14 October 2007

The kidney stone(s)

So... We're writing this from Bishkek, where our plan was to stay a single night and then to head out to Issyk-Kul, the world's second-largest alpine lake (second only to Titicaca, whose very name can never be surpassed).

As has been typical of this trip, plans were thwarted. This time, it wasn't a crooked Krygyz promise or a slipshod Chinese travel agent. It was the kidneys.

Attempting to pass two kidney stones (yes, two...no one's ever accused me of being half-hearted) while battling a case of food poisoning all in a single night makes one ill-disposed to do any canyon-walking.

It's been a hellish two days. Any words I find to describe the pain of these sub-centimeter demons are all devoid of meaning for their overuse. Agonizing. Excruciating. Doubled-over. You name it, I felt it.

What this did enable us to do, though, was visit the inner workings of the Kyrgyz medical system.

Word to the wise: if you travel, 1) Don't get kidney stones (I mean, really. Who gets kidney stones when they're travelling?), and 2) Avoid the inner workings of the Kyrgyz medical system.

To bring my Western weltanschauung to bear on this situation: from the dramatic beginning of the symptoms, it was eminently clear what was going on. Kidney stones aren't subtle. And if you show up in a doctor's office in the US with one, you're given a cocktail of pain relief and anti-emetics and then a bunch of tests are run on you. Not so in Kyrgyzstan. And God help you if you get this kidney stone on a Saturday.

Stop #1: The on-call urologist at the Kyrgyz Republic President's Hospital. This was your stereotypical NGO hospital—painted a pale blue, with doors that didn't completely close, and nurses in stockings and slippers and tall hats. I've worked in hospitals like this. The on-call urologist, however, labors only until noon. The same is true with the entire radiology department, and there is no emergency room (at least, not one open to foreigners). Come noon, best of luck to you. Unfortunately, we showed up at 11:30, so by 12:30, we were sent—on foot!—to another hospital where "Maybe, I think, they should be working."

Stop #2: The Kyrgyz National Hospital. Absolutely indescribable. Filthy. Dank. Dark. Dripping. Dirty. Desolate. This is what hospitals used to be like. This is where people go to die. Lasciate ogne speranza...

The doctor there saw me, pounded on my back, and sent me for an X-ray. With which I had radiation therapy to my kidneys. I kid you not—enough radiation in that thing that you could actually feel the hairs on your body stand at attention when it was on.

And don't get me started on the bathroom. Unisex (yes, I'm from New York, where unisex bathrooms can be kind of hot. This one? Not hot). And filthy, with heaped-up middens of past occupants floating in places they shouldn't be floating. At the Kyrgyz National Hospital, you give your urine sample in a well-used, barely-rinsed baby food jar. So much for sterility. (In fact, the only thing that was sterile in the entire place was the lancet used to draw blood.)

The X-ray showed nothing, at which point he wanted to inject me with contrast so he could see exactly where the stone was so he could operate on it! Yes, I'm a surgeon. Yes, I'm constantly telling people we need to operate. But there was no way a man in a hospital worthy of the eighth circle of Hell was coming anywhere near me with sharp objects.

Thither we came, and thence down in the moat
I saw a people smothered in a filth
That out of human privies seemed to flow

So, I lied. Forgive me. Told him I was allergic to contrast.

Stop #3: Walk another 15 minutes in search of a sonographer who's open. Have that sonographer push, prod, press on your abdomen in search of the stones. I can't malign him, though. He was competent and genuinely kind, and the only one of his ilk that we met all day.

Stop #4: Back to the Kyrgyz National Hospital, armed with information about the two stones you're harboring. Be told by Belial the Urologist that—now!—it was finally time to operate. Refuse (vehemently) again.

Ask next for the results of your blood and urine tests, and get told, "Well, you know. Tests. They could be one thing today and another thing tomorrow." (I insisted. He gave in, reluctantly). And then—the clincher, even to my pain-addled mind—get handed a prescription written on Big Chief paper for four things:

1) Normal saline + potassium.
2) Two herbals "for the urine," one of which you had to drop on a sugar cube before taking (thank you, Albert).
3) A single injection of ketorolac, for which you have to walk to a neighboring pharmacy. Once you purchase the injection, you're welcome to come back to the hospital, where, for a small fee, they'll be happy to give it to you.

As for the normal saline drip, we were told that we could come back for that too. On Monday!

I refused, and Belial thought I was bargaining with him. "Alright," he said begrudgingly. "You can have the drip today." I still refused, so he told us that we could take that prescription to any hospital and have the drip there. But it was of utmost import that, after the IV, I needed to hop on my left foot. Specifically, by the way, on the instep; the outstep just wouldn't do. This was how you got rid of your kidney stone. I am not making this up.

Stop #5: Find a rare, open-on-a-Saturday pharmacy, purchase your own narcotics, straight over the counter (the objection from the pharmacist, "Well, it would be better if this was given by a doctor," was overridden by, "But we are doctors."), and tamsulosin, which Belial had forgotten to write.

Stop #6: Finally, home. For another night of agony.

One stone has made its way out. The other? Well, we'll see.

1 comment:

Anonymous said...

Oh, I'm so sorry! I think every American's nightmare is getting sick in a foreign country. BUT (as I'm sure others have told you) you haven't been through labor.

We've enjoyed the pictures, as well as the vivid narratives.

-BGG (can't remember CRG's Blogger password)