Christmas is Coming

Tck tck tck tck tck.

Tck tck tck tck tck.

Like a computer game the red laser beam at the end of the scope shoots holes in the rough yellow rock lodged firmly in tunnel of the ureter projected on the screen above my head. My shoulders are weighed down by the lead apron we wear under the surgical gown (to protect my little ovaries from the x-rays) . My glasses dig into my nose from the pressure of the goggles to protect my eyes from the laser. It seems a little ludicrous that the laser beam will bounce off the kidney stone lodged in the ureter get all the way down the tube to the bladder and somehow out of the penis and bounce into my eyeball . . . oh well, protocol I suppose. After shooting up your rock you put in a little basket and pull out the pieces. Urologists really have fantastic tools and seemingly get to play video games all day.

Yesterday they took out someone's bladder because of cancer and made her a new one out of a piece of her colon. It took six and a half hours, but it was pretty incredible! There's a downside to any specialty though, even if they do have cool toys and fascinating operations. There's kidney transplants that don't work after family members have donated their own kidneys and there's always cancers that recur and eventually are untreatable.

Near the end of my day today I was called with a consult from the palliative ward. A 50 year old lady with a recent spread of her previously treated cancer now had a kidney that was swelling up and its function going downhill, just over the past week. This can often happen when cancers grow and block off one of your ureters. In my mind it was a no brainer, we just put a little tube in the ureter to release the pressure and save the kidney. Its a simple procedure and would relieve a lot of pain and nausea. I sat on her bed and explained it several times, listened to her questions, thinking myself quite convincing.

Eventually she asked a question that stopped me cold.

How would you want to die?

Skydiving perhaps? Maybe in the Congo.

Although I disagreed with her, even thought her foolish to want to die in such discomfort, I had to accept that this was her body and her life, not mine. I can explain things and give recommendations, but the choice is hers of how to go. Oh so somber a note as she lays in hospital with Christmas approaching. Merry Christmas to all, and to all a good night.