I hadn’t used an urgent care clinic in fifteen years, but Friday evening I encountered what I determined to be a non-emergency situation that maybe shouldn’t wait until Monday for treatment.
As the night wore on, I was using the bathroom more and more frequently. It got to the point that there would only be a few drops, yet before I could get back in bed I felt the need to go again. It was annoying, but not an emergency. After a few hours, my lower back started to hurt. Also annoying, but still not an emergency. Deciding that I must need more fluids, I drank a glass of water. After that, every time I used the bathroom, I would also vomit. Ewww. I drank more water because I didn’t want to get dehydrated and (not to be overly graphic), upchucking water was preferrable to dry heaves.
Three hours later, I typed “low urine output and back pain” into a search engine and learned that possible causes included cystitis, sepsis, prostate cancer, end-stage kidney disease, and kidney stones. My symptoms didn’t match cystitis or sepsis, prostate cancer was easily ruled out, and given my recent lab results, so was end-stage kidney disease. That left kidney stones or something Dr. Google didn’t reveal. Since kidney stones are a possible side effect of one of my meds, I figured that was most likely what was going on. Reassured that it wasn’t an emergency, I let my husband continue sleeping.
And, although it wasn’t an emergency, I knew I’d be significantly dehydrated if I spent the next thirty hours vomiting. Googling “urgent care clinics,” I learned that the nearest one was quite a distance away (and in the opposite direction as my family doctor). I love living out in the country, but sometimes there are disadvantages – like taking an hour to get medical help.
Once morning arrived, my dear husband drove me and my bucket (so I didn’t make a mess of his car) into the city. The PA asked questions, did an exam, and told me that I needed to go to the ER. It sounded to her like kidney stones, so the hospital would need to do some imaging and lab work. She was also concerned that I was getting dehydrated. How ironic that the PA had the exact same thoughts I’d had, but I’d chosen the wrong place to get help.
At the hospital, things got weird. The doctor focussed on my vomiting, which I had been convinced was only a reaction to the pain in my back. He ordered x-rays, not a CT, and also blood work and another urine dip. The nurse went to bat for me and called the urgent care clinic for results instead of repeating the dip, however the doctor later insisted on repeating that test. Eventually he decided that mtx made me more susceptible to infection, so told me I had “stomach flu” and sent me home with a prescription for an anti-nausea medicine.
Saturday afternoon I wore a path between the bathroom and the sofa. No matter what the ER doc said, feeling the need to urinate three times every five minutes is not the stomach flu. When bedtime arrived, I took feldene, acetaminophen, and more zofran, and slept like a log for three hours. At 2 a.m. I awoke in agony. The back pain had moved to my side, and it felt like someone was stabbing me.
Eventually I was able to crawl to the bathroom where I huddled, moaning. There was no way I could wait until Monday to see my family physician. The pain was excruciating. My husband got me another zofran tablet, and also dug through the medicine cabinet to find morphine left from my surgery two years ago. The zofran didn’t work, but the morphine lowered the pain from a 9 to an 8, and we headed back to the ER.
This time there was a different doctor who explained that although people with kidney stones are usually agitated and move around a lot (I just wanted to curl up in a ball and die), he thought that’s what I had. He waited patiently while I puked my guts out, then did an exam and sent me for a CT scan. Testing proved he was right. The PA was right. I was right. What on earth was that first ER doc thinking? I have a kidney stone, not the stomach flu.
Now I have different prescriptions and am waiting for this stone to pass. And I’m wondering: What could I have done differently? What should I have said when doc #1 patronizingly tried to convince me that I had a simple case of gastroenteritis? That wrong diagnosis cost me unneeded x-rays, a second trip to the ER, lost sleep, worry for my family, and a ton of extra time. I suspect that in the future I’ll be asking doctors lots more questions. Even though I haven’t been to medical school, I won’t be as accepting of a diagnosis that doesn’t sound quite right. What’s the solution? How can a person get good care without seeming obnoxious?
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Life-threatening situations are what I consider emergencies: heart attack, stroke, blow to the head followed by loss of consciousness, etc. There are other instances in which medical care is needed, but nobody’s going to die if it takes a few hours instead of a few minutes to obtain help. Hospital emergency departments are for emergencies. Doctor’s offices are for other situations. In my opinion, urgent care centers are for times that the doctor’s office is closed and the non-emergency situation can’t wait until the doctor’s office will be open.
