style="font-size:15px;"> “A urine specimen. I need one now.” He handed George a urinal.
“Yeah, sure.”
“I’ll examine you after you finish. I’ll leave and close the curtains and you can pass the specimen right here. Urinate through this gauze, so in case you pass the stone we’ll catch it.”
Pollard returned, passed the urinalysis to the nurse for testing and proceeded to examine his patient. George’s pulse rate was eighty-four, and his blood pressure of 136 over 80. Not bad for a man who had been in pain and was visiting the threatening environment of an Emergency Department. Eyes, ears, nose, throat and thyroid were normal. Carotid artery pulsations were equal. There were no abnormal lymph nodes palpable. Lungs and heart were normal. Integument normal. Genitalia and rectal exam normal. Neurological examination was normal. The only positive finding was some left lower quadrant abdominal tenderness, and a positive Murphy punch on the left. The Murphy punch is a gentle, closed-fist punch overlying the kidney region in the back. If the kidneys are involved, it may cause a sudden deep pain in a startled patient. Everything was consistent with his initial diagnosis of a kidney stone. The clincher was the urinalysis report of blood in the urine.
Pollard made the provisional diagnosis of a kidney stone. Based on the test results, he also recommended hospitalization. For the first time, George fixed his expression on Pollard and bolted straight up on the cart.
“Hospital? No way. I don’t need a hospital. My pain is almost gone.”
“Are you certain?”
“Yes.”
“These stones can pass by themselves. If you’re sure you’re better, I could chance it and send you home.”
“That sounds good, doc.”
“I’ll tell you what. Stay awhile and walk around. Maybe this stone is passing, or it might have already passed into your bladder. I’ll come back soon to check on you, and if everything’s okay you can go home.”
“Okay, I’ll wait,” he said, “but I’ve got too much work to stay in a hospital.”
Pollard conceded that it was better to let this patient have his way, since he was agitated and his symptoms might be letting up.
Patient volume was already picking up. In the next room was a frightened ten-year-old boy with a lacerated hand. Pollard placed four sutures, administered a tetanus injection, dressed the wound and gave the mother verbal and written instructions before sending him home.
When he returned to check on George, he knew his patient’s pain had probably passed. He was pacing back and forth.
“Feeling better?”
“Yeah.”
“What about the pain?”
“It’s gone. I can go home now.”
“Your pain was five. What about now?”
“It’s ZERO.”
Pollard sighed knowing that George’s emphasis on the score was his way of insisting on going home. He told his anxious patient, “Look I’m ninety five percent sure it’s a kidney stone. Everything points to it. An X-ray could clinch the diagnosis. Sometimes the pain leaves and that could be temporary or permanent, but we can never be certain what will happen.”
“Can I take some medicine and take my chances at home?”
Pollard sensed his question inferred an ultimatum.
“Do you have a family doctor?”
“No, said George, forgetting or failing to mention Dr. Crowell.”
“All right, Mr. Gilmer. We can let you go since you are feeling better. Understand, this means you might have passed the stone into your bladder or are just having some temporary relief. If the pain returns, come right back. In the meantime I’ll give you the names of the doctor on call to follow up with.”
“Sure thing, doc.”
“Take these pieces of gauze,” offered Pollard. “Urinate through it like before so if you pass the stone out of your body you will catch it on the gauze. If that happens, take it to the doctor so that so that he or she can have it analyzed. Now, before you leave I would like to get an X-ray and some blood tests. The X-ray may help us pinpoint the stone’s location, and the blood tests may help us determine why you developed the stones in the first place. People develop stones for many reasons, including rare ones, and if you do have a stone, you have to find out why, and that takes tests.”
“Thanks, but I’ll see the doctor you give me and get them then.”
George’s response came as no surprise. He never stopped pacing the examination room, nor did he stop staring at the wall long enough to make eye contact with Pollard. He left as soon as he received written instructions, test requisition slips, and the name and phone number of the on-call doctor
Pollard watched as the patient walked away. Moments later, he heard his name called by one of the nurses.
“Dr. Pollard, we’re receiving a telemetry strip from the field. It looks like the paramedics are bringing in a sixty-one-year-old man with a possible acute myocardial infarction. Also there is a very serious ventricular arrhythmia.”
The pace was picking up. Things were getting back to normal in the Emergency Department.
CHAPTER 12
George rushed out of the Emergency Department. He felt uncomfortable in a medical environment and wanted to end the experience as fast as possible. No doubt, he probably had a kidney stone. That first episode at Fred’s house was all too similar. Two kidney stones were double bad luck. How could anyone tolerate such pain if the stone was stuck for days? Maybe, thought George, he should get those damn tests done.
Gail was waiting at the kitchen table when he got home. She glanced up from her coffee and felt reassured. By his calm expression, she was certain he was pain free.
“What happened?” she asked.
“The doctor said I had a kidney stone. Lucky for me, though, they didn’t have to do anything. The pain is gone.”
“A kidney stone? What the heck…”
“Yeah.”
“Hmm. I can tell that you feel better. I called your work today and spoke to the foreman. It’s Andy Simpson, right?” He nodded. “I told him that you went to the hospital because of the pain.”
He looked relieved. “Yeah, good idea.”
“It wasn’t my idea. You told me to do it.”
“I did?” he said, looking startled.
“Don’t you remember?”
For several uncomfortable moments, he stared back at her with a blank expression.
“Must have forgotten,” he mumbled. “That pain was all I
