D J Rout

On Monday I thought :I haven't posted to LIveJournal in a while."

On Tuesday morning at around ten o'clock I had a few rumbles in my tummy. By 10:30 the rumbles had ceased, but I had a pain in stomach, accompanied y a feeling of constipation and then that salty taste in your mouth you get before you vomit, but with no consequent vomit. I knew these symptoms, having had them before.

Kidney Stone

Fortunately, one doesn't forget that much pain too easily, so I knew what I had to do. I shut down the laptop, grabbed the phone (then charged to 68%), cane, jacket and hat and headed down Sturt St to the Ballarat Base Hospital. I thought I'd be in there for a few hours on some morphine and and a fluid IV, pass the stone and be out of there.

When I say 'headed' I mean 'hobbled'. By the time I was down to the post office, halfway to the hospital, the pain had become so demanding and noticeable—so painful—that I was kind of wobbling down the road as evert time my left foot hit the pavement it felt like a gunshot wound to the guts. Still, after fifteen minutes or so I got down to the Sturt St entrance of the hospital, at which point I was completely lost. The hospital has undergone renovations in recent times, but even if it hadn't, I had no idea of the inner labyrinth of labs, wards and cost centres that make up a modern hospital.

Fortunately, there was a nice volunteer lady there, Jill, who assisted me ot the emergency area, wherein they conduct triage and organise their billing information. By 10:48AM, there was a huge queue of people there. Jill the volunteer said this was a normal day. We see the major problem with hospitals, but we'll get to that in a minute.

By 11:27 I had got to the front of the line. By this time I was in considerable pain, and was leaning on my cane just to keep standing. I had been so distracted they called out 'Darren' something-or-other, I thought they'd called 'Darren Rout' and I thought "Ah ha! Got you, you bastard who's been using my name for the last ten years to fuck up my credit history'. This shows you how distracting the pain was. I had come in with pain of around 4 out of 10, spiking to 5 when I put my left foot down. By the time I sat down at the triage desk it had stopped spiking, and was fairly constant.

:On a scale of 1 to 10 — ", said the woman.
"Seven!" I gasped.
"I"ll just get a bit of your history. Have you been here before?"
"Yes, March 2009."
"Still at 403 Drummond St?"
"Drummond St North?"
"Yes."
"No." I gave her my new address and updated my phone details.
"Go to the next desk and give her your details, then come back and see me and I'll give you something for the pain."

I went to the next desk and sorted out my details with them—Medicare number, health care card number, star sign, any party affiliatins, previous employment history…—well, it hasn't got that far yet, but you've seen a glimpse into the future. After that I went back to the first desk, but she was seeing somebody else, so I sat down to wait until she was free. Of course, that wasn't likely to happen, was it? The emergency room was still busy, with people coming in all the time, and I was sitting there in incrrasing pain.

A man sitting next to me in a wheelchair was complaining that he'd been there for five hours, and that if they could arrange to get him across the road in his wheelchair he would go to St John of God Hospital, across Mair St. I'm not sure, but I think that's a private hospital, ie, you need private health insurance to go there or a mountain of cash to cover their exorbitant fees. so, if he could go there, why hadn't he gone there in the first place? But of course he didn't actually mean that—he was, like me, venting his spleen at the inefficiency of emergency rooms.

Meanwhile, doctors were coming out asking for people who weren't showing. They had presumably been there long enough to register, but had left in disgust, contempt, pain or high dudgeon at the wait. In which case, I thought, why were they there clogging jup the emergency line in the first place? These people who don't show should be tagged and treated as private patients next time. If they turne up to emergency but then can't wait to be seen, fuck them up every accessible orifice with a pineapple.

These uncharitable thoughts came to me as the pain escalated into the stratosphere. I was maintaining 6 or 7 out of 10, more if I breathed in, and I was hunched over gasping and trying not to swear and thinking that if only the law allowed me use of a firearm I could kill everone ahead of me in the queue and the idiot triage nurse and that that would make them sort their fucking ideas of triage right out for next time. Isn't it obvious that someone turning up to an emergency room would be in pain? Presumably not if people are turning up and then just wandering off as if emergency was an early doctor substitute or some kind of drop-in centre where ICE addicts go before the coffee shops open. Or whatever the fuck it is they do. There aren't that many addicts up this end of the world and ievne if there were, I doubt we'd mix in the same circles.

A nice lady who was waiting to be seen noticed this grimacing, muttering dwarf next to her and said:
"You seem to be in some distress. Let me see if I can get someone to see you."
"Thank you," I said. "They said they would get me painkillers, but—"
"I'll find someone."
"Thank you."
By this stage I was trying to think of every phrase for 'thank you' I could, because I was supernaturally grateful to this woman, for doing what the hospital staff are paid to do. The volunteer culture has become so pervasive in our society that it's being crowd-sourced on a daily basis. In due course of a geological epoch a nurse did appear, with two Panadol, two Neurofen and one tablet of Endone^®. The former two are paracetamol and ibuprofen, the latter is a synthetic opioid that is proof of some divine presence in the universe. Unlike Pethadene^®, which saved me from the most painful experience of my life back in 1995, this didn't give me a rosy warm glow and a sense that, although the pain was still there, I didn't need to worry about it. This stuff, the active ingredient of which is oxycodone hydrochloride, eliminates the pain.

It does, however, render me somewhat woozy. The first volunteer, Jill, came up and asked me how i was getting on and if I'd been seen yet.
"Seen? Yes. No. Not seen. Yes, seen. I've been seen. I'm just waiting for a doctor," I replied, running off the cogency area into some weird, warm, woozy world. She seemed to get the idea, though, and went off about her volunteering. I felt extremely grateful to her, too. The people who actually care about you are volunteers and passers-by, but I had a kidney stone so I was lapping up the pity wherever I found it.

At 11:48 a doctor came out and asked for me. Not bad. I'd only been in emergency two hours or so, but it was mainly the two or three people who were called for but didn't turn up that had got me in this fast, I assumed. Pain or not, I hadn't lost blood, consciousness or movement, so I was low on the triage totem pole that morning. In any case, he asked for my medical hisgtory. I gave him the ol' spiel about the diabetes, the glass eye etc, and said that the eyeball history was complex but if he wanted it, stand by. He sid that was okay. Had I had a kidney stone before? Yes, January 2004. Can I give a urine sample? Well, it had hurt like hell to pee, but maybe I could. He gave me a specimen jar and I hobbled off to the toilet. Yes, the Endone had taken away the pain, but I wasn't going to push it. In due course I was able to squeeze out a sample, a short stream of urine that stopped too suddenly, as if there was something blocking the stream. Well, of course there was if I had a kidney stone, but it was an odd sensation. The urine itself had most unfamiliar colour, resembling nothing more than a brush-cleaning jar after you'd been hitting the watercolours for a decade or so.

"Looks like there's blood in the urine," said the doctor.
"What?" I said, alarmed. Blood in the urine is supposed to be a bad thing.
"blood in the urine is what we would expect with a kidney stone. So we will admit you for a CT scan to determine exactly where it is. Are you in pain?"
"No, I'm feeling okay at the moment. Slight loss of balance, though."
"Well don't worry, we'll get you a wheelchair."
"No, I can walk."
"How good is your vision?"
"Ah, good point."
The ol' eyeball had got very blurry indeed, proving that it is very sensitive to pain, illness and whatnot. So in the end I accepted the wheelchair.

They got me a bed 13 in ward 3 North. At this point I should say how attentive the staff are at Ballarat Base Hospital. Once you're actually admitted you get a lot of good help. so I settled down and they got my clothes and put them in a bag while I got into a gown, and they went off to sort out a CT scan (CAT scan) to determine where the offending chunk of calcium or whatever it is was located. This required me to drink 300ml of water to fill up my bladder and then to hold my breath while they tomographed me.

With that information they were able to get me up to the actual ward while the urologists had a squizz at the photos. They were able to identify a 4.5mm (diamter, I assume) kidney stone in the left ureter, same as the previous one, which was obstructing urine flow. The kidney could possibly be infected, which is not a good thing. Well, no infection is good, but in a kidney it can be particularly nasty, I'm told. Then it was time to lie down on a bed and get wheeled up to the actual bed. The Endone was working well, so I could've walked with some assistance (since the eyeball was still blurry), but I was in a gown with bare feet so they insisted on wheeling me around.

Around 3:00PM the urologists came down, or up, I don't know where their offices are, to say they had identified the stone but they needed to go in for a closer look, and to put a stent in there. They don't naturally appear there, so this would require surgery.

The problem here is that I can't find a record of when I posted to Facebook that I was going in for surgery. I know I did it but the precise timing escapes my memory, and I was relying on Facebook to at least give me the timestamp for it. I've had a fair bit of surgery, but not so frequently that it isn't something unusual or remarkable. This lot of it was gong to not be the eyeballs, and that is unusual and consequently remarkable.

In any case, they wheeled me in, and got me to sign a consent form I couldn't read. Meh. If you can trust a publicly-funded hospital system, what can you trust? Plus, they might get in there and do a lot of unnecessary, experimental or recreational surgery, and might not get paid for it, so of course there just going to do the proper thing, so it was safe enough to consent to whatever it was. Then they asked me what it was. I parrotted what I'd heard them say they were going to do as they were wheeling me in, so I said:
"A Richard's sysyphtry, where you'll have a look at the stone and its location and then put a stent in to widen the ureter—left ureter—nd drain the kidney. Then you're going to use a camera to look at the stone."
"That's a very clear decription."
"Yeah, I've had a lot of surgeries, so I'm used to these. But I do do better on eyeball ones. I don't know much about this end of the body at all."
Yes, I was thinking to myself, 'Oh, I'm all nice and calm. I'm handling this' when in fact my actual nervousness was telegraphed by my garrulity. This wouldn't end soon, either.

In fact and real life, the procedure is a 'rigid cystoscopy', so I was way off. anyway, the anæsthetist asked me the various anæsthesiological questions and I could answer those with confidence. I asked:
"Is there any way we can do this without a general anæsthetic?"
"We could do a spinal."
"What does that involve?"
"We give you a local anæsthetic to numb the skin and then an injection to numb you below the waist. That injection just feels like pushing on your back."
"We won't be there that long," said the urologist. "Are you sure you don't want a general?"
"You could be in there for two minutes," I said, "and I'd still feel crook as a dog for hours afterwards, which I'd rather avoid if there's any way to do it."
"I can't see any reason for a general," said the anæsthetist.
"Well, we won't be very long, so you won't be under very long," said the surgeon.
"I'd still feel crook no matter how short it was," I replied.
"Okay," said the surgeon.
"Okay," said the anæsthetist.
"Okay," I said.
So I rolled over on my left side, wincing as the movement of the internal tubes put pressure on the dexter bits. 'Dexter' because you use the terms 'dexter' and 'sinister' to describe positions from the point of view of someone looking at you, so bits on my left are on the right of me if you're looking at me. Then I felt them washing my back with something cold.
"What is that, Betadine?" I asked.
"Chlorhexadine," said the anæsthetist.
"Ah, I've washed my hands with that after some of the eyeball surgeries."
"Skin anaesthetic. A bit sharp," said anæsthetist. He was quire correct, but that was no different to the canula in my arm they had taken a blood sample with.
"Anaesthetic," said the anæsthetist. (See what I did there?)
There was no sharp pain, but there was a feeling of something the size of a drainpipe being pushed into my back. If you're as old as me, you may recall this long pushing sensation in your gum when the dentist anæsthetised you. It felt just like that. In due course, I could roll onto my back and they could get started.

The first thing they did was put up a screen between my eyes and my naughty bits. I pointed out that I could barely see anything, so I wouldn't need a screen, but they put it up anyway. This was probably also for infection control as well as my perceived squeamishness.

Meanwhile, everything below my navel was deadening. I could still feel my legs, but that was going, too. They put my legs into the stirrups, and I could feel them change position, but I certainly had no motor control. In a few minutes, the feeling below my waist had disappeared completely. Was this what it felt like to be paralysed? How horrible. They started doing things I couldn't see, because of eyeball blurriness and the screen, but I was laying back wondering what was happening. Then I realised I could still feel my legs a bit. I began to do what I do when I'm feeling ill or miserable—I think about the Jews etc in the Holocaust who had all these experiments done on them, and how miserable they were, and why I shouldn't be complaining too much because at least that isn't happening to me.

At the same time, nervousness about this unusual position having its effect: garrulity. I couldn't shut up talking to the anæsthetist about whatever thought came into my head. We ran the gamut of what the anaesthetic chemical was to identity theft and how I thought I'd found the guy impersonating me at the emergency room earlier that day, which showed etc etc etc and how I'd been on a jury with one of my relatives, and how I'd moved around the corner from the only other person in Australia with my initials (who recently died, incidentally).

During this time I felt a bit short of breath. This is good information for anæsthetists, as they like to keep you breathing during surgery, so I advised him accordingly. He said my oxygen saturation was 100, which was where they wanted it to be.
"Well, I can't—eeyagh—expand my lungs properly," I said, gasping a bit.
"So, it's your diaphragm."
"Diaphragm, yes. Like something's pushing my diaphragm."
"That's what it is. They have to insert the stent in near your kidney, and your kidneys are just under your diaphragm."
"They are?"
For five and a half decades I've thought my kidneys were down in my lower back, where I'd felt the pain that morning, in line with my waist, but they are actually much higher up the ol' trunk. With his new knowledge I could calm down but the amount of pushing going on suggested that they were using something the size and like of a Greathead Shield to get the stent up there.

In about twenty minutes they had finished their surgery, andI could be wheeled back to the ward. They got me off the surgery bed and into the normal bed. It felt like my legs were still in stirrups.
"Are my legs flat," I asked.
"Yes."
"It feels like they're still in the stirrups."
"That's because your brain is recalling the last position it could feel them in. Once the anaesthetic wears off they'll feel like they're in the right position."
"Huh!" I exclaimed surprisedly.
I patted my legs. This was even more surprising. I could feel the pat in my hands, but I couldn't feel any impact on my legs. This was a very weird sensation, and I thought again about how it must feel to be paralysed. I did a few drum solos to get the full effect, and then settled back to wait for something to eat.

In due course of time they brought around some coffee, which I elected because it's easier to consume in bed, and some biscuits. A bit later on they brought around some tea—that is to say, dinner—which was chicken and gravy. I still wasn't seeing too well, so eating it was a real chore, and cutting up the chicken some kind of weird prandial roulette, with blades chewing away at the plate, the veggies and anyone within range, and then the dredging or levering process to get the food to my mouth without bits of it falling all over the place.

One other aspect of the anæsthetised gams was what it is like to move around n bed with the dead weight of them dragging on you. It was taking some considerable effort just to sit up enough to eat properly. This is an insight into the life of the paralysed that I don't think everyone should have, but if you get the opportunity it is most enlightening.

Other surgeons were coming in to talk to the other people. I was surprised to find that one of the girls in the ward—oh, yes, coed wards—had had a cornea graft. I didn't know they did them locally. Handy. But I doubt they would tackle another graft on me, but they could probably learn something by loooking at my eyeballs. Another woman there, and I don't know why I use different words to describe these females, except that the 'woman' had a birthday near mine and thus gets the 'senior' noun, was in for some kind of cancer treatment. It's amazing how some people can be in a miserable state and still be happy and cheerful, and other people just wallow in self-pity and relish how miserable they can seem. Still, I suspect she felt a lot worse than I had at 10:30 that morning, and she was looking at a much longer stay in hospital than me.

And so to a sleep punctuated by observations and whatnot.

Wednesday morning I had some corn flakes and juice and coffee for breakfast. Hospitals generally have much better breakfast than I have for myself. After breakfast, I lay around just staring at the ceiling while the feeling in my legs came back. Several times they asked me whether I could wiggle my toes or move my legs, and I made the effort, or formed the intent, to do those things but had no idea whether they'd complied or not, not being able to see or feel whether my legs and toes were doing what I told them to.

They wanted to check whether I was emptying my bladder properly. Fortunately, I could tell that my bladder was full and had a bottle to pee into, and by around 11:00AM I could even walk, slowly, to the toilet. I peed away, grimacing with the pain, and then came back to the bed. Tjey use a kind of ultrasound to determine how much liquid is in your bladder. I pulled my jama pants down low enough for the nurse to use the thing, which exposed my penis to the nurse. Now, I like to think I'm not as fascinated by my penis as the feminazis think I should be. I just thought that that's how far I had to dak myself in order for this thing to work.

Around 2:00PM I had peed enough, and was empty8ng my bladder so that there was less than 130ml of urine in there. My legs were tingling but they would obey me now and I could walk at something like a normal pace. I had had lunch and was feeling much better than I had 28 hours previously. I got dressed. The urologist came up and was about to get me to sign a consent for the next stage of surgery, when he suddenly realised that I can't sign anything, or consent to anything, since it was less than 24 hours since I'd had anæsthetic. Even though I had remained conscious, lucid and garrulous through the whole thing. Ah, well.

They made up some antibiotics and other stuff for me, after contacting both the GP and the chemist to make sure they got a complete prescription for all my medications, even though they only filled the antibiotic part of it, and I was out of there by 4:30 and getting a cab home.