The Ghost of Gallstones Past

So a while back, I had gallstones.  This meant suffering semi-random gall bladder attacks, which left me pale and writhing on the ground in pain.

After several ER visits and doctor examinations, my doctor recommended surgery.

Naturally, I wanted to see what else I could try before it came to actually being cut open and getting my gall bladder removed.

There was a popular remedy I’d seen online, involving fasting and drinking epsom salts to clean you out, then drinking olive oil.  So I gave it a shot.

It was horrible.  Drinking olive oil straight is dis-gus-ting, so bad that even today, years later, the smell makes me a little queasy.  It also didn’t help at all.  Ultrasounds before and after showed, if anything, more gallstones after the olive oil.  I ended up getting the surgery, which was meant to be outpatient but due to a complication ended up being 3 or 4 days in the hospital.

Flash forward to today – the surgery has been effective, and life without a gall bladder is largely the same as before I had it out.  If you’re curious, the only real change is if I have a fatty meal, I’ll have to go to the bathroom 30-40 minutes later.

My mom just forwarded me a quote she found, thanks to Google Books, from Ellingwood’s Therapeutist, an eclectic medical journal from 1914:

If there is an infection of the gall bladder with gallstones, give an ounce of olive oil twice daily, which has a tendency to liberate the stones. This remedy was first suggested by Dr. Horatio Firth of Brooklyn, N. Y., and is on record.

Dr. Horatio Firth is my great-great-grandfather, on my mother’s side.  So it turns out that drinking olive oil, the popular remedy I found on the internet, was actually invented or at least popularized by my direct ancestor.

Small space-time continuum, eh?

p.s. Thanks for nothing, great-great-gramps!  Bleh.

The Future of Healthcare

Based on what’s going on in the medical community, a series of consistent themes emerges that provides some insight into what the future of medicine will look like.

Here are some things rising to the top of the discussion of future medicine:

Digital Records

Currently, this is kind of a mess. Some hospitals and doctors can share patient records with each other, some can’t. The ones that CAN often don’t. Usually the patient is cut out of the equation entirely, and will only see their own records if they demand to. There needs to be legislation about this soon, to standardize secure digital medical records and require all health care providers to use them, and make them more easily available to patients. It also needs to ensure patient privacy and make sure insurance agencies won’t take advantage, while at the same time perhaps making anonymized records more available to researchers. Shared data can be incredibly powerful, and increase knowledge about human health as a whole.

Cheap Sensors

Inexpensive sensors can provide continuous monitoring where previously a patient would have to come in and only get a single measurement.

Doctors seem to be both excited and terrified by this prospect. This is unfamiliar territory for many of them. They are used to seeing, for the most part, single data points when a patient comes in for care. They aren’t sure what to do with more data, because they may not have a very good grasp of what is “normal”. They are concerned that more data will reveal “false positives” where, for example, someone’s blood pressure may spike several times a day – this might be normal in a healthy person but doctors fear it might be mistaken for high blood pressure.

This is why doctors don’t like full-body MRI scans. They are presented with a vast amount of data, and there may be numerous things that appear to be wrong that are actually fine for that person. They don’t have any easy way to sort through these false positives, so they’d rather not use the system at all.

This is a short-sighted view. As I like to say, more data is more fun. What if doctors had yearly full-body MRIs for all their patients, done as part of a yearly check-up? The vast amount of data not only for a single patient but all patients globally would provide huge insights into human health, and what is normal for each person. As we get more data, our methods of parsing it become more refined, software becomes more sophisticated.

Cheap Labs

Right now labs are slow, expensive, and generally inaccessible to consumers. Doctors are afraid to order tests because of cost, and afraid not to order tests because of lawsuits. But new tests are being developed that are not only better, but cheaper. What used to take a large lab might soon be a small piece of paper, or a cheap “lab-on-a-chip”. Instead of sending samples to a remote lab, tests can be done directly at the point of care, or even remotely, administered by the patients themselves.

Genetic Testing

Along with cheap labs comes the possibility of cheap genetic testing. The Army already has a portable genetic analyzer, used mainly for identifying bodies on the battlefield. Currently most doctors wouldn’t know what to do with genetic data if a patient gave it to them. But as the process gets cheaper and faster, genetic testing may become a standard part of medical care. Databases of genetic information cross-referenced with conditions and gene mapping will make this genetic data more and more useful. Maybe science will even begin to understand epigenetics.


Cellphones are one of the most prevalent pieces of technology in the world. Each generation is more sophisticated. Essentially, nearly every person either owns or has access to a tiny portable computer connected to a global network. Hospitals will take advantage of this, and be able to combine the use of cheap sensors, cheap labs, and cellphones, allowing patients to upload medical data directly from home. In poorer countries, mobile care facilitators – not doctors but volunteers – could serve communities with a backpack with cheap sensors, cheap labs, and a cellphone. Diagnostics could either be run directly on the cellphone, or data could be sent to a server and results returned to the cellphone.

Decentralized Medicine and Preventative Care

All of this inexpensive and networked medical technology also means the individual has more control over their own health care. Feeling sick? Pop over to CVS and pick up a lab-on-a-chip test that tests for all known viruses and bacteria. Then either view the results locally, or transmit them to your doctor.

Some doctors fear this, believing that individuals cannot handle their own care, that they will freak out over every piece of data. Undoubtedly, some people will obsess over this, but you can’t let a few hypochondriacs ruin the entire concept of personal care. The vast majority of people will benefit from greater patient education and more access to their own health care data.

Currently, the medical system is a reactive one. When I go to my doctor for an annual checkup, he is literally uninterested if there is nothing wrong with me. If there is nothing wrong with you, there is no problem to solve, no puzzle to sort out, so nothing that interests the doctor. But with probability maps from genetic testing and increased focus on national health, this may shift to a more proactive view.

Regenerative Medicine

This is just starting to take off now, but has already made impressive strides. It is currently possible to grow a replacement bladder for a patient. Replacement muscle tissue and hearts are in the experimental phases. Through collagen lattices and cloned tissue, it may soon be possible to replace most internal organs with healthy new ones grown in a lab. And since they are based on the patient’s own genetic material, they don’t have the same problems with rejection that make organ donation so tricky.

It may seem like science fiction, but research is already underway, with lots of military funding – the goal eventually being that a soldier who comes home with a leg blown off could simply grow a new one.

And after that, the next logical step is to get the body to do its own repairs, or assist the body in this, so that instead of involving a lab, a patient’s own body can repair damaged organs.

Inkjet Printers

Ok, so this one isn’t directly obvious, but indirectly it’s amazing the applications medical researchers have found for standard off-the-shelf inkjet printers. The aforementioned replacement organs can essentially be PRINTED, layer by layer, from a standard inkjet printer. And those paper lab kits can also be created on an inkjet printer. This means that the technological advancements could end up being extremely cheap to implement.

Suspended Animation

I had to mention this one after seeing an incredible TED talk on it. Researchers are currently in human testing phases of using a normally toxic gas in very low doses, along with cold, to basically put people into a state of suspended animation. The patient’s body slows to a point of almost stopping, like a sort of hibernation. In this state, the patient needs very little oxygen and can survive damage or blood loss that would normally cause fatal shock. And revival from this state is simply a matter of putting the patient into a warm room and letting them “thaw out”. We may soon see all ambulances and emergency crews equipped with this, allowing them to basically “pause” critical patients so they can get to the hospital to get treatment.

I give the pain a 9 out of 10

Last night, I got back from Sarah’s. Traffic had been crappy on 90, so it took me a half-hour longer than usual. I had a bowl of ceral and started installing the iPhone SDK on my mac mini, so I can take it with me to WA.

Adam came downstairs and said he’d been watching movies all weekend, he got a Hitchcock box set.

We decided to watch North by Northwest.

We got about 30 minutes in, and all of a sudden my abdomen started to cramp. I shifted around on the couch, but then the pain hit. Not mild pain, but 9/10 pain. My face was suddenly wet with sweat, and I could barely breathe or speak the pain was so great.

I took a couple oxycodone, I’d never timed them to see how long they take to kick in, though.

I IM’d Sarah to distract myself from the pain. She pointed out it could be a blocked duct, and that I should probably go to the ER, since a blocked duct can cause complications.

I waited a few more minutes, but the pills weren’t kicking in. So I asked Adam to drive me to the ER.

He dropped me off and told me to call when I was ready to be picked up – usually trips to the ER are 6-hour affairs.

Since I was obviously in horrible pain, and barely able to speak, they got me a bed quickly.

A doctor examined me and a nurse put an IV in my arm and drew some blood for labs.

Finally the oxycodone began to kick in and the pain subsided, I could breathe and speak normally again.

A doctor came in with a student doctor in tow, she did an ultrasound while the student watched. She was nice, I asked lots of questions, and she turned the ultrasound so I could see. It looked like there was a small pile of gallstones at the bottom of my gallbladder. She couldn’t find any obstruction.

An RN came by and adjusted my bed for me and got me a warm blanket. I texted Sarah as I lay waiting for the lab results, sent a picture to my blog, and finally took a little nap.

The labs came back. A couple numbers were elevated, but not indicative of a block or infection. So they gave me a new prescription for oxycodone and sent me home.

I called Adam to pick me up and walked out in front of the entrance to wait.

Suddenly, I felt lightheaded, and nauseous. My vision dimmed, and I could feel I was passing out. I stumbled back inside and sat down in the waiting room, and took deep breaths. I figured perhaps it was a mix of getting up after lying down so long, the pain meds, and dehydration.

Adam arrived and drove me home.

I wasn’t really able to fall asleep for long, instead slept in bursts throughout the night.

This morning I woke up feeling shaky and nauseous. I half-slept. Then, I got that overactive salivary gland that means one thing: vomit is coming.

I threw up, though not a lot.

Then a half-hour later, just now, I threw up a lot. Everything left in me, I hope. Now my throat is burn-y from the acid. Bleh.

ultrasound, microinfo

I had an ultrasound today and had more blood drawn for labs.
No info though. Guess I’ll have to wait till next week to hear anything from my doctor.
I asked for copies of the ultrasound images so I could see what my insides looked like, but the radiologist said no. Boo. Apparently I can request that my doctor request a copy of the images, if he agrees to it. Doen’t sound very HIPAA-compliant to me. >=(

Meanwhile, I’m in a sort of limbo… not really stricken, but not really well.
I have a more or less constant low-grade fever and headaches, abdominal soreness, and at night I wake up with abdominal pain, which isn’t super-severe, but enough that I can’t fall asleep without taking an oxycodone.

I’m worried that the doctors might not schedule any sort of treatment until after I get back from my trip to Washington, so I will be feverish the whole time and not able to fully enjoy it.

Especially since I don’t have enough oxycodone to last that long, which could mean a lot of sleepless nights up tossing and turning in pain (apparently that’s when Gall Bladders do their thing, most gall bladder pain happens to people at night).

I’ve been looking forward to the trip for a while now, it would suck to have it spoiled by my stupid insides.

No answers yet

Had some blood drawn for lab work and an ultrasound scheduled for Friday.
I’ll get to find out the sex of the baby!
Just kidding.
I’ll get to find out if I need to have some of my insides lopped out.

Right now my guts don’t hurt too bad, but I have a bitch of a headache.

The day my insides went horribly wrong

Sunday started as a slightly off day. I could feel something, a not-quite-rightness about things.
I broke a container of chervil when making breakfast, shattering the small jar and covering the floor with the spice. I cleaned it up, and didn’t mention it to Sarah (she was taking a shower at the time).

After breakfast, we were going to Old Sturbridge Village, Sarah’s parents were in the area and would meet us there.

I had trouble getting ready – trips always slightly discombobulate me, but I felt extra helpless as I got ready go.

As we pulled up to Old Stubridge Village, I felt sort of grumpy and out of sorts. “I feel like every decision I make today will be the wrong one,” I said to Sarah.

We met up with Sarah’s parents, and wandered around OSV for a while. Sarah’s dad had bought a big bag of lemon cookies at the bakery there, Sarah and I split a cookie (a bad decision, a precursor to the upcoming really bad decision).

We saw pretty much everything there, some interesting stuff, some just reminded me of growing up in rural Maine. I saved Sarah from stepping in an enormous pile of horse manure, she had been tromping along reading a brochure, oblivious to the potential messy fate.

“Colonial times were really stinky,” she commented.

After we’d made the rounds, we decided to get something to eat. When we go to the tavern, though, it was closed. So we left OSV and went to a place Sarah’s parents had been 10 or so years before, the Publick House.

It’s an old-style upscale hotel/dining/event place, a massive structure with a rambling, maze-like interior.

We finally found the dining area (with some assistance from one of the staff) and perused the menu.

I settled on getting the Chicken Pot Pie, and a salad and a dessert. “Remember from the book ‘Eat this, not that’,” Sarah commented, “those are loaded with fat.”
“Yeah, but tasty,” I reply.

Little did I know then that my decision of dish would nearly destroy me.

The chicken pot pie was yummy, though I burned my tongue a little when eating it, blowing on each spoonful instead of waiting for the dish to cool.

For dessert I got Indian Pudding, which I don’t think I’ve had before. It was good, not too sweet, with a scoop of ice cream. I had some of Sarah’s Apple Pie, which compared to the Indian Pudding, was almost too sweet.

After dinner, we headed back to my car to drive home, and Sarah’s parents headed back to their hotel.

On the ride back, I could feel something wasn’t right.

“Oof,” I commented, “I feel stuffed.”

“Me too,” said Sarah.

[Warning: The remainder of this story falls into what most people consider the “too much information” category.]

But I felt more than stuffed, I felt over-stuffed, bursting at the seams.
I had been constipated for the past couple days, which worked out great for the bike ride, but now I was afraid I really *was* filled to bursting.

On the drive home, the pain got worse and worse.

A couple years ago, I felt a similar pain, and ended up going to the ER for it. The said it was constipation, and proscribed me some laxative.

I still had some of it left, so took some. I couldn’t remember how long it took to work, though.

The pain continued to escalate.

Sarah went out to get some different treatments to try.

In agony, I prayed for her return.
I tried meditation, which worked, but only for small periods of time. Then the pain would come bursting back into my awareness. I heard Sarah come in, and eagerly greeted her.

“Sorry,” she said, “every place was closed. But there is a 24-hour Walgreens on Park, I’m looking it up in google maps.”

She tried to print out directions, but couldn’t get the printer to work. I was in too much pain to help. She wrote down directions and headed out again.

I had noticed that lying on the cool tiled floor in the kitchen seemed to help a little, so I tried an ice pack. I’m not sure it helped at all, but it didn’t make the pain worse.

Sarah came back again, this time with supplies. She was concerned about me trying too many things on my body, but I was in so much pain, I was willing to try anything. Things that seemed disgusting and unthinkable at any other time were welcome. I tried an enema and a suppository, both of which had little to no effect. I forced myself to throw up, anything to try to decrease the pressure, but it did little but leave me with the taste of vomit in my mouth and throat.

Then I took a warm bath, which did help, but I have the smallest bath in the universe – I had to put my legs straight up on the wall to lie down in the tub, and even then the water didn’t cover my abdomen, where the pain was. So I gently splashed water over my stomach, which helped. Not only were my intestines crying out in pain, but my abdominal muscles were as tight as possible, as were my back muscles. The warm bath helped relax them a little.

At this point, Sarah was pretty exhausted, she had been tired earlier, and now it was past midnight. She fell asleep, and I went to the couch, so my pained thrashings wouldn’t wake her, and tried to get some sleep.

I realized after a while there was no way I was going to be able to sleep, there was simply too much pain.

I remembered my trip to the ER last time. It had been ridiculously expensive, but they had given me morphine, which made the pain go away. At that point, I was desperate to make the pain stop. There was a pair of scissors on the kitchen counter that I had to put away, because every time I walked by them, I would eye them and think about stabbing myself in the gut, anything to stop the horrible, horrible pressure and pain.

Finally I resigned myself. I knew it was an amazingly expensive rip-off, but the ER seemed like the only choice. My insurance would cover some of it, at least. The thing that gets me about ER visits is that what is expensive is not the doctors, or the medicine. The expensive thing is the time you spend in a bed. That’s right, the medicine and doctors only cost tens or hundreds of dollars, but time in the bed costs THOUSANDS. So they have an incentive to keep you in the bed as long as possible, since it’s like a taxi with the meter running. The most expensive taxi on earth.

I wake Sarah up. “I can’t take the pain anymore,” I say, “I’m a wuss. I need the ER and some sweet, sweet morphine.”

“Ok,” she says.

We get dressed and head over.

I check in and a nurse takes my vitals and gets some info about my condition.
Then we wait in the waiting area. I give Sarah my iPhone to play with, she plays Quordy (which a friend from college wrote) while I squirm around on a couch, trying to find some mythical comfortable position, but it’s a hopeless quest.

Finally I go up to the reception desk, I ask her if there’s a water fountain.
“You have abdominal pain, so we can’t give you any liquids,” she says.
“What about a bathroom?”
“You’re just going to go drink some water, aren’t you?”
“No, I… I’m feeling a little queasy (I was) and want to know, just in case.”
“I can give you a bucket if you need one,” she gestures to a pile of plastic bins.
“I just… I just want to know where the bathroom is.”

She is about to tell me, when a woman walks up, saying “I’m ready for him”.

I call to Sarah, and we head into the ER “pod”. I’m handed off to a nurse. “This way,” he says, and sets me up in a bed. He tells me to remove my shirt and put on a hospital gown. Oddly, he leaves the room. I’m removing my shirt, not my pants. I guess they treat men and women removing their shirts the same? I’m not sure if that’s progressive, or prudish… seems weird in a hospital, but I guess they want to make extra-sure no one sues them for sexual harassment…

A number of nurses and doctors examine me, all asking the same questions. I’m never able to get through the full recounting of my tale before they cut me off with another question. Seems inefficient, that they would get more out of letting me finish, or asking new questions, instead of each asking the same ones. Seems like that information isn’t getting passed from one person to the next – the very first nurse took notes, but doesn’t seem like these doctors and nurses were. I was pretty distracted by the pain, though, so perhaps they have some system I didn’t see.

They bring in an ultrasound, and scan my belly. I can’t see from where I am, but they say I have three gall stones. They also say I have an unusually large gall bladder, but don’t say what that means.

They take some blood to run some tests.

At some point, they finally offer me some pain relief. I’m not sure if they didn’t want it to mess up my lab data, or they just liked watching me squirm, but it seemed like a while before they finally got me some morphine.

Morphine is great. It didn’t completely eliminate the pain, though, just knocked it down a few notches. I felt almost like I could drift off to sleep.

After a while, though, the morphine begins to wear off. I’m not sure how long I’ve been in the bed. Hours?

A doctor comes in to talk to me, I forget exactly what he said, a lot of horrible stuff about possibly removing my gall bladder, how fever might be deadly or something, but I was distracted from what he was saying, because the pain was back.

He chastises me for trying chemicals to cure my constipation, said that I was dumb not to just use lots of prune juice. Well, excuse me for using the medicine that the same ER prescribed last time…

Finally, he says he’ll get me some more pain reliever, this time morphine and another one, which Sarah says is extra-strength ibuprofen.

A couple times, I ask for a copy of my medical records from the visit. One nurse blows me off, he tells me some bullshit about that not being allowed under HIPAA. In fact, HIPAA says the opposite, that unless there are special reasons, a patient is allowed copies of their records on request.

One of the doctors was better about my request, though she only gives me the lab results, not the other records (for example, the ultrasound scan had been recorded).
In my experience, doctors and hospitals are notoriously secretive about medical records. Even though they are obligated to release them if you ask, they will usually dodge and weave to give you as little as possible. I say “all”, they make their own interpretations, thinking to themselves “well, obviously he doesn’t want *all* the info, I’ll just give him this one report.”

When I say “all”, it’s what I mean. I swear, you’d have to be a lawyer or bring one with you to get them to ever comply fully with HIPAA.

So anyway, they release me, and give me a prescription for oxycodone and that extra-strength ibuprofen. It’s been about 4 or 5 hours total, which is pretty fast for an ER, though I imagine the bill will be several thousand bucks… we’ll see.

We get home around 5:30, and drop off to sleep, exhausted. Sarah doesn’t have to work Monday, or doesn’t have to work till later in the day, we don’t wake up till around, I dunno, 11am or 1pm or something.

Sarah has to head home to feed her cat and get ready for work the next morning, which is at early o’clock.

I head to Stop & Shop, and feel like an old man shambling through the store, buying my prune juice and milk of magnesia, getting my prescriptions filled. It occurs to me, I have white hair, age spots on my face, failing organs – I don’t just *feel* like an old man, I am one.

Which plunges me into despair. I mean, I’ve tried to live a fairly healthy life the last few years. Sure, I could exercise more, and I do eat the occasional slice of pizza or pasta dish, but by-and-large, I go for the healthy choices.

And what does it get me? Gall stones. Which, as a friend pointed out, are usually found in, as Wikipedia puts it: “the four F’s: Fat, Female, (nearing) Forty, Fertile.”

I’ve always fully expected to live to 100 or above, which seemed perfectly reasonable – I take care of myself, eat well, have a generally positive outlook.

But now I am told that if symptoms continue, I may need my gall bladder removed. At that moment, standing in the supermarket, I felt a complete failure. Anything I had done to try and stay healthy had been either too little, too late, or doomed to failure from the start.

The prune juice and milk of magnesia did the trick, got my insides cleaned out and working again.

However, I’ve been feverish today. Which I remember the doctor saying something about, something very bad, but I don’t remember it all. The long and short of it is probably just that I’m fucked.

I have an appointment to meet with my regular doctor tomorrow morning, where doubtless he will give me his own rendition of the “you’re fucked” tune.

I remember the good old days, back on Saturday, when I used to be healthy.

Sigh. Days long gone, I guess.


I am sitting at my kitchen counter, sipping a mixture of coffee and Nesquick, and listening to the synthesized sounds of “it’s a small world” blare from an icecream truck drifting down the street.

My grandfather is dying.

I took the day off from work today to drive out and see him. I got up this morning and printed out some photos to complete a little photobook I had intended to give him earlier, but hadn’t finished for one reason or another. It made me run later than I planned, but he really loved it, so it was worth being a little late.

He’s in rough shape. His arms are dark and bruised-looking, and covered with sores. His dressing gown reveals the edge of a large bruise on his shoulder and chest. He has a tube going up his left nostril, and a breathing mask around his nose and mouth. I know somewhere he has IVs hooked up, probably a catheter as well. His breathing is thick, as there is fluid in his lungs. He says he is really thirsty, but he is not allowed to drink, since the water would just go into his lungs.

He tells me of his first date with Ida.

“We drove to the beach. We sat there, but dammit, I didn’t have the nerve to put my arm around her. It wasn’t until later… We were at her house, and her mother and sister went into the other room. It was cold out, I was getting ready to go. She was helping me get my coat on, and was leaned in close. Her face was very near mine, and I thought ‘Well, Seymore, it’s now or never!’ and I leaned in and kissed her. It was the most delicious kiss, ever. At that moment, wild horses couldn’t have dragged us apart.”

He misses her, terribly. Since she died, there has been a void in his life.

“I need my family. Without my wife… a man without his wife is nothing. I need someone to hug me. My parents never… never hugged me. Not once. I wasn’t abused, but… I can’t remember once having a conversation with my mother or father. They just didn’t talk to us.”

I show him the photos I brought. The book has a ribbon on the front and back covers, so it can be tied closed with a bow. Instead, he has me tie the very ends of the ribbon together, so he can use it as a wrist strap. He clings to the book, rubbing the fabric cover with his fingers, as if reminding his fingers of what it is to touch.

I stay with him for a couple hours, talking and holding his hand. A nurse comes in to change his bedding. “I’m going to get some rest after this,” he says, “so you should go now. I’ll just be resting. I’ll try to see you again.” I hug him and head out. As I walk past the ICU nurse’s station with a large lump in my throat, I hear his voice. “A good boy, such a good boy.”