Kidney stone pain, as experienced by a man and a woman

As a typical guy, there are several painful illnesses that can hit our brotherhood in an instant. No warning given. No “Get out of jail free” pass, either. Just cruising along, having another fine, healthy day and baam!–suddenly you are lying on the floor in severe distress.

The most feared? A testicular torsion. It can happen spontaneously. It can happen suddenly. And if you are the owner of a testicle or two, it can happen to you. Simply put, the testicle can twist on its supporting ligaments and vessels, in essence cutting off the blood supply while stretching and irritating the supplying nerves. Sounds painful, yes? Excuse me for a second while I wipe my eyes–they’re welling up just from talking about this one.

Or better yet? Taking a direct traumatic hit to the groin area. We’ve all seen the funniest home video shows where Dad takes one to his manhood, only to buckle over and writhe in pain. It’s funny, sure, as long as it’s not one of us that took the shot. And usually, the laughing female voice we hear is the guy’s loving wife or girlfriend, still recording. Explain that one to me! Whatever you do, maam, don’t put the camera down to help out your man!

At least with these afflictions, though, we can’t be compared to a woman dealing with the same illness, shaming us with their inner strength. We can carry on and on and never have to explain ourselves and our pain. Or worry about comparisons.

However, the illnesses we do share with the more stoic and stellar species–you know, the ones with two xx chromosomes–are numerous. Chest pain. Abdominal pain of a million etiologies. Migraines. Broken bones. An asthma attack. The list is long. If you came and worked one shift with me, you would find it very evident that a woman is so much more tolerable and less whiny than a man with a similar problem. Almost always. Us guys? Yeah, for the most part, we are big wimps.

A few months back, I had two patients, a man and a woman, present to our emergency department, within an hour of one another, with the same illness. Unrelated, they were both suffering with kidney stone pain. Pain that was sudden. Pain that radiated from the flanks toward their groins. Pain that they both graded a ten out of ten.

Walking into the woman’s treatment room, I found a patient with her eyes closed, breathing deeply in and out. Her tight grips on her cot’s side rails were her only clue to being uncomfortable. Calmness permeated her room.

After a brief review of her history, which included a previous history of kidney stones, and a primary exam, I offered her some pain medications, in addition to some IV hydration and nausea medicines.

She smiled, taking me up on my offer. “Thank you, Doctor,” she quietly said, “that would be wonderful.”

After ordering her CT scan, urinalysis, and baseline blood work, I continued into another treatment room, just two doors down from her, to see the male patient.

I heard him before I even walked into his room. Between the cursing, the moaning, and the angry words directed at his wife, I knew he was going to be a difficult patient to manage.

I walked into the room, ready to briefly introduce myself and obtain a bare-bones history and physical, before offering some similar pain relief. I didn’t get the chance to do either.

“God-damn it,” the patient said, sarcastically, greeting me, “are you the doctor? I’m in pain here.” He, by the way, arrived after the previous patient. The drama in the room was suffocating, to say the least.

I assured him that yes, I was the doctor. After a few more obnoxious words, and some dramatic flailing, he refused to tell me anything about what brought him to our ER. Now, I’m all for giving someone a break when they aren’t feeling well, but his actions and words were bordering on ridiculous. “I’m not telling you anything f…ing more until I get some God-damn pain medicines,” he said, crossing his arms over his chest. If he hadn’t been lying in a cot, I know he would have been stomping his feet.

I know that kidney stones can be painful. I’ve seen enough patients with them to get that. I also know that I never want to have one. But, I also know that pain does not give one an excuse to be as blatantly rude and disrespectful, with the medical team providing care, as this patient was. Sometimes, a patient may forget that we are on their side. At any rate, it’s hard to get under my skin and, after walking out of the previous stoic patient’s room, this gentleman succeeded in doing just that.

“Sir,” I said, “I understand you are in pain, but I won’t let you talk to me or anyone else in my presence in that manner. Do you understand?” He eyed me while receiving my direct stare. “Do you understand me, sir?” I repeated. He nodded yes. “If you cooperate, I will be more than glad to help you after I learn what brought you here and perform a brief exam. I’m sorry if you don’t understand this process, but that’s how it’s going to be done.” His nurse, standing by his cot, nodded her agreeement.

Translation: Man up, you wimp!

With a little coaxing from his wife, we arrived at an understanding. As I requested, he provided me with the details of his sudden onset of pain. He was home lying on his couch when he suddenly had been overcome with pain in his right flank area. “I know it’s my kidney stones again,” he said. “It’s just like my last one.”

After cooperating, he also received pain medications with some IV fluids and nausea medicines. “Finally,” he complained to the nurse, “that took forever.” Yes, sir. Twelve minutes to be exact, from the time he was placed in his room until the time we pushed his medications.

Ultimately, both patients had results conclusive of a kidney stone via CT scanning. His, three millimeters. Hers, four millimeters. Both stones were in the UVJ, or the uretero-vesicular junction, the distal part of the ureter, the tube that connects the kidney to the bladder. Both stones were near their journey’s end. There was no hydronephrosis, or backed-up fluid, to either’s kidney.

I walked into the woman’s room and explained her results. She looked more at ease, greeting me with a smile as I entered. “Thank you,” she said, continuing to be stoic and kind, her grips lessened on the side rails, “for all you did. This was a wonderful experience.” She had refused any further offers of IV pain medications. “I’ll be fine,” she had assured us. I wished her the best, advised her to return to our ER if she had uncontrolled pain or fever, and sent her home with a prescription for pain medication. She would follow with her urologist in a few days.

She had been an absolute pleasure.

Next, I walked into the man’s room and to explain his results. He had received several additional doses of pain medication and appeared much more comfortable, although his complaining nature was still evident. “God-damn it,” he said, now rating his pain a one out of ten, “why do I have to suffer with these god-damn stones. Why couldn’t someone else get them, instead?” I explained to him that his stone was small, was near the end of passage, and that we would be sending him with a script for pain medications. On review of his previous records, he had always passed his stones without complications. I suspected that this would be no different. I referred him back to his urologist for a follow-up appointment in a few days. Yes, I was sharing the love.

I know this is an extreme example of comparing a man to a woman, with many variables to consider (a family history of stones, the size of the stone, an individual’s response to pain, age, etc.). Consistently, though, through my career, women have demonstrated to be much more stoic, mature, and admirable in dealing with illnesses than men. You can’t change my mind of that. It could be something as simple as the flu, or something as complex as a myocardial infarction. It doesn’t matter, really.

My one buddy has a theory–the more screaming and carrying-on from a patient, the less the likelihood of that patient being seriously ill. Likewise, the more stoic a patient, the more serious the illness. At first, I laughed at him and his observation, thinking he was just joking around. “Seriously, Jim,” he said, “just think of all the guys we’ve treated who were crying when we walked into the room.” Unfortunately, after this many years spent in the ER, I’ve seen his theory prove itself true.

What do you think?

I think us men need to toughen up and start spitting out some nails. Or eating black licorice to grow some hair on our chest. Even throw away that certificate for a pedicure and an hour massage. Hide the cologne. Quit watching “Dancing with the Stars.” Maybe, just maybe, we should step up and offer to deliver a ten-pound baby, au natural. That might put our pain in perspective.

On second thought, though, maybe I should hope to get a kick in the balls or a spontaneous testicular torsion instead of any other painful illness…that way, I won’t be embarrassed or shamed by my fellow womankind when I start my high-pitched screaming in the ER. Or flailing my arms. Or crying…

StorytellERdoc is an emergency physician who blogs at his self-titled site, StorytellERdoc.

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  • Susan Kramss

    I disagree with you completely! Your sample is ridiculously inadequate to base an professional opinion (or even one tongue in cheek). Both my husband and I passed kidney stones within a very short time of each other. Gee – my study group was as extensive as yours! Let’s compare results.

    The pain can only be compared to labor, only the product is a lot cheaper to raise. In both cases we were calm, vomiting and in too much pain to move. The first time I was the louder and more difficult if anything. After 2 c-sections due to Bandle’s Ring, 2 partial oophorectomies, a hysterectomy and breaking all three bones in my lower leg, snapping off the foot you would think I would have fared much better being familiar with pain. Of course the incompetence and dismissive attitude of the ER doctor could have made anyone spit tacks. After my fifth stone, it was standard procedure.

    My husband was calm and cool. He knew what was wrong and had seen me through so much that all in all, he made a far better patient than me. Of course, years of working as an EMT and being in medical research for 25 years helped him to keep everything in perspective. I was just in a really bad mood that first time.

    To compare all men against women perpetrates stigma and stereotyping (so typical among younger doctors who are trained to view the patient as the enemy, at least that’s according to several Med School professors we’ve spoken to. In fact there’s even a book about it written by a PhD Anthropologist/Sociologist who went to med school to study the mentality and evolution involved with training of doctors. Great read!

    By ignoring variables in individual personalities, mental health, relationship factors, early life experience, previous experience with healthcare, pain tolerance based on u/k contributing factors and the size & shape of the stone with a study group of 1 v/s 1 I’d say you need a refresher course in clinical research not to mention some all round training in the empathic treatment of human beings. As you quote – you “KNEW” the patient was going to be difficult. Was this an assumption based on what you heard, are you psychic, or was it based on hard data? Did you ever think he just didn’t like you (or his wife)? Fair is fair – you went in not liking him! ER doctors know very little about a lot. Specialists know a lot about very little. It’s time they get together and share notes.

  • Alfonso bedoya

    #1 quite right, though her sample with a husband who was an EMT worker in medical research is hardly representative either! I just passed my first kidney stone….so had no idea what was going on (though not pleasant ) until CAT scan etc occurred in hospital. I felt like crying out in pain often but didn’t see what it would accomplish, and tried to remain calm and focused on issues including administration of pain medication (my internist had warned against this before diagnosis, as I could have had ruptured disc impinging on bladder, for which pain medication could have posed other problems)

    My wife commented on how calm and uncomplaining I was and said in similar circumstances she would have been writhing in agony. What does this prove? Very little….Perhaps I would not have have been as calm and collected without her (calm) support and concern . So it probably all goes down to personality, past history, and context – not gender.

  • SarahW

    Shame on you. Give him the pain medincine, THEN the lecture. It isn’t about you or the social graces in that situation.

  • boundbyinsurance

    Susan, could you please post the name of that book? It sounds very interesting!

  • http://nostrums.blogspot.com Doc D

    Great stories but…

    The plural of anecdote is not data.

    My ER background is 10 years; I moved on to another specialty after that. But I never noticed a gender pattern about pain.

  • Susan Kramss

    I picked the book up in a used book store. It’s an oldie but goodie. It’s called “Becoming a Doctor – A Journey of Initiation in Medical School” by Melvin Konner, M.D.
    Penguin Books

  • Susan Kramss

    I agree with SarahW. Comfort then educate in a respectful fashion, as equals – not superior. Don’t lecture, scold or give the “Sir. You must….” Translation – “Get off your high horse and try to be understanding.” The female had had stones before – she knew what to expect. He did not. A degree confirms you are a doctor, it does not symbolize your status above others. If dealing with his “mood” was beyond you, call in someone who is more competent. Try reading “Physicians’ Reactions to Patients: A Key to Teaching Humanistic Medicine”, by Richard Grolin, M.D. and Howard Zucker M.D.

  • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

    Laughing.

    The story of my stones:
    http://drjshousecalls.blogspot.com/2007/08/giving-birth-not.html
    http://drjshousecalls.blogspot.com/2007/09/stoned-again.html

    The second story (“Stoned Again”) is the dooser.

    And I named my “babies”. I keep them in a drawer.

  • http://storytellerdoc.blogspot.com storytellerdoc

    To the comments:

    First, this is a post that is extremely out of character for my writing. I was playing with the tongue-in-cheek fun that many of us in our large trauma ER noticed recently, with a rash of men and women coming in for similar complaints and the ways in which those complaints are dealt with. It was meant in fun, and the seriousness for which some of the comments have come forth astound me.

    To Susan K, I am not a young doctor. I have been out of residency for 14 years. I also am involved in a core faculty position at our hospital training residency and trust me, I do not view patients as “the enemy.” To suggest otherwise on one simple post is not right of you, and I do take offense to that suggestion. If you need proof, read some of my other postings on my blog site. Secondly, to assume my sample population were these two people is your assumption, and is not fact. I have many years of clinical practice and many patient interactions of which I am very proud. I am especially proud of the compassionate care I provide and the level of caring that I instill in my residents-in-training. In fact, I have received national awards for such. Despite your mean-spirited comment, I would not judge you soley on such words. Your anger through multiple comments, though, does come through loud and clear, despite not knowing anything more about the cases than what I volunteered.

    To Sarah W., thank you for for the “shame on you” bit. You are wrong, though, plain and simple, although I can hear loud and clear your judgement. Do you have any ER experience? I can vouch that there exists a subpopulation of patients that come in “writhing” in pain simply to get their fix of narcotics. I will not typically treat until I have an inkling of an idea of the complaint. I doubt many others would as well. And again, it was 12 minutes from presentation to treatment of pain. If you think that is too long, in today’s ER environments, then again, I question your experience. This patient, despite calling us every obscenity in the book, was treated as well as the next patient.

    All this said, I appreciate Dr. Mary Johnson and Doc D for appreciating my perspective. Thank you to the both of you.To those of you offended, this was a light-hearted piece that I think was given significant weight by a few commenters when the weight wasn’t there.

    I thank you for reading… I hope future comments can refrain from such mean-spirit.

  • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

    Welcome to the blogosphere, storytellerdoc (do you realize the intitials for your handle would be STD?).

    My philosophy is this: You wrote something that (1) pissed some people off and (2) made some people relate/laugh.

    A good day for a writer.

  • http://www.kidneystoneout.com kidney stones treatment

    I think screaming has nothing to do with recovery of the patient who have kidney stones whether it is a man or a woman. Extensive research should be made to prove this theory.

  • http://www.drjoeletraslpd.web.officelive.com Joel Etra, SLPD

    Personally, I have been in an ER in pain (not a stone). I was not pleasant but I was never abusive to my caregivers. I believe that is more a matter of character than gender.
    As a communication specialist, I was interested in the language and attitude in the story. Why is it that patient behavior that is less “trouble” receives the more positive adjectives? Why is all the “advice” to the male put in terms of being more “manly?” Somewhere in there we are betraying a misconception and willingness to follow prejudices. Why do we approach patients with preconceived notions about their behavior based on gender. Does the patient’s awareness (at some level) of such beliefs effect their response to pain or to receiving care in general? We expect a “man” to be tough and when he acts tough we call him uncooperative.
    There is much to learn from this story.

  • http://twitter.com/amandaecollins Amanda C

    I have a kidney stone and I was crying like a baby in the ER but was always respectful and the one dose of Toradol was all I needed. I could have kissed the PA and nurses who treated me promptly. And, unlike the man in your story, the woman probably had to wait until they got her pregnancy test results in before recieving pain meds, much longer than the 12 min. the man had to. Then again, I am a nurse and understand what these medical professionals go through. I would never be disrespectful. I had hernia repair surgery last month and in pre-op the guy next to me getting shoulder surgery was swearing at and being very beligerant to the nurses. why? was he in pain? No, he had forgotten to get his pre-op CXR and was swearing up and down he didn’t need one and why couldn’t he have a smoke then if he had to get CXR. I thought my husband, also a nurse, was going to punch him. Here I am, very nervous about surgery and feeling icky cause I  ( unlike him) had to bowel prep the night before and he is swearing at fellow nurses. It took all I had not to pull the curtain back and tell him to F off.