My gallbladder had enough

Thai-Inspired Chicken Meatball Soup has 5 stars and 8,700 reviews on New York Times cooking. I think I ate less that evening with the intention of having leftovers for lunch the next day- the start of the endo-repro module, and the end of a much needed break. My relationship to chicken, and many of the meals brendyn enjoys cooking is complicated.

I did not grow up eating chicken, or a lot of high fat meals. Even then, I have come to love certain chicken dishes, and try my best to expand the options for our mostly joint dinners.

The chicken has to be in small pieces, this is key. Meatballs, as unappetizing as the term is to me, are good for this requirement of mine, because they can be smushed into smaller pieces and distributed among the other elements of the meal.

Brendyn sometimes jokes that I should write a manual on the specifics of my eating habits, the size meat must be, the texture, the characteristics of cheese I’m willing to eat.

 I did not have Thai-Inspired Chicken Meatball Soup for leftovers. In fact, it was 44 hours before I had anything else to eat or drink.

 The pain started at 1:30 am and lasted over 12 hours. It never lasted this long before. I knew this epigastric pain well, as it radiated through my belly, screaming to be let out. For the last ten years I’ve had this pain. It wakes me from an otherwise uneventful, maybe even more restful sleep. I learned a routine. While the pain gets louder, thumping under my costal margin, I gather the heating pad, heat up water with ajwain seeds, maybe add lemon-honey- ginger and head to a future at the base of a toilet.  

I am lucky that this house we live in has two bathrooms. The guest bathroom is a perfect layout for this painful episode. I lay a towel on the floor to shield me from cold tiles. I try to have a bowel movement, I sweat profusely, I repeat to myself “this will pass, this will pass” and try to focus on something else. To say it is the worst pain I have ever experienced in my life is not an exaggeration.

This kind of pain does not stop with morphine. It is as if someone has seized my esophagus, pylorus, duodenum, and twisted them until they exploded. It is very sustained and severe, like pain you might get from severe cramps, but they don’t come in waves, it just starts and then eventually stops abruptly. It is a pain that makes you want to stop breathing.

Ten years ago these started off as very short episodes that were easily cured with a hot tea and bowel movement. I thought it was related to having rumination syndrome since the age of 15, but many GI specialists convinced me that the problem was stress related to my depression and anxiety. No one ever suggested an ultrasound, and I struggled to comprehend a life where those illnesses didn’t impact me in every way including my bowels.

I am laying on the floor, I’ve taken all my clothes off because I cannot stop sweating. I am sobbing in between violent jolts of my body heaving vomit into the toilet that now needs to be cleaned. I am making involuntary sounds that embarrass me. Goodbye Thai-inspired chicken meatball soup, I think.

I feel dizzy. I remember a clinic lead training shift that needs to happen in 4 hours, and think, well this will surely end before 7:30 am. It does not end. I find respite momentarily when I fall asleep on the green towel, exhausted from the feeling of my entire body clenched like a fist, from vomiting, from constipation.

I do not go to clinic, because the pain did not end like it had in all the episodes of the last ten years. This is not stress, I think. I spent the weekend painting arches in my kitchen, cooking meals with my boyfriend, going hiking with the dogs. I am not stressed. I am not mentally ill. I am managing it.

A quick Telehealth appointment with a campus health doctor cements the fear that something else is wrong, and her urges to send me to the ER are met by my ignorance and first year medical student diagnostic skills.

Eventually I go. For the first time, the woman at the registration desk asks me “honey, what’s wrong?” And I burst out in tears. Simultaneously feeling great pains and also relief that someone might care enough to fix me. I am afraid of being in the emergency department, I am afraid of getting COVID. Brendyn is there, and he is allowed to stay the whole time. Something I will never be grateful enough for. I was quickly given a private room, fluids, and toradol. The room was silent, the window faced a concrete wall. Brendyn tried to cheer me up by trying to eat 5 saltines without drinking water, and succeeded. I was scooped up into a wheelchair multiple times for imaging. The ultrasound technician was kind and gentle, it did not escape me that I had a negative Murphy sign by ultrasound. She said that the doctors will always give a more thorough reading, but she could see gallstones.

24 hours before this moment I was in a standardized patient activity where my classmate and I did an exam and history on a patient who had cholelithiasis. It was a session combined with simulation, and all the high yield information emerged. I thought back to this as I tried to self diagnose every symptom I had in the last 10 years, wondering how it was missed.

Ochsner uploads test results to the portal sometimes sooner than the physician on call can address it. This is an unfortunate benefit of their system for patients like me, who have enough knowledge to ask questions, but not enough to stop anxious thoughts from overflowing. It’s been 1 week, and I am still staring at images of this MRI. I zoom in and rotate the MRCP that shows my tiny gallbladder filled with stones. I trace the anatomy that I learned two blocks ago, cystic duct, common hepatic duct, common bile duct. Just before the sphincter of oddi I see a tiny black spot. The on call surgeon comes in and here begins a day of communication blunders, tears, and waiting.

She explained what was happening in the most matter of fact tone I’ve ever heard. More drugs, and I would have assumed she was telling me that tonight’s forecast was sub 40 and a coat would be necessary. Sub 40 here being there is a stone in my common bile duct. A coat meaning I cannot leave the hospital, I have to get the stone removed, and then my gallbladder. The next day as I was hitting over 30 hours without eating or drinking, not one person was able to answer our questions. A nurse practitioner came in to explain what was happening, and when we probed for answers, she said “ im just a navigator here.” When she left the room, taking her condescension with her, Brendyn asked if I caught her role. She’s an NP. She spoke to us like she was just passing by, not even working on that unit.  I was supposed to be transported to the main hospital for the ERCP hours ago, but no one can tell me anything. I wanted to know if the transport would be covered by my insurance, but the only person who came to talk about it disappeared shortly after. I make a note to myself about how to talk to patients when their expectations aren’t being met, how to show empathy and compassion for their suffering even when I cannot fix it.

I learned that if you order an ALS ambulance it could take hours longer than if you just order a BLS one. I was not on a monitor, and they stopped my fluids. The EMTs transported me with great care, sharing their experiences and offering advice to future doctors- “be nice to us.” Isn’t that important? Be nice to your patients. Be nice to your first responders, and to your nurses, to your clinicians, to everyone.

 I wake up from the ERCP, the person at the bedside gives me apple juice on ice, which I’m guessing I requested. I tell her it’s the best apple juice I’ve ever had in my life. It’s the first thing I’ve consumed in 44 hours. They transported me back to the hospital with the ED staff who have probably seen so much at this point, empathy is running dry; except now I get admitted to the medicine floor.

My room has soothing lighting and windows that open to trees. The art on wall isn’t too bad, and my nurse, Nancy, is the most wonderful person I’ve met in a long time. She feels like family. We exchange stories about bowel movements and laugh. I get a lot of morphine between now and the surgery. My surgeon is someone I aspire to be. She immediately acknowledges my anxiety and need to understand what is happening and goes through all the imaging and reports with me. She treats me like a normal person, a person who has not seen 1000 cases of choledocholithiasis, and she teaches me like a medical student. I am so grateful for her. There was a moment where I felt such fear after the surgery. I was having more post op pain than the hospitalist expected, and again saw the results of the imaging before they had time to talk to me about it.

I was crumpled over in a bedside chair with my heating pad as Brendyn tried to console me. I asked for the nurse repeatedly to quell the pain I was having. Concern turned to panic which turned to tears which turned to seizing anxiety that hit me like I was being stabbed every time I heaved. Brendyn tried to show me videos of the dogs, and I am sure that the look in my eyes was so helpless. A call with a friend empowered me to ask for the medicine I needed, and the presence of my surgeon soon after I received pain and anxiety medication calmed me. She explained the pain I was feeling what the imaging showed, what the labs showed, what the medicine would help with, what it would not help with. I gave her a drawing I made the night before while the nurse pushed a suppository into my rectum. An experience that would normally strip me of my dignity but I now embrace it with humor.

Now I am home. Recovery is different for everyone, and I wonder why I am so depressed. Why I am allergic to the pain medicine, why I still feel waves of crampy jolts every few minutes. It feels like someone tied a string to the loops of my intestines and put small weights at the end of the strings. It doesn’t feel quite right. I am fatigued, I want to sleep for 15 hours. The brain fog is potent, and it feels like my thoughts and covered in mayonnaise as I try to get through a single lecture and Anki deck. I keep going back to look at my MRI. I keep thinking about the pain and being on the floor for ten years wondering why I was so stressed out that my body would react this way. I feel deeply depressed in a way I haven’t felt in a long time.

The idea that my body failed me in such a way, that when I brought it to the attention of several doctors over the years it was diagnosed as a result of my depression and anxiety. It makes me feel tied to mental illness and to a time when it was impossible to study for hours on end because my mind and body were not working as they should. Naively, I thought that my mind and body were done misbehaving. I thought they would leave me to thrive in medical school, because it had taken everything to get here.

My surgeon said that I didn’t cause this. Everyone asked if I ate a lot of burgers but I’ve never had one in my life. Aside from a guilty pleasure of fries maybe once every couple months, I eat mostly vegetarian, mostly home cooked meals that aren’t high in fat. I feel the judgement of my medical school curriculum, looking back on the slide deck for the GI module. They were surprised my labs were not much worse, and that I had lived with this for so long.

 I wrote this because I cannot move on like I think I am expected to. It wasn’t an acute event, it was ten years of feeling this intense, horrifying pain at random moments, getting in the way of my life, social activities, school, and work. It was ten years of laying on a bathroom floor and wondering why my depression and anxiety caused this; even now when I know it was probably biliary colic I cannot peel myself away from the shame that I somehow did this to myself. And because the pain is not gone, I need to see more specialists. I do not care if I cannot eat all the fat and dairy New Orleans has to offer; I simply want to sleep through the night without a quiet twisting sensation that grows into a monster that steals my time and energy from me.

I mostly want to hide from the demands of my life, I don’t want to participate in the clubs I am responsible for, I don’t want to walk the dogs, I don’t want to cook dinner or wash the dishes. I want to crawl into a bed under a pile of fuzzy blankets and sob until everything stops feeling so intense. My emotions are tired, my sister said. I wonder how tired my gallbladder must have been, to hold onto the stones and the sludge.

I tell myself that this will pass, and that I am here because I am resilient and that I must make another Anki card, I must draw another diagram, I must study in order to put this behind me. I just wish that resiliency was not required of me, not right now.