At 4am, I woke up from a crazy dream with pain in my abdomen. I was sweating and my heart was racing. I initially thought it was just a dream, but realised it was all too real when I pressed around and found some generalised tenderness in the right lower part of my abdomen. Hopefully, just some intestinal colic, I thought to myself. I could not find any definite signs when I examined myself of involvement of the inner abdomen and its organs. I got out of bed and immediately doubled over. I made it to the kitchen, drank some water and took some over-the-counter Pepto Bismol, and waited for the pain to pass.
Over the next hour and a half, I tried to contort myself into every posture possible, tried to go the bathroom multiple times and tried other over-the-counter products for some relief—unsuccessfully. The one constant was my dog, Kona, who was getting very restless and would not leave my side. She even squeezed into the bathroom with me, and watched me sitting there doubled over. I was in too much pain to kick her out and let her be. My wife and daughter were out of town for a tennis tournament—and I finally called her. Also a physician, she demanded I go to the ER immediately and have my son drive me—he was 17 and had just finished high school.
I learn stuff from my patients. Earlier in the week I had done a procedure on a stoic, ex-military gentleman. After the procedure, I asked to speak to his family and he said that he had not informed anyone as he did not want to cause any worry. He had taken an Uber there, and was going to take one back to the Marriott, where he had booked a room for a couple of days to recover. “What happens if you need something?” I asked. He shrugged. “I just call and someone comes up,” he said. “Worst case, I will call emergency services.” I personally liked that approach. It was 6am now, and I took Kona out, hoping that a brief walk would help. I noticed I was holding my abdomen and as I watched the sunrise, I told myself I had better head to the ER, or I may never see another sunrise. I did not want the Emergency Medical Services showing up and did not want to worry my son, so I drove myself.
The pain was getting incrementally worse during the drive. I worked on my breathing, and purposely drove slowly. I could not get the temperature in the car right; I was either sweating or shivering. I made it to the parking lot and as I was walking in, I realised that I had worn my jacket inside out. I put it on right, fixed my hair as much as I could and walked into the ER. I headed to the doctors' station; there were a couple of doctors and nurses standing around. One of them looked up, saw me and said, “Well, good morning, Dr Arab”. I sat down next to him, slumped over and said, “Dude, I need help. I think I ruptured something.” I saw the colour drain from his face as I closed my eyes.
I could hear the urgency as they got moving. “Can you walk to a bed?” one of the nurses asked. “Sure I can,” I said. I was feeling woozy now, and felt I would pass out soon. I made it to the hard hospital stretcher, and when I lay down it felt delicious and silky. I did not even feel the nurse starting an IV. We had a new electronic system and they were trying to get me into it to dispense medication. The pain was intense now and I could sense the frustration of the nurses as they worked with the computer. “I think I might die before that EMR gets working,” I quipped, as the nurse got the morphine into me. I had never had morphine before, and I remember thinking what a beautiful drug it was. It did not take the pain away, but definitely changed my reaction to it. A derivative of the opium poppy plant (the plant of joy), morphine is ten times as potent. The name is derived from the Greek god of dreams and sleep, Morpheus. It was first commercially made in a parlour behind a retail pharmacy in Farringdon Street, London, in 1821, and went on to completely change the management of surgical pain.
The ER physician was quick and gentle with the exam. I remember thinking he looked like a kid—which was more a testament to my age. I was whisked away for a CT scan, and when they asked me if I could move myself, I shook my head and let them do the moving. It turned out to be a kidney stone stuck in my ureter. The pain of the kidney stone (renal colic) has been described as being worse than childbirth and as intense as being stabbed by a knife. I pride myself on exposing myself to the procedures my patients undergo so that I get to know what it feels like—pharmacological stress tests, lidocaine injections, IV. Now I have a new one. The good part, one author writes, is that once you go through renal colic, all other pain seems milder in comparison.
I am still in a little pain, as I drink fluids and wait for the stone to pass naturally. The pain will pass. It always does.