Extracorporeal Shock Wave Lithotripsy

It’s Monday—overcast, dreary, and drippy. I’ve checked in and been called back to the pre-op area for prepping. I’m lying on a stretcher, butt naked under the hospital gown, a sheet, and a blanket. I’m wearing a blue-plastic hairnet and the plastic-treaded stockings. I’m a fashion statement! An IV flows D5W slowly into a left arm vein. Nurse 1 stands to my right, pecking at the computer as she asks me some standard questions and checks my standard answers against my recorded history.

“So, Mr. New, your PAT (pre-admission testing) bloodwork looks fine.” Says Nurse 1. “Your EKG is completely normal. That oxygen sensor on your right index finger registers you’re breathing well. And your blood pressure is also normal. How do you feel?”

I want to say ‘with my hands,’ but I’m not much of a smart-aleck. “Fine, a little concerned.”

Nurse 1 pats me on the shoulder. “Oh, you’ll do fine. Is there someone here to drive you home?”

“My wife Carle is in the waiting room.”

“Fine, I’ll bring her back in a moment.”

Another lady approaches my stretcher.

“Hello, Mr. New, I’m your Anesthetist. I’ll be watching over your breathing this morning. Mind if I take a listen?”

Anesthetist waves her stethescope at me.

“Go ahead.”

She reaches her hand underneath the blanket and places the stethescope’s business end against the sheet over my left chest.

“Deep breath, please.”

I breath deeply and exhale. Anesthetist moves the stethesope to my right chest.

“Again, please.”

I comply.

“Ever had any problems with anesthetic?”

“No.”

“Very good, Mr. New. Sounds very clear in there. Okay, I’m going to get your happy juice ready to send you to sleepy land.”

She pats me on the hand and moves to a locked cabinet, unlocks it, and withdraws two glass vials. Absently, I watch her load two syringes with different narcotics.

Ah, radiance! Carle arrives and stands at my bedside.

“Mr. New,” booms a well remembered voice. “Good morning. All set to get this last step done?” It’s Doc from the Urology Clinic.

“Sure thing, Doc. Say, I thought you said this was a non-invasive procedure. Why the surgical prep?”

“Well, yes, it is non-invasive. The shock waves are administered from outside your body by the ESWL machine. All of this,” he waves his hands around the space my stretcher occupies, “is in case something goes wrong. We put you under to control your body’s motions. With the machine focused above your left kidney, we don’t want you thrashing around because of the noise it makes, which is a loud thumping. Very rythmic. Oh, and remember, Mr. New, after the procedure, you may have a reddened, rectangular area where the shock waves entered your body. There may be muscle pain in the area also.”

“Okay. How long will the procedure take?” I ask.

“About thirty minutes,” Doc replies. “Call it forty. We have to get the ESWL positioned just right and then you positioned just so. Then the techs that run the machine start the process. I’ll be there to observe and oversee everything. Sorry we’re running behind schedule.”

“What do you mean, ‘behind schedule’?”

“The rain has slowed getting the machine in place. You see, neither the Clinic nor the Hospital own an ESWL machine. We don’t have enough kidney stone cases per month to warrant that. So we schedule with an outside company that runs a truck in and around Florida. The techs that run the machine are on the road Monday through Friday. Messy weather tends to slow them down. But, we’ll get things going soon. By the way, which side are we working on today?”

Oh, yeah, I remember this little drill. “You told me it was in the left kidney, Doc.”

“Correct. Here, I need to initial over your left kidney.”

I lift the sheet and gown, exposing my torso’s left side.

“This is a water-based marker. It should wash off after a shower or two.” Doc puts his initials over my left kidney. “There, target acquired!”

Doc turns to face Carle. “Hello, you must be Mrs. New. So glad to meet you. In case he didn’t tell you, I had to chastise your husband for self-diagnosing himself.” He grins at Carle.

“Hey,” I interrupt, “I did not do that! I just ran several urinalysis’. I knew something was wrong and only monitored my situation until I could present the data to my GP!”

“Still …” Doc smiles and moves over to another computer console.

Several minutes pass while Carle and Nurse 1 do small talk. I won’t bore you with the details. It wasn’t about me.

Anesthetist returns.”Mr. New, I’m going to give you a little of the happy juice. This may make you a tad groggy.”

“Okay.”

I watch her open a three-way port in the IV and shoot me a small dose from each syringe.

“Won’t be much longer, Mr. New,” says Anesthetist. She moves away.

“Hi, Mr. New, I’m Nurse 2. We’re finally ready and you’re the first one this morning. Ready to go?”

“Guess so. Bye, hon,” I wave to Carle as I’m wheeled away.

Nurses 1 and 2 wheel the stretcher through halls and around corners. They pass me through a final set of doors and position the stretcher against a white machine with its own stretcher-like bed. It squats in the room with a gimbaled arm-like extension hanging above me.

“Mr. New, could you move over to the other bed, please?”

I comply and that’s the last thing I remember. Thank the Lord for Anesthetist.

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