Adventures in Gallstones: Part 1

  I woke up at 3am Friday morning in excruciating pain.  I couldn't call for help. I couldn't scream. I just lay in bed, gasping in pain.  Penguin was next to me, and my cell phone was just out of reach. Mr. C was right downstairs, but I couldn't do anything.  I switched into labor pain management techniques. Breathe, breathe, breathe.  Eventually the pain lessened just enough to get movement in my body to get downstairs to get help.  I gathered up the baby, and got downstairs.  At that point, I could only manage the word "pain" "Pain...PAIN. take. baby." And ran to the bathroom.  I vomited bile. 
       I got into the shower, turned on the water, and curled in fetal position on the floor of the tub.  Rob kept asking me to describe the pain, and the animal side of my brain wouldn't let up enough to give me the words beyond a strange howling sound.  He did some massage, gave me Ginger tea, and activated a few points which brought the pain from a 9 to a 6 or a 5. Thank god he studies acupuncture.  I decided to go to the hospital, and called my dad to take me there. The hospitals near here are...questionable. I wouldn't be able to relax enough to be treated. I knew if I traveled farther away, I'd get better care.  Mr C got me to the point where I was stable, and asked me to run through my head what I would say if they told me I would have to have the gallbladder removed.  He was certain that was what they would want to do right away without asking.  Silly me, I thought doctors only made pressure moves like that during childbirth.  I said that even if the pain got really bad again, I would want to wait for emergency surgery until I had more facts, and felt comfortable with the idea of the surgery.  I wouldn't want to feel pressured or violated. 
          During admission,  I had another attack. Let me just say that I gave birth, at home, and had a second degree tear.  Gallstones are WAY more painful.  The woman at the desk was asking me my phone number, and tears are just streaming down my face.  I had to breathe, contraction like, through each number, bearing down white knuckled on the edge of the counter.  My dad rubbed my shoulder, and just tried to urge the woman through the necessary questions.  She went as fast as she could, but it still felt like days.
          I entered triage.  The pain had passed, or at least lessened its hold.  The triage nurse got through all the questions...and then her computer crashed.  Another attack started.  Again, birth prepared me for what nothing else could have.  I just had to raise above the pain, and get through it.   The ER was quiet. Empty. Almost peaceful.  The very kind doctor explained that I had classic signs of gallstones, and explained that depending on what they found would depend on the kind of treatment.  I explained that I was a nursing mom and would need a breastpump.  He congratulated me, and got me one right away -- personally making sure that it worked and that I understood how to use it.  A medical student did a "practice" ultrasound -- before pain medications were administered.  I offered up my pain to it being a "learning experience."  As he got to the areas where there was more pain, he got a better image.  I just focused on the idea that my experience would make him better able to diagnose future patients.  He was very kind, and explained that this ultrasound wouldn't count. Id still be sent up to the radiology department for an "official" scan, but that this would help him, and give an initial idea of which specialists would need to be called in for consultation.
           It was surreal to receive an ultrasound for something not prenatal related.  I joked with the doctor "so is it a boy or a girl."  He commented that I was in an amazingly pleasant mood for what must be excruciating pain.  
           When he finished, the nurse came to put in an IV.  My veins are hard to get, and the needle bounced right off, causing a huge bubble of blood to form under the skin.  Even now, 8 days later, I have a three inch by two inch bruise.  Eventually he got it, and I was given morphine.  The pain loosened its grip, and I was put in a wheelchair and wheeled away for my "official" ultrasound.
           It was surreal to be on morphine, lying on my back, again getting pushed and moved to see the gallbladder.  Apparently, my gallbladder was so inflamed it had stretched and distended far beyond its usual size.  Just by having me roll forward the technician could see stones move.  I saw the look on her face.  Knowing that she would get in trouble for giving unofficial information, I let her know what I saw on her face.  She tried to comfort me by explaining that she had her gallbladder out last year, and that after the operation, the pain was gone.  
           Wheeled back to the ER, I was informed officially that my gallbladder was filled and distended. I had stones in the common bile duct, one of which was approximated at least 5mm in diameter.  I would need to undergo two operations: a endoscopic retrograde cholangiopancreatography/ sphincterotomy. and a cholecystectomy.  My blood levels would determine the order of operations.  The fear was that if the gallbladder/bile was already infected, I could develop a systemic infection and die.  Or, the blockage to the pancreas could cause pancreatitis, and I would develop a systemic infection and die. Or...(insert variation here) and I would develop a systemic infection and die.  Bowel perforation, tearing of the duct, etc...lots of ways to go.
I know because I asked.  They wanted me to just sign off and do the surgury.  "But you'll die without it."  Urgh. It felt like the "dead baby card" women get played when in labor.  
"But you could die" is not an acceptable reason for me, at least not with out quantitating the information.  I live in NYC. I could get hit by a bus and die.  There is pollution. I could have a ticking time bomb in my brain. There a multitude of things that "could" kill me.  And I needed to be convinced before I'd let them just slice me open.  I wanted to know options, alternatives.
This frustrated the female intern consulting on my case. "But, you'll DIE. You HAVE to get this surgury."
Me: "with all due respect, it is called informed consent for a reason. I don't HAVE to do anything, I can sign myself out AMA and be done with this.  I need more information and explanation."
Her: "You. Will Die. Without this surgery. And it will be painful. If it was me, I'd get the surgery. Now. Right away. You can't wait with this. We have to do it."
Me: "How would I die? How? What is the mechanism? What are the percentages? I have to think about this.  There are often other ways around a problem. I have to know more about this."


The poor intern was just beside herself.  I imagine they don't get a lot of kick back.  They eventually brought me the head/program director of the gastrointestinal department to talk with me and answer my questions.  I felt better. Small victories.  I knew that if I could feel "good" about going into the surgery, I'd stand a better chance of recovering.  


Next, I met with the surgeon who would do the cholecystectomy.  That surgery would need to wait until my body had healed at least half a day from the first procedure.  I had time, and refused the surgery until I could get more information.  My dad said to worry about that when the time came.  One thing at a time.  Eventually, I was admitted to a bed upstairs, and an orderly came with wheelchair to gather me and my belongings to the next level.


Coming next:  Nurse Rachet and the Rachettes, Penguin Saves the Day, and Don't leave life and death paperwork to right before you get on a gurney....