severe abdominal/flank pain, history of kidney stones x 10-12.
Hi there nurses and ER docs! I read several nursing/ER blogs from time to time, and from what I’ve gathered, that brief signalment and history makes you shudder. Maybe not quite as much as “35 year old male, 10/10 back pain, allergic to (all the non-narcotic pain meds), seventh ER visit this month”, or “50 year old female, obese, generalized pain, history of Lyme disease, fibromyalgia and chronic fatigue syndrome, brought pain contract”, but definitely a distinct twinge of apprehension.
Well, that person is me! Through my body’s preference to make kidney stones at the rate of one every 6 months–several years for whatever reason, I’ve had the opportunity to visit many ERs over the course of my teenage and young adult life. I’ve pursued the etiology of my weirdness with various nephrologists and urologists, but none have yet been successful at pinning it down*. My urinary tract has been imaged from stem to stern in multiple modalities. I’ve completed more 24-hour urine collections than I care to admit. Sidenote – if you think your high school experience sucked, try carrying around a jug of your own urine for an entire school day while you pee in it every so often. It’s like a scene from American Pie. Anyways!
I am pretty good at drinking an insane amount of water per day. I don’t drink coffee, I pee more frequently than your grandmother on a 12-hour road trip, and I watch what I eat. Unfortunately, I’m not always successful at “washing it on through”.
I’ve met some nurses and doctors who are stunningly excellent at their jobs. I’ve met others who have shown me that some ER folks have a hard time dealing with a patient who seems at first glance like a drug seeker/chronic paineur/dying swan young woman…but actually isn’t. Here are some tips and observations from my side of the curtain:
1. Drug seekers want Dilaudid (or whatever). I vehemently don’t.
Most of the time, I end up in the ER by myself. Sometimes I’m traveling, and oftentimes I need to go to work/class early the next day. I will probably be driving myself home after discharge.
Although I’m very painful, I generally don’t want narcotics. Not only do I potently dislike the feeling of being high, it interferes with my ability to advocate for myself in the hospital. It also makes my adventures after discharge much more dangerous/funny**.
I will sometimes go the NSAID route, but (alas) I get all the GI side effects the next day. That’s not fun. So I usually just suck it up as long as I can. I am very stoic about the pain aspect of the kidney stone adventure, but I am a total weenus about the nausea. Which brings me to…
2. I WANT ALL THE ZOFRAN. ALL OF IT. AND A BUCKET.
My innards like to translate intense visceral pain as nausea as well (thanks guys), so yes please to the Zofran and the vomit pan. I am generally a very low maintenance patient – the one time I’ve ever pushed the call button was when I was just about to spray the walls with my dinner. The awesome nurse got me the bucket just in time. #winning!
3. Doctors! I know CT is easy and fast for you, but I’ve had about seven of them.
That’s a helluva lot of radiation for my ovaries (not to mention the rest of my abdomen/pelvis in the field). Therefore, unless you can convince me that one of my internal organs is actually legitimately exploding at this moment, a CT is not happening. Call your favorite friend the ultrasound technician! He/she will get the job done.
4. Nurses! I want to be out of your hair as fast as possible.
My ER goals are usually pretty simple: get rehydrated, nausea/vomiting control, maybe pain control if it’s really awful and the stone is taking a long time to get to Bladderland, and peace out as quickly as I can. Not to be a hater, but the ER is not my first choice for where to spend my day or night. You understand.
I understand that I probably have the least emergent problem in the entire ER. I want you to spend all of your time taking care of the people that are ill and dying. I want to be by myself in the “ignore” room with my fluids and meds. I also have no idea what you are doing when 1) the last thing that has to happen before I leave is taking out my IV, 2) it’s a nonbusy night in the ER and 3) you guys are chatting at the counter instead of sending my ass on my way. Shenanigans? I don’t know.
5. Doctors! I am sexually active. I am not taking birth control. There is no chance that I could be pregnant. These statements are not contradictory.
I’m also not at all shy. I will tell you straight up that I sleep with exclusively women. Feel free to believe me, feel free to not believe me and order a pregnancy test anyways, but those are your only two options. Hey, there - asshat physician who argued with me for a while about why I “could technically” be pregnant - NOPE. Don’t do that. It makes you instantly a douche.
* I’m optimistic about this latest guy! He’s like a kidney ninja. During the hospital visit where I met him, he kept bursting into my room, striding over to my bed, fixing me with a firm glare, and asking me questions like: “Are you abnormally short compared to your parents?” and “Did you ever eat lead paint chips as a child?”. It was hilarious.
**Ohhhhh so this one time, I ended up in the scary hospital near the train station after becoming ill on the train. I was given assloads of narcotics, discharged into the inner city night while still remarkably high, and retrieved by some very kind friends. Apparently, the ride home was peppered with my non-sequitur questions such as, “Hey, do fencing helmets have ear cutouts?”. A few hours later that morning, I went to class. I turned to one of my classmates during discussion group and asked, “What month is it?”. My professor (a neuroscientist), laughed extensively and sent me home.