My patient was upset with me.
He said he had horrible back pain from kidney stones. He said he’d had stones so severe before they were removed surgically. The scar was in an odd place for surgical removal of stones, though.
His urine samples were full of blood, so that was a possibility. His symptoms and his bloody urine continued, despite treatment. Funny, his CT scan didn’t show a damn thing, though. They’re usually good at picking up stones.
He wanted Vicodin or Oxycontin and/or Soma. (I hate Soma. It gets metabolized to a barbiturate, and IMHO is good for nuthin!) Got quite incensed when I told him that given his medical problems and his history of extreme drug abuse (the reason he was in prison), those weren’t good options in this particular moment. He tried to bargain. Said he wouldn’t report me to the Medical Examining Board for withholding necessary treatment if I gave him those drugs. I told him to feel free to report me; just make sure you spell my name right. Qadgop with a Q, but no U.
He demanded something be done. I told him we should get him to a urologist for cystoscopy (well, I told him we’d put a scope up his penis to see what the problem was). He said he’d rather not bother with that. Soma would be ok.
His story and his symptoms didn’t add up. Sitting there calmly and comfortably, telling me his pain was a “10 out of 10”. Blood pressure, heart rate normal. To me, a 10/10 for pain means you’re tearing the skin off your arms with your teeth to distract you from the discomfort. No relief from Toradol. Odd, the literature indicates toradol (a nonnarcotic painkiller, and a potent one at that) works better than opiates for kidney stone pain! His exam was really normal too. None of the signs were there of someone with renal colic or other painful pathology.
But we’d better do something, he told us. He was peeing blood, dammit! The newspapers would hear about this. So we did something.
I told him: Give a urine sample, now. He did, unwitnessed. Loaded with blood. See, he says! I’m bleeding. Wait, I say. We’re gonna watch you give the next one. I can’t go, he laments! No problem. Sit here, under the eye of the officer, and drink water until you can. 45 minutes later, he produces a witnessed sample: Absolutely o blood at all.
Well, I tell him. Blood in the urine can be other things than a kidney stone. It could be a fatal kidney cancer! It could be Lupus, which will also threaten one’s life and maybe send one to a dialysis machine. It could be an overwhelming infection. But you don’t have anything to worry about, because you don’t have any blood in your urine! Isn’t that swell?
As he left the office, he asked one last time if he couldn’t get some Soma.