Tuesday, July 07, 2009
THE KIDNEYSTONE SO FAR
Today I went to the emergency room because my 28 month old quintuplets residing in my right kideny started kicking far more seriously than before. On a pain scale of 1 to 10 it was a "Oh (explicative)," for about 24 hours. So, in the ER of my hospital they dope me up through an IV (hep-lock) and do all the tests. High white blood count, blood in the urine, acute pain. "Come back to see your urologist next week.". Uh, could you call one in? "We did. He said since your stone has not moved there is nothing he can do. Want a pain shot again before you go?" No, I want a second opinion because I am diabetic... Remember? "Oh... OH! You should go get a second opinion," the ER attending said with sudden understanding.
So an hour later I am in a hospital that is older, closer to my home, and owned by the Presbyterian Church. The ER doctor there says, upon seeing my x-Ray and having NO other history, "Wow! Those will have to come out with surgery. No way those can be disolved sonically. Come see the urologist first thing in the morning and see if we can't get those out soon."
Tomorrow I will go to the urologist and HOPEFULLY get my octuplets... Yes, octuplets now that someone is bothering to count more closely... Get my octuplets delivered. So far the largest is 2.5cm and the smallest is just under 1cm. I am hoping this can be done early next week because I don't want to be on pain meds all that long. It could even be tomorrow.
Will let everyone know.
-in His grip,
Michael The Haggard
New doctor... new headaches.
So this urologist sees my x-ray and says that those stones need to come out by surgery but that he is also troubled that there is hydronephrosis in the other kidney as well. So, ultrasound and contrast study later...
... I have bilateral Uretero Pelvic Junction Obstruction, congenital, due to ureters that are too thin. So, Monday I go for a gamma-camera study of my kidney fluid production for possible surgical correction of BOTH kidney pelvic joints.
"What about the stones?" I asked remindingly.
Oh. Those can't be bothering you. Let's just leave them alone. Even if we go in, we would only get the three or four largest ones.
"But I have blood in the urine, bacteria and WBC elevations and acute pain."
No (he smirked) you CAN'T be having pain from those 9 (yes 9) kidney stones. Ha Ha Ha. Just take these pain pills.
"Doctor... I DONT want Pain Pills."
Oh... okay... just come back to the ER each time the pain is too high.
"So... you wont take them out."
No. "Kidney Stones do not cause pain. I can't imagine why you would think 9 kidney stones, each the size of of a Buick, would cause any pain at all. I think you have a congenital birth defect."
Uh... Doc, I am 45 years old. Wouldn't such a birth defect show up by now?
"Come back later for a gamma scan and we will see about fixing the defect in both kidneys."
NEXT (next Doctor, that is...)
So Sunday night I get back from a long trip on the train to the North of Taiwan. I am starting to get unbearable flank pain again, so I go to KMUH's (Kaohsiung Memorial University Hospital) ER at about 9:30pm... luggage and all (since I am on my Scooter from the train to home).
I give the triage guy my National Health Insurance Card and sit down. As he is filling in stuff on the computer and communicating through pantomime and semaphore communications that resemble the mating dace of the Red Crested Mockingbird, he finally asks me through the group of candystripers' collective english, "How will you pay for this?"
"Uh... the National Health Insurance."
Surprised, he asks, "You have?"
I point to the card he is holding. Oh, yes. "Okay, follow me," at which time he walks away briskly through a crowded maze that in my state of mind made the Minoean Labyrinth seem like a simple two rights and left. Just before I lost him he turned to wonder why the old guy with luggage from a recent trip who was bent over with flank pain could not keep up.
Neither my doctor nor the nurses spoke much english and often had to have me repeat many times and much more slowly what it was I was there for. A couple of hours sitting, an IV of normal saline and a pain shot later I was told to go home now. WHAT??? I am still in pain and I haven't seen a urologist! Confusion sets in. The foreigner is confused. He clearly doesn't understand that he should be pain free now.
At 2am I finally see a urologist that looks to be about 22 years old. That would be 3 years younger than my ER doc. He wonders why I would have pain from just 9 renal stones. I begin to wonder if the majority of Taiwanese walk around with multiple large, non-passible kidney stones regularly because it sure seems to shock all the doctors I see that this might hurt in some way. Finally he agrees to let me see a urologist in the morning. Wait... aren't YOU a urologist? Yes, but this is the ER, we only deal with unstable patients. If you had acute pain, infection, unstable vitals, then I could help you. DID YOU READ THE CHART??? I have acute pain, infection, blood in the urine, elevated white blood cells, and a BP of 160/110... I think THAT is in your criteria!
But this is the ER. You need Outpatient.
So, I wait until 11:30 am to see the Outpatient Urologist.
Yes... until 11:30 am - I was in the ER for over 12 hours.
When I leave the ER I almost have the police called as I have seemed to seek drugs and medical attention with a false name. My chart says "Hagga Mi" but my Health Card says "He Mai Ke" (My correct name in Taiwan is He Mai Ke for those of you who know me but have always used my false name of Hagga Mi or the Americanized Michael Haggard)- I have NO IDEA where the Hagga Mi name came from but sure enough it is on ALL my paperwork. Now understand, every time I got an injection, and x-ray, a tissue or a deep breath I was asked by a nurse, "What is your name" and I would answer, "He Mai Ke" at which they would nod and give me said treatment. Now I find out that no one has bothered to actually READ the name on my charts. After we get that all cleared up, I sit in the outpatient waiting for an hour...
... I get called in, tell the doctor my history... wait as he explains everything I already know about Kidney Stones and the like... and get told he will see me next monday.
Next monday we will discuss treatment options.
"Can we talk treatment options now?"
Of course not! You have to go to all your other ER visits from other hospitals and get your x-rays on CD for me!
You see, all medical data in Taiwan is digital. Xrays and the like are transmitted to the doctor's desk from the other departments instantly. EVERY hospital does this... and they have no way to do that between hospitals??? I have to go to the hospitals myself and ask for a CD???
So, I have a week's worth of Pain Pill which I will most likely NOT take because I already have something stronger (I have a bottle of Aspirin already, thank you), and instructions to not come back until I have all my ducks in a row and why didn't I think about having all those with me at the time (having just gotten off the train from a trip and running to the ER, mind you).
So tomorrow I will go to the other hospitals, each an hour away, to get a CD from a department that speaks no english and always has attendants that start acting like either junior high students all giggly and shy or like judges who can't figure out how badly I should be punished for having so little Chinese skill.
I really need that bottle of 12 year old scotch now.
JULY 6th 2009
Today I visited my seventh doctor, the third urologist, in my quest to be pain free from kidney stones through removal of said.
I drove the one hour from my home to Kaohsiung Memorial University Hospital and got there at 9am. According to the waiting room chart, I was to be number 48... the counter said the doctor was seeing patient 6. I got some studying done.
When I finally saw the doctor, I handed him my CDs from the two other hospitals showing the history of my kidney stone progress. He studied them for nearly 8 minutes without saying a word to me. Finally, he told me that there were two paths we could take in treatment. The first would be to watch the diet, drink more, and avoid infection. I told him that this had been the treatment since January 17th 2007 when I first was seen for this problem. Now I have had 3 infections and the pain worsens. Okay, he said, the other option would be surgery. But, that would be complex because you have so many, and it would traumatize the kidney too much. So, he said with finality, I think there is nothing we can do.
"Yes," he said, "we shall use option one, the conservative approach! However... wait... what country do you come from."
I live in Taiwan.
"No, no, I mean originally."
"Oh! Well then, you could go to America and talk to an expert. Perhaps they would remove the stones."
Uh... Doctor, YOU are an expert at a teaching hospital.
"Yes, Well, I will have the nurse cancel the appointment today." (At which point she did, immediately and erased my visit from the computer, deleting any evidence that I had been there today) "So, you have no bill. You may leave now." (he said pleasantly and with a giant smile.) "Pay nothing. Don't see the cashier."
I must have looked pretty dumfounded because the nurse also then said, "You may go now."
Ah... no pain meds, no antibiotics? No labs? No vitals? I mean, hey, you gave me meds last week for an infection... don't you want to see how I responded?
The doctor might have said, "No, we are hoping that you go to another hospital and die before anyone finds out we saw you." But I was still in shock so I am not sure I really heard that.
I sat there a moment longer, the doctor and the nurse just smiling at me and sweating... either hoping I would get the hint and leave soon before I came unglued and did the American thing on them... or hoping I would in fact first "thank" them and leave.
I thanked them and left... Because I can't own a gun in Taiwan and do the American thing. This may be the reason.
So I wandered aimlessly around Kaohsiung in a stupor from shock. I came to suddenly in a Pizza Hut buffet with a sore tummy and about a dozen empty dirty plates before me on the table... I blacked out again then and found out later that I had gone to the Game Store and bought a new box of Assault Marines for my table top wargames and a magazine after having broken several of the models that were on display by violently throwing them across the room and into a wall. The store owner, James, wondered why I was breaking things but since I spend so much money there he really lets me get away with murder...
I hope he didn't let me get away with that...
I found myself at home, drooling on the couch, Sandy rocking me in her lap and cooing, "It will all be okay." The numbness is fading...
Now I am going to just take handfuls of Naproxen Sodium (Hey Mom, send me a case of it, will ya?) and drink vinegar until my eyes ooze sour wine in an attempt to self medicate and dissolve the nine slabs of granite in my side. I have informed Sandy that a bottle of Glenfiddich and a hobby knife are in our future and she is now reading "Urological Surgery for Dummies" that we got at the library... it is in Chinese but its all greek anyhow.
Onward and upward,