The Course of Reason

Medicine: Where Real Miracles Happen Every Day

December 20, 2011

As many of you know, I’ve been off the radar the past few days due to a kidney stone. Note: Some of the following will contain some explicit medical descriptions, just to let you know. I’m also still on pain meds, so I apologize in advance if this post is a bit rambling!

 

So, on Tuesday, I was over at my parents’ house taking a nap. Around 3:30 PM, I woke up because of some kind of pain in my abdomen. I though I just had to take a leak, so I went to do that, but didn’t have much luck. Some time passed, and the pain was getting worse, and I thought I should try defecating, but again didn’t have much luck. I waited awhile as the pain worsened further, and thought, if this hasn’t cleared up by the time my parents come home, I will talk to them about it (they are both medical doctors).

By 4:30, I knew there was no way I could wait until 6ish for them to come home, so I called my dad and explained the problem: I had some kind of pain in my belly, hard to describe, mostly in my right-front side. It was enough to wake me up an hour ago, and had only gotten worse in the meantime. Because unknown abdominal pain can turn life-threatening in a very short amount of time, he suggested that he should come home early and take me to the emergency room to find out what was wrong. I agreed, and after a few minutes of mentally pumping myself up, I stood up to go downstairs to get my shoes & glasses. I made it to the hallway before I had to start crawling, and by the time I got to the top of the stairs, I collapsed, writhing in pain.

My dad found me a few minutes later and helped my down the stairs. I have never felt pain like that in my whole life – it felt like I had been kicked in the testes at the same time someone had stabbed me in the side and twisted the knife. I do remember the drive to the hospital, but mostly because I was going back and forth between moaning and screaming the whole time.

My dad gave his medical opinion as a kidney stone, based on the fact that I had pain in my groin in addition to my belly, and that during the drive, small bumps didn’t seem to make it hurt additionally (in cases of appendicitis, jostling – like when you go over a curb in a car – makes the pain much worse).

This came up when I googled “kidney stone.” I don’t know why.

At the ER, I don’t remember a whole lot about checking in other than that I was hyperventilating and when they sat me down to take my blood pressure, I nearly broke the swinging arm of the chair from gripping it too hard. They lay me down on a bed and gave me IV pain meds (Dilaudid) and also an anti-inflammatory and something else (I don’t remember what). After that kicked in, they asked me to rate my pain, and I remember saying it was down to about a 7 on the 1-10 scale posted on the wall – distressing, but no longer unbearable. I remember asking who the nurse was who gave me the pain meds, and saying to him, “Thank you.” It was very important for me to do that at the time – I’m sure it was partly the drugs, but I remember thinking, THIS is who deserves the credit for my feeling better right now, and it was important to me that he knew it. I don’t remember if or how he responded, since I was kinda out of it.

The doctor saw me a little later and ordered a CT to positively rule out appendicitis, and to confirm a kidney stone. They gave me some more pain meds and wheeled me off for the CT, which confirmed a kidney stone. Around 8:30, they sent me home with a prescription for Percocet, one for an anti-nausea medication, and another for a medication called Flomax, which is usually prescribed for prostate-cancer patients – it helps loosen the abdomen to make passing the stone easier. They also gave me a thing that looked like a funnel with a screen in the bottom, with instructions to urinate into it each time I had to go, in order to catch the stone, so they could analyze it after I passed it.

A lot of human behavior makes more sense when you keep in mind that for much of our evolutionary history, food was scarce. We hunted when we could, and ate whatever we could find before other animals got to it. Whether that food was spoiled or not was a secondary concern. The purpose of the anti-nausea medication was explained to me this way: Apparently, our bodies respond to abdominal pain by saying, “I don’t know what the fuck is going on; better vomit just in case in was bad food.” I didn’t sleep at all that night, but I did manage to vomit up the first two Percocet I took (3 hours apart), as well as the anti-nausea medication and the Flomax. I’m estimating I vomited about 15-20 times that night, and was unable to keep down any water either, which – along with the vomiting itself – makes it rather difficult to work up enough urine to pass a kidney stone. The next morning (Wednesday), the pain was just as bad as the day before (since I couldn’t keep down any pain meds), and my dad took me back to the hospital so they could give me pain medication and some fluids via IV.

Since I was so dehydrated, they were unable to find a vein, and they had to stick me in the bicep. They eventually got the pain meds going and gave me two bags of saline, too. As it turned out, the reason I was in so much pain was that the kidney stone got stuck – I was too dehydrated to pass it, so they decided to remove it surgically.

Now, here’s the fun part. This is how you remove a lodged kidney stone: First, they put you under general anesthesia. Then, using a scalpel, they cut the opening at the tip of the penis open a little wider, so they can snake a flexible, tube-like instrument up your urethra. The instrument has a camera at the end, and a tool for grabbing the stone once they find it. They snake this device up your penis, find the stone, then reverse course and back it all the way out. Then they snake the instrument back up there and put in a stent (a little plastic tube thingie) and install this in your kidney where the stone was, to keep the blood flowing while your body heals. The stent stays there for about a week. Then you come back to the hospital, they put you under again, and repeat the process with the scalpel and the snaking instrument, and finally take the stent out.

When you wake up from this, the tip of your penis is bleeding and you have to urinate (since they’ve beeng giving you IV fluids this whole time). They tell you there will be blood in your urine, and that’s normal. So you get up to go pee, and you can look forward to that very same stabbing pain in your lower back, in addition to an unbelievably painful burning when you urinate – that’s the uric acid flowing over the cut in the tip of your penis. “Blood in your urine” is an understatement; it looks like you’re pissing straight blood, and feels like it, too. The same happens the next two or three times you go to the bathroom, until the tip heals. After that, it doesn’t burn from the acid anymore, but the feeling of being stabbed in your kidney is still there every time you go to the bathroom.

When I see it feels like you’re being stabbed in your back, I mean that every time you take a piss, even with pain meds, your kidney hurts such that for the next 45 minutes or so, you can barely stand up. There’s really nothing you can do about it except wait it out, and take pain meds. I’ve developed an aversion to drinking over the past few days and have had to force myself to remember to drink water so I don’t dehydrate again. I’ve lost about 8 pounds since this started, I’m guessing mostly water, although I’ve also only eaten two small meals total since Tuesday AM (it’s now Sunday AM).

I go back to the operating room on the 22nd to have the stent taken out, and I’m told that I should be okay to resume regular activities a few days after that. Whew!

Historically, we didn’t really know much about what caused disease. We still don’t really know what causes kidney stones specifically – some people believe there is a tie to drinking lots of soda (because of the phosphorous), but studies are inconclusive. Lots of people drink soda regularly and never develop kidney stones; others rarely or never drink soda and still get them. It’s rare for people to get them more than once, so it’s hard to attribute them to some sort of dietary or activity pattern, although taking excessive amounts of vitamin supplements (containing minerals) can cause them.

For hundreds of thousands of years before modern medicine, society’s best guess for things like kidney stones or appendicitis was cosmic punishment. All we knew was what we observed, which is that out of nowhere, somebody develops excruciating, debilitating pain. In cases of appendicitis, before modern surgery, it was not only excruciating painful, but fatal. Without the ability to remove an inflamed appendix, there was nothing you could do except wait for it to burst. People tended to become septic and die soon after.

It certainly does feel like punishment, considering that these things strike without warning and nobody is immune from having a few skeletons in their closet – it’s very easy to put 2 & 2 together, even if “cause” and “effect” are totally independent. That is why we have to be so careful when trying to link cause & effect – correlation does not imply causation. I’m reminded of an old “Got milk?” television ad:

Why is this man’s partner upset at him? Although she lets him in on the mystery at the end, imagine if she was an imaginary, invisible god instead of his partner. Lacking any surefire way to communicate with her, the best he could do would be try to apologize or offer sacrifices whatever he might have done to offend her. This is more or less the basis of the practice of sacrifices in various world religions, from the Aztecs and Mayas of the ancient Americas, to the deserts of the ancient (and current) Middle East, to the “offerings” of cash in churches, mosques, and synagogues around the world.

Deep down, even though we may do our best to live ethical lives, we’ve all done at least one thing we’re not proud of. Naturally, we’re seeking forgiveness for the things we wish we hadn’t done. We want to be told that we’re still a good person and that life goes on. It’s easy to anthropomorphize nature, and once you cross that line, it’s even easier to believe that some agency is keeping track of our wrongs, if we don’t know better. At that point, all we’re “waiting” for is someone to come along and tell us that this “God” is pissed, and you can make it all better by giving your money to “God” (although, of course, in practice, it really goes to the person claiming knowledge about how to make it all better). I consider this tactic the height of immorality. In the words of John B. Hodges, “Religion… gives a moral blank check to those bold enough, dishonest enough, to claim to speak for God.”

And it does feel good to do something to pay back our wrongs. When we hurt someone, we want to make it up to them. When we’re not able to do that, it feels wrong to just shrug and say, “Guess I’m off the hook then.” Somehow, it feels more moral to do something to say we’re sorry, even if we know, rationally, that they’re independent.

As humans, we like having answers to our questions. We like being right and having a sense of understanding about our environment. This makes sense – what we don’t understand is scary and potentially dangerous, so it’s in our best interest to try to figure it out as best we can. When it comes to detecting patterns in nature, evolution designed us to be paranoid, not accurate. This is, I think, one of the most important realizations in all of scientific inquiry. We have this desire to “just do something” when bad things are happening, even if our actions are useless or even when they actually worsen the situation. We don’t like feeling powerless and the idea that “things just happen” can be scary. I understand that.

But that doesn’t mean that karma is real, that fate is real, that everything happens for a reason, nor that there is a pattern to everything. We are excellent at detecting patterns – too good at it, actually.

I think as a society, we could make amazing progress on a vast array of social, political, and economic problems if we required all high school students to take introductory statistics, probability, and philosophy of science. I am continually dismayed at how few people, scientists even, understand the problem of induction, or understand basic concepts in epistemology and the philosophy of science like the difference between a fact, a theory, a hypothesis, a law, a model, and a proof. This is something we can fix, if we decide to.

In closing, I want to thank everyone out there who has paved or is paving the way for science to help us solve our problems. I certainly appreciate the knowledge and abilities of the medical staff who have helped me the past few days, and I sincerely say, thank scientists for painkillers. You are awesome.

- Dave

This post originally appeared on the MU SASHA blog.

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About the Author: Dave Muscato

Dave Muscato's photo

Dave Muscato is Vice President of University of Missouri Skeptics, Atheists, Secular Humanists, & Agnostics (MU SASHA). He has appeared in Rolling Stone, People, Time, The New York Times, SPIN, and Entertainment Weekly, and on MTV News, VH1, NPR, MSNBC, ABC, and Howard Stern. Muscato is a junior at the University of Missouri majoring in economics & anthropology and minoring in philosophy & Latin. Muscato posts updates to the Official SASHA Blog every Monday, Thursday, and Saturday. His website is DaveMuscato.com and he can be reached at mail@DaveMuscato.com.

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