complex simplicity

A few months ago, I woke suddenly at 3 a.m., aware that something more than just the recently-released Marvel movie The Eternals was very wrong. I felt movement internally on my left side, and soon I was in the bathroom, on my knees, worshipping a cold and unforgiving porcelain god.

I’d indulged in a package of delicious, day-old discounted sushi 12 hours before, and now, unable to keep down any food or even water, it seemed I was suffering from a clear case of food poisoning. Acute pain in my side, which I attributed to stomach cramping, had me popping ibuprofen and unable to sleep more than an hour or two at a time. But visits to Urgent Care and RWJ Hospital revealed that the sushi was “off the hook” in not just one, but both meanings of that idiom—a CAT scan revealed a “medium-sized” (5 mm) kidney stone as the cause of my misfortunes.

Kidney stones have a long-standing reputation for causing discomfort, as evidenced by their regular appearance on lists of the most painful medical conditions, alongside problems that sound like they were made up by the writers of a TV hospital soap opera, like “trigerminal neuralgia,” “complex regional pain syndrome” and “frozen shoulder.” An appointment with a urologist to review my treatment options had me walking not into an examination room, but a plush office that made me feel like I was applying for a loan, a feeling that was not altogether off the mark.

My pain had lessened significantly, and the doctor explained that the stone had probably reached the bladder, which would provide a respite but didn’t address the underlying issue. Using tongue-twisting terms like “percutaneous nephrolithotripsy,” “laser lithotripsy,” and”extracorporeal shock wave lithotripsy,” he described the options for therapy: something to do with surgery, something to do with lasers, something to do with ultrasound, or another procedure in which he’d “go in and extract it.”

“Or,” the doctor said cheerfully, “you could do nothing.” There was, he said, a better than 50/50 chance that the stone would pass naturally. A “natural” delivery sounded nice, but bore all kinds of potential for pain, as any woman who’s endured natural childbirth can attest. (In another strange link to childbirth, some people feel the need to name their kidney stones; I did not, but I admit, possibilities flashed through my head: Roger Stone, Stone Cold Steve Austin, or, keeping with the wrestling theme, Dwayne “The Rock” Johnson.)

Since my health insurance has a high deductible, a significant portion of any medical expenses would fall to me. So, before making a decision, I asked for an estimate of costs for each procedure. The doctor chuckled and said, “I have no idea.” Indicating his office staff, he continued, “You’ll have to talk to them outside for that.” I left, happy that I could brighten his day with a bit of amusement.

The next day, after several phone calls and the acquisition of many procedural codes, I was able to get a rough idea of the expected costs. It was rough indeed. “So at least $3,500,” I said, confirming understanding. I still don’t know if that included anesthesia, which seemed to be considered separately as if it were a non-essential upgrade, comparable to adding cheese to a hamburger deluxe.

Over the years, I’d heard stories about the pain of passing a kidney stone, so it seemed like a good idea to try to avoid it. On the other hand, I couldn’t imagine anything being much worse than what I’d already experienced. Feeling lucky, cheap and in no pain, I decided to do nothing and hope for the best.

But given the stakes, I wasn’t really about to do nothing. There are a lot of unproven self-treatment suggestions for kidney stones on the internet: some recommend apple cider vinegar and olive oil; one calls for drinking the juice of a can of asparagus, and following that up by downing of 10 to 12 cans of Coca Cola. In 2018, scientists won an Ig Nobel Prize for their discovery that riding certain roller coasters aids the passage of stones from the kidneys, sending them on toward the bladder. I was past that point, so a visit to Six Flags, however enjoyable, was unlikely to help.

Comparing information and judging sources, it seemed the best thing for kidney stones—preventing them or passing them—was to drink a lot of water, preferably with lemons or lemon juice, since the citrate in citrus can help break up stones.

Some sources recommended at least 64 ounces a day, others 100 ounces, another one 5 liters, or 169 ounces. That’s about a 10 oz. glass of water every waking hour. Other advice focused not so much on what goes in, but what comes out, citing 1.5 to 2 liters of urine a day as a good goal. I’ve never tracked my water intake before, but doing so seemed easier and more pleasant than measuring urine. Either way, it looked like I was going to be drinking a lot of water.

As health-driven lifestyle changes go, this one was pretty easy to implement. But there was a new complication: I had to pee. Constantly.

Any trip outside was an adventure, since even a short walk with the dog could end in a mad, urgent dash back to the house—or more specificially, the bathroom. Some situations—standing in check-out lines, for example—presented tough choices, reminding me of childhood hide-and-seek games in which maintaining a well-chosen hiding spot competed with a bladder’s warning of imminent explosion. At social gatherings, I often “danced like no one was watching,” as William Purkey once advised, but it was always the foot-hopping improvisation known to children and parents as “the pee-pee dance.”

In the weeks that followed, I got to know the locations and states of disrepair of dozens of public bathrooms, and in less-trafficked areas, made note of clusters of bushes or trees that might do in a pinch. One night, far from home and desperate for relief, I brought my dog into a park bathroom with me; another time, we drained our bladders simultaneously against a massive old tree that surely deserved more dignified treatment.

Seeing this pattern as unsustainable, or at least likely to lead to a ticket for public urination, I began planning and adjusting my hourly water intake based on where and how long I’d be out that day. Nights were a challenge, too, as I went from sleeping uninterrupted to waking multiple times; my dreams were saturated with images of large bodies of water, swimming, and drowning, until I set a limit on liquids after 8 p.m. These adjustments helped, but they also meant I’d have to drink even more water during the other hours of the day. The benefits of adult diapers never seemed so compelling.

On the plus side, I saw the insides of friends’ bathrooms for the first time in 15 years. I was finally able to relate to the complaints of older men who’d been prisoners of their bladders (or their prostates) for much longer than me. And I certainly wasnt dehydrated.

The ancient Persian adage says, “This too shall pass,” but apparently my kidney stone didn’t know that one. The prevailing wisdom says that a kidney stone the size of mine should pass within an average of 45 days, but month after month has gone by without any unusual sensations. Friends ask, “Did you pass it?” and I respond “nope” or “not yet,” while eavesdroppers are left guessing the subject of our conversation, unaware that after age 40, the phrase “Did you pass it?” is less likely to refer to some important qualifying exam in one’s professional field of choice, and more likely to mean delivering a small stone out of an even smaller bodily orifice.

While another visit to the urologist might be in the future, I’ve made some dietary changes, and for now the problem seems to have resolved itself. I’ve also calmed the intensity of my water consumption, and I’m starting to feel like a normal person again, rather than a halibut. Maybe I’ll celebrate by enjoying the dry humor of Stephen Wright, along with a dry martini.

Peter Dabbene’s website is peterdabbene.com. His latest work, “Call Waiting,” can be seen at idleink.org. His book Complex Simplicity collects the first 101 editions of this column, along with essays and material published elsewhere. It is now available at Amazon.com or Lulu.com for $25 (print) or $4.99 (ebook).

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