Monday, April 19, 2004. Five o'clock in the afternoon. I was at work, sitting at my computer. Without warning, I felt an acute stabbing pain in my right kidney. Adjusting my posture didn't affect it. After a few moments, it transformed into a moderately severe aching sensation in my right flank. That's the only way I can describe it. The pain, which had started in the lower back close to the spine, I now perceived as equidistant from my front, back and right side. I sat more upright, and it seemed to help. Soon after, I experienced a burning sensation in the urethra. The ache persisted.

I surmised I might be passing a kidney stone, and took advantage of the fact that I was sitting in front of a computer to research the subject on the Internet. As I was reading, I suddenly felt weak, nauseous and light headed. My vision began to dim.

I lay back in my chair and waited for it to pass. Instead, it got worse. I could feel consciousness slipping away. It occurred to me that if I passed out in that position, no one would be able to tell that I was in distress. My normal working posture was the one I was in now: reclining in my chair, facing the computer with my back to the entrance to my cube, and, since I tend to do more thinking than typing, not moving much. I could die there and not attract notice until the following morning.

With some effort, I eased out of the chair and carefully lowered myself to the floor and lay flat on my back. Now if I passed out my body would be the message. My eyes closed.

I could hear people passing, but no one stopped. I opened my eyes. One of my colleagues, Willie Wang, walked past. He slowed, stopped, turned back.

"Hey, Joe, you all right?"

"I'm not sure."

"You want me to call a doctor or something?"

I asked him to locate my boss, Ken Fuiks. He left and a minute later they returned together.

Ken stared down at me.

"I think I'm passing a kidney stone," I said.

"Why would you want to do that?"

"I don't," I answered. Ken wasn't being obtuse. Trained in first aid, he was assessing my cognitive functioning.

I asked if either of them knew of a nearby Emergency Room. Willy brought up San Jose General. Ken knew of one closer, though he didn't know its name. I asked Ken if he would drive me there, and he agreed. If I came close to passing out again, I didn't want to be behind the wheel when it happened.

I got up, slowly. I wasn't too steady. We took the elevator down.

The ER turned out to be Valley Medical Center. A catering truck was double parked at the entrance. Ken dropped me off and went to park the car. I circled around the truck and went in.

The reception area of VMER consists of 70-odd chairs and a diagonal row of seven teller-like stations along one wall. Unlike real teller stations, these are protected by bullet proof glass.

The first three are signed: Patient Check-In; Triage Nurse; Visitor Check-In. The rest are simply numbered and used, I would discover, for identification, registration, and gathering insurance information. Each station had a tray under the bulletproof glass for the exchange of materials, very much like the ones at 24 hour gas stations.

The first five stations were unoccupied. There was a line in front of Patient Check-In. At the head of the line was a young woman attending an older one, perhaps her mother, who was seated in front of the empty work station. The young woman told me they had been waiting for half an hour. Behind them was a woman in a wheelchair who had been sent to the ER from another part of the hospital. I was next.

Ken finished parking and joined me. He gave me a chair to sit in while we waited in line. The pain had subsided to a moderate ache, but I was still pretty shaky. Soon after, the check-in nurse arrived.

Check-in, it turned out, consisted of taking the patient's name, temperature, pulse and blood pressure. This station had a small window in the glass to accept the patient's arm. The nurse placed a pressure cuff on my arm, a pulse clip on one finger, and handed me a thermometer to put under my tongue. The thermometer was protected by a disposable sheath and connected to a monitor on the nurse's side of the window. She read the numbers from a digital display and entered them into a computer. BP 119/63, pulse 50. The BP was in my normal range. The pulse was a little low, but not a lot. Normal for me is 60, a result of regular workouts. She wrote my name on a plastic bracelet and put it on my wrist. Then she told me to have a seat and wait. It was 6:00 pm.

Ken found us two adjacent seats. I was feeling somewhat better, but I definitely wasn't right. We talked for maybe half an hour. Then Ken got an urgent page and bade me farewell.

At 7:00 pm I was called to the triage nurse. I described my symptoms and she recorded them in her computer. Then she, too, told me to sit down and wait to be called. How long, I wanted to know. She couldn't tell me. I asked her for an estimate. She wouldn't guess. One hour? Six hours, I asked? Maybe one, she said, maybe ten. I returned to the waiting area.

I was getting hungry. Figuring I had some time, I went out to the catering truck and bought some Teriyaki Chicken on Rice. I brought it inside.

I was halfway through it when my name was called. This time they wanted my insurance information. The clerk at the counter took it and gave me a form to sign. I finished my dinner.

It was nearly 8:00 pm. I decided to take advantage of a vacant toilet. There were two, marked men and women, but as each room accommodated a single occupant there was little reason for the distinction. I went in and locked the door.

I had barely begun urinating - painlessly - when I saw a dark round object resembling a BB sinking to the bottom of the bowl. Though I'd never seen a kidney stone before, I knew exactly what it was, and at this point it was good news. It meant I wouldn't need surgery or lithotripsy, a procedure that uses ultrasound to pulverize stones while they're still in the body.

In the brief time I spent researching my condition before I passed out, I came across one writer who advised peeing into a strainer to catch the stone to show the doctor. There are different kinds of stones caused by different things. When deciding which lifestyle changes would best forestall a recurrence, any clue is helpful. I had no idea how important such information is. It could be trivial. It could be vital. I simply didn't know. I knew I didn't have a strainer, not that it would help now.

I stared at this thing at the bottom of the bowl. The water had been clear when I began, but of course it wasn't now. I imagined telling the doctor the stone was "small and dark". I imagined the doctor rolling his eyes. I looked over at the basin. There was plenty of soap. There was any amount of water. There were lots of paper towels. Okay. I can do this. I rolled up my sleeve and reached in. Because water refracts light, it's always deeper than it looks. It came almost to my elbow. But I pinched that tiny piece of information between my thumb and forefinger and triumphantly brought it out.

I rinsed it off and set it on the side of the basin. Then I soaped up and thoroughly scrubbed down. Then I did it again. Finally, I wrapped up my trophy in a paper towel and put it in my pocket.

I re-entered the waiting area and considered my options. The pain had gone, but having had no experience with kidney stones, I didn't know what to expect. Was that it, or were there more to come? I decided that it would be prudent to wait and get x-rayed to see if there were any more. I found a place and sat down.

I passed the time with my Palm Pilot. (Yes, I know they can't call it that anymore, but I can.) I played a couple of games of FreeCell and then began writing this account. At 10:00 pm I needed a break and began chatting with the person next to me, a young woman who had hurt her hand in some way. She had arrived right after me. We both preferred talking to waiting in silence and so kept it up for the next hour and a half. At 11:30 pm she went back to her book and I to my writing. At midnight she gave up and went home.

Trauma victims began arriving. A young couple carried in a friend of theirs, a semiconscious boy in his late teens. They sat him down in front of the check-in nurse and put the thermometer under his tongue. It fell out. Drug overdose, probably. There were accident victims and weeping parents. Police officers began wandering in and out.

Shortly after midnight a nurse came out with our paperwork to do a roll call and see who was still there. Mine was the seventh name she called, which I found encouraging since she wasn't going in alphabetical order. She sorted the documents into two piles, depending on whether the patient was still there. As she looked at one she said "Oh, my God, people been here since 2:00." 10 hours ago.

At 10 minutes to 1:00 am a nurse took my blood pressure again. 109 over 54.

At 1:45 am the 2:00 pm party was called, after nearly 12 hours. Since roll call 12 patients had been called, not counting some who had lost patience and left. Among the latter were the young woman and her mother who had been ahead of me. Evidently the order of the roll call didn't mean much. At 3:00 am I determined from the security guard behind the Visitor Check-In window that there were still 13 people ahead of me. 13, that is, plus the emergencies, who continued to arrive. I gave up. I called a cab and left.

I never did see a doctor. After further research I learned that kidney stones usually come one at a time. If you've had one, there is a 50-50 chance of recurrence. Mine was the most common type, probably calcium oxalate. There is a fairly long list of risk factors. Some of these, such as age, gender and certain diseases or genetic disorders, one can do little about. Controllable risk factors which applied to me included "high" amounts of brewed tea (I drink up to six cups a day) and "excessive" vitamin C. I take 1000 mg every morning. I didn't know there was such a thing as too much. And you're always advised to drink 8 to 13 glasses of water daily. Other items on the list to avoid are vitamin D, alcohol, salt, animal protein, and calcium and oxalate-based foods. These include apples, black pepper, chocolate, coffee, cheese, grapes, ice cream, vitamin C, yogurt, tomatoes and oranges, to name a few.

As for the bulletproof glass, the occasional gang fight keeps going all the way to the ER and even into it. Another danger to ER personnel are patients who have been waiting for hours in discomfort or pain, and parents of children who they believe, correctly or not, have a life threatening condition but are nevertheless made to wait.

Finally, Ken got that urgent page because his dog was critically ill and needed to be put down. The dog was a long-standing member of the family and is sorely missed.

Click to Enlarge