some kind of narcotic (they eventually used morphine). What pissed me off more than anything (I hadn’t mentioned this before) was that they told me that they were putting me on morphine when they injected the Toradol.
I’m not a doctor, and everything I’ve heard/read since is that Toradol is uniquely effective among NSAIDs for renal pain (it’s also used post-surgically), though it can only be used short term. (Because side effects develop after a few days?) So if they’d told me that they were giving me a prescription drug that I’d never tried that was non-narcotic, I’d be happy to give it a go for a few hours, or at the very, very least for an hour. I wasn’t insisting on any particular treatment, just being honest that I’d been on OTC drugs for days and t’weren’t doin nuttin.
Anyway, the Toradol wasn’t enough to actually control the pain, though at least it had a non-zero effect. But no one was paying attention to me, really, and after 7 hours of waiting, awake, in a chair, even the Toradol effect was wearing off. I know that morphine is metabolized fairly quickly (though I didn’t say that out loud, b/c they didn’t need to hear it from me) and 7 hours seemed like a long time to go without another dose. So with the pain never under control, with the pain worsening, and with enough time having passed, I asked if it might be appropriate to get another IV injection (they weren’t using a drip, obviously). A nurse obviously not familiar with my chart asked, “of what?” And I said, “I’m pretty sure they gave me morphine”. She looks at my chart and says, “You’re not approved for any morphine. It looks like the doctor ordered some Toradol, though, I’ll see if we can give you more.”
Since I was clearly told in no uncertain terms that they had been injecting morphine, I was pretty upset. Now, I hadn’t felt any large amount of drowsiness or other obvious narcotic effects, but I thought maybe they’d used a conservatively small dose. But it never occurred to me that they were flat out lying about the drug being injected. That just seems … fucked up.
It also was part of what made me think that they were concerned I was an addict engaged in drug-seeking behavior. Yeah, I’ll be annoyed by that memory every time it comes up pretty much indefinitely. I prefer my health providers to be honest. Even when they are providing what they think is the best care, that’s not a reason to lie to me about what care it actually is just to fend off hypothetical criticism that hadn’t even happened yet.
In my experience, it does not matter how much or little information you give them, or even how much info they already have available to them. Nothing a patient says is the actual truth if the doctor can’t verify it with their own senses. If you say it hurts but you’re not writhing on the floor screaming, you’re either an exaggerating hypochondriac or outright lying. You answer questions on a form, the nurse asks you the same questions, then the doctor asks the same questions again, because the patient can’t be trusted, and this redundancy will hopefully catch up any lies.
For example (by far not the only one I could produce), I went in to have my leg x-rayed about a week after breaking the fibula while backpacking. I told them it was broken, that I’d heard the bone pop, and seen it sticking out under the skin before the swelling obscured it. They shrugged me off, said, no it’s not broken, maybe sprained, follow me back to x-ray. Once they saw the films they were suddenly, “Oh no, don’t stand on it!”
I also had a hospital doctor trying to trick me into admitting to being an alcoholic because, after a month of prescription pain-killers pre-surgery for a ruptured disk, my liver enzymes were not surprisingly rather elevated. The third time he ignored or revised my answers to his questions about drinking, I finally told him to get out, I wasn’t going to talk to him anymore.
So I thoroughly relate to your experience, but I honestly don’t think giving them more or less information would have made any difference. Medical personnel seem to be trained to treat patients as the enemy, and finding one who has resisted this indoctrination is as golden as finding a good mechanic (side note, I’ve also found that mechanics tend not to appreciate car owners who know anything about their cars, especially if you’re a woman). And I share your anger about being lied to regarding your treatment. That’s just inexcusable.
(sorry for the rant, but reading stories like yours just really sets me off. When you say you’ll be annoyed indefinitely, I hear ya)
I am still furious at the ER doc who, on the second ER visit by my husband with the same kidney stone, came into his room and said “Three millimeters! Not so bad, eh?”
I too have had, and still have, kidney stones. I would gladly donate them to dump and dence. The last time I had one, they broke it up into 17 smaller ones that were passed one at a time. That wasn’t so bad until the stone hit the end of the stent with the string on it. They busted up a 5mm stone in my right kidney and left a 5mm one in my left kidney. As far as I can tell, the only reason they left the one in my left kidney was so they could get another 28K out of me. (That’s what they charged for four hours of time to knock me, bust the stone, and let me recover from being knocked out) That doesn’t count what the urologist got. I know I have another stone in my right kidney now because I get bouts of that pain that only comes from a kidney stone. Im sorry you have to go through this, because to be honest, I wouldn’t wish that kind of pain on anyone. Well, except for dump and dence anyway. Oh, when I went to the emergency room, they gave me nothing for pain, and didn’t actually believe I had a stone because I wasn’t “writhing on the floor in pain, crying and puking like most men do when they have a kidney stone”. It wasn’t until I was able to pee into a cup and they found blood in my urine that they started taking me seriously.
I had the reverse experience with Toradol. I had already failed opiates and other NSAIDs (yes, I took everything in my medicine cabinet between rolling on the floor and vomiting) when my PCP stabbed me in arm with Toradol. The colic was gone in 5 minutes. My left shoulder felt like a crocodile was eating it, but that was way way better than the renal colic.
You should have been given morphine in an hour or so after not getting relief from Toradol. Every caregiver has an ethical requirement to relieve suffering. I’m sorry they lied to you; there is no circumstance where it is ethical to lie to a patient. Honesty is the foundation of the therapeutic alliance between caregiver and patient. If they didn’t feel comfortable treating you with morphine, they should have told you that. They also should have tried to reach your PCP to confirm the history of stones, rather than leaving you in pain. Or treated you properly and then found out. Anything but what they did. That behavior is a legitimate reason to place a complaint with the Office of Professional Conduct in my state.
PS Yes, we try to only use Toradol for 24-48 hours. And never give it by mouth. It can cause wicked gastritis.
@Raucous:
Can it cause gastritis even when injected? I’ve been having some ever since that night, though today it’s just a background rumble, the first couple days it was pretty significant (though not what I would call “wicked”, and it didn’t approach the kidney pain itself in anyway. I’d rather have 2 or even 5 body parts feeling that pain than 1 feeling my kidney pain). My first thought would be that it would be unlikely to cause gastritis when given IV, but I don’t know anything about the drug. (I hadn’t ever even heard of it until this ER trip.) Since my ignorance of Toradol is essentially total, and since my gastritis has no particularly obvious cause (could be from naproxen, but I usually have to take naproxen for a lot longer to have that kind of effect on me), I thought I would ask.
As for complaining to the province, I doubt I’ll do that, but it’s a thought. Thanks for what you’ve written here. It’s helped me think even more -and more productively- about some things
Yes, it can. It’s even WORSE when taken orally. I’m fairly certain that the GI side effects are dose limiting. Also, fun fact, your symptoms of gastritis may not correlate to the degree inflammation in your stomach. A stomach can be volcanicly inflamed with the patient not having any symptoms. And vice versa, of course.
Happy to contribute. 😀
Pissed mine away in December. His name was Wilhelm. I don’t miss it all.
And – not that you are one – I wouldn’t wish a kidney stone on my worst enemy. They tend to occur with gout, as well – another one of those things best avoided. Drink lots of water for the rest of your life, and take miralax or metamucil at the slightest inclination to have a large meal or a fast.
Re: various drugs – I’ve seen doctors describe oxycodone as “morphine” (it’s NOT) and Valium as “an anti-anxiety drug” (so is gasoline!) – they appear to be extemely casual, which is prolematic given the number of junkets that pharmaceutical companies take them on. For damn sure if someone was buying me a suite at a nice hotel and some pretty girl to accompany it, I’d make a point of remembering whose NDA I signed. Ooooo…. NDAs… Do you think there are NDAs involved?
you’re either an exaggerating hypochondriac or outright lying
It’s remarkably similar to trying to explain to a cop that you’re not black.
PS –
thoughts and prayers!
Marcus, you’re talking out your ass again. Doctors do not get taken on junkets anymore. That was 20th Century stuff.