My First Surgery
What Happened?
I just recently experienced my first illness that resulted in surgery. After 10 years working in the operating room, I finally saw what it was like from the patient’s perspective. On a Thursday evening I had a sudden onset of intense left flank pain that I could not find relief from. I was nauseous and wasn’t able to hold any medication down. I also had noticed decreased urine output. After hours of dealing with the pain and telling myself it would pass I decided I wasn’t able to take care of this at home. I had a pretty good idea a kidney stone was what I was dealing with. I finally went to the ED about 0300. I was so confident in my diagnosis that I wrote “possible left kidney stone” on my ED check in slip. I’m sure that got a few eye rolls. They got me triaged and back to the room immediately. I think every person I spoke with said “have you had kidney stones before?” Each of them shocked when I said no. I was barely changed into the hospital gown when the CT tech was there to take me over for a scan.
Diagnosis
A few hours later (thanks to remote radiology) results were back. I had not one, but two kidney stones lodged in my left ureter obstructing the flow of urine causing hydronephrosis. The stone proximal to my kidney was 10 mm! Yes, 10 mm!! The distal stone was still an impressive 7 mm. There was also one floating around in my kidney just waiting to try to make it down my ureter. After the ED dox consulted urology, I got a phone call from the urologist talking me through his plan (perk of working in the OR). The plan was a cystoscopy with retrograde pyelograms, and stent insertion. This was a ‘palliative’ approach because unfortunately, I also had a UTI, he was hesitant to enter my ureter with a scope and risk sepsis. Instead, he suggested a stent placement to allow my kidneys to drain. This would allow time for the antibiotics to treat my UTI, it would allow my kidney to drain, and the stent would somewhat dilate my ureter making things easier for my next surgery. The second surgery will be scheduled as cystoscopy, ureteroscopy, retrograde pyelograms, holmium laser lithotripsy, possible stent exchange versus removal.
Surgery Here We Come
Of course, I was able to hand pick the team that would be taking care of me (another perk!). I remember scooching over to the cystoscopy table, the CRNA fluffing my pillow while saying that she didn’t like my IV, then nothing. The next thing I knew I was getting warm blankets and was rolled by the family waiting room on my way to recovery (phase II) where we picked up my husband and oldest son. While we were in recovery, the nurses knew my son had a tonsillectomy last week and offered him a snow cone—he was so excited. Unfortunately, the plan was to admit me due to the risk of me becoming septic. I learned that during the surgery, after they inserted the stent, I had purulent drainage from my kidney. I am still unsure how I never had any symptoms of a UTI or kidney infection, not even a fever.
To The Floor
After not sleeping the entire night before and having four young kids at home (if you know, you know) that was some of the best sleep I have gotten in a long time. Yes, I was woken up every few hours for vitals, but all I had to do was raise my arm for the blood pressure cuff—I didn’t have you to use any of my brain cells. I woke up the next morning, got some breakfast, then spoke with the surgeon about discharge and what plans from here are. He commented that the culture results aren’t back yet, so sometimes that prevents the hospitalist from discharge, but he would do his best. He sure did too. In his follow up note he wrote “Pt. is an OR RN. She will report directly to me with any concerning symptoms and will follow up for culture results”. Those were the magic words. Again, perks of working in the OR!
Still Stones but No Pain?
At one point when I woke up through the night, I started wondering how I am no longer in pain, but the stones are still there. I was in disbelief that the stent stopped the pain. When speaking with the surgeon in the morning I said I couldn’t believe that I’m not in pain considering the stones are still there, so the pain must be because of the hydronephrosis?”. He said I was correct and was happy that it had for the most part resolved my pain. I was left with only a little discomfort. So, now I’ll live with a ureteral stent for the next few weeks before my next surgery! Wish me luck!
What Caused My Stones?
I know there are various reasons that stones form and that the main reason they become stuck in the ureter is related to their size/shape. I explained that to my husband, but he still asked the surgeon in pre-op, he replied with “dehydration.” Nurses (hello!) and teachers are at high risk of dehydration leading to stone formation and potentially obstruction. Then I began thinking about it, I likely was very dehydrated over the last week, if not month! The previous week, my oldest had a tonsillectomy and had a rough first week so I was heavily invested in his care, not necessarily my own. I tried to recall when I filled my water bottle up last, and I couldn’t. Then, thinking back weeks before my husband was hit with a bad viral illness that also raised questions about potential blood cancer (CLL). During that time, I was doing all the parenting, housework, etc. alone while he tried to rest and recover. Another time I highly doubt that I filled my own water bottle. I will also admit that I do enjoy a white monster, which is also no help toward dehydration or stone formation. I assume this all played a part in why this happened, but the stone analysis will tell us more.
