I want you to reminisce to when you were 21. Remember those days? The good years. When nothing ached. When the bills weren't big. When your biggest decisions were what to wear, how to fix your hair, and who to go out with.
When you could pee without a struggle.
Now, hold on, don't assume this is about me. It's not. I'm way, way too young to worry about that problem just yet (I think I just heard my wife laughing).
This is about my next patient, a local 21 year-old college student.
I live in a town where we have four colleges. Really great, fantastic schools. As a result, though, a portion of our ER patient population are college kids not from this area. Anonymous kids who aren't afraid to come see us so we can cure their "drip" or "discharge." Well, at least until the next time. But, all in all, good normal kids.
So, imagine my surprise when a nurse walked into the nurses' station and asked me to urgently see her new patient. A man who couldn't urinate. A 21 year-old man who couldn't urinate. Now, we're used to the older male patients who can't urinate, but 21?
"Are you kidding me?" I asked, waiting for her to say "Gotcha."
"I wish," she answered, all business-like, "and he's really uncomfortable."
Well, at 21, there isn't much to hold the flow back. A UTI. An STD. A kidney stone. Trauma. Neurological disease. Medications. Crazy. I ran through my internal list as I approached his room.
I walked into the room to find a young man writhing in his cot. "Please cath me!" he exclaimed before I could even introduce myself. Now, this was a first for me. Go back to when you were 21 again and tell me if you knew what catheterizing even was (heck, I'm not sure I could have even spelled it!). How did this kid? And what was his story?
It turns out this was a heck of a nice kid who had this happen to him once before. He had a phobia about airplane bathrooms and urinating at 15,000 feet. He was on a return flight, after a visit to home, when he felt the urge to urinate, just as Murphy's Laws would dictate. Thinking ahead, he believed he would have enough time to relieve himself in the terminal once he landed and before catching his connecting flight. Wrong!
His airplane didn't land in time, instead circling in the air waiting for its clearance. This poor kid's kidneys didn't know this, though. They kept filtering his blood and dripping more and more urine through their connecting tubes into his bladder. A dripping faucet filling up the clogged sink. Drip. Drip. Drip. By the time the kid had landed an hour later, he was in misery.
With only five minutes to catch his connecting flight, he hobbled through the airport, passing several bathrooms. Can you imagine making such a decision? Should he keep running to make his connection or should he stop to urinate, miss his flight, and then sit around and wait for the next unknown connecting flight?
He opted to catch his connecting flight. He told me he spent half of the hour flight in the airplane bathroom trying to go, ignoring all the knocks. He was obviously unsuccessful. Even without a phobia, I wouldn't be able to relieve myself with someone knocking on the door, either. Ducking down from the low ceiling, rocking back and forth from turbulence, staring down at that ridiculous metal basin they call a toilet, and then multiple knocks on the door? Sorry, bud, no can do. They need to get some Depends dispensers!
An hour and a half later, he was my patient. I ran and got our portable bedside ultrasound and hurriedly placed its probe on this kid's belly. Sure enough, he had a bladder big enough to fill a backyard pool. Eight-feet deep, no less!
The bladder is a tricky organ. Once it is stretched enough from filling with urine, the nerve fibers convey to your brain the need to find the nearest bathroom, do not pass go, and relieve yourself. In this kid's case, though, his bladder continued to fill beyond its capabilities to contract. Thus, he had a bladder screaming at him but no longer able to squeeze out the urine. An "atonic bladder" for those of you hoping to answer the final question on Jeopardy someday. This can be quite an uncomfortable predicament. A catheter was his only answer.
The nurse, relishing her role as a patient advocate, hip-checked me out of the way the second I was done with my ultrasound. She had a catheter in her hand and she was ready to save another life (her second one that day if you count the dental pain patient she and I had treated earlier!).
Unfortunately, the nurse was unsuccessful in passing the "too-big" catheter into his bladder.
"Hey, Doctor K," she yelled loud enough for three rooms over to hear, "can you grab me the smallest catheter in the med closet or, better yet, a pediatric one?"
Say what? Are you kidding me? He's 21, for God's sake, don't insult his manhood this way! Where are all the understanding male nurses when you need one? I made a mental to tell the nurse that if I ever needed anything less than a garden hose for a catheter, she better not yell it out to the other rooms, thank you. If I'm being honest, though, if I do need a garden hose, I would be okay with her letting the whole ER know (that better not be my wife I hear laughing again!).
The nurse was successful in placing the smaller pediatric catheter in this patient and immediately, almost one liter of urine drained out. Before he was discharged, he had drained two liters of urine. Can you imagine? Two liters! I am not embellishing here, we have markers on the collecting bag. And let me tell you, the day I can fill a two-liter Coke bottle in one squirt is the day I'll win a pissing--oops, I mean bragging--contest!
The patient did awesome. As soon as the urine started flowing out, he was a different person. We tested him for a UTI, a kidney stone, and STDs and he passed with flying colors. That's my boy! We offered to let him wear the catheter home with a draining bag attached to his leg, but he refused.
"What, are you kidding me? You mean wear this thing to class tomorrow?" he asked incredulously. I understood completely. I could only imagine what a chick-magnet a catheter with a leg-bag would be in college. Picture it--biology class. Pretty girl on his left, speaking to him. "Excuse me, but is it me or does it smell like a nursing home in here?" A pause and then she'd continue. "And why is your left thigh so much bigger than your right?"
When he left, without his catheter, he couldn't have been more appreciative...and comfortable...and homesick.
"Please cath me!"
Yeah, right--I'll take quotes you'll never hear a 21 year-old say for $200, Alex.
As always, a big thank you for reading. Next post will be Wednesday, January 27. A shout-out to all of you who have blogrolled me, twittered me forward, and have left cool insightful comments. And to those who have nominated and are supporting me for the 2009 Medical Webblog Awards at MedGadget.com, I thank you. I am very humbled...