Off Main Street

by Michael Perry

  After four years, I took my nursing boards, convinced I’d fail, and passed just fine. Worked as a nurse for a while and liked it. But I kept having trouble remembering all the numbers, and how Demerol interacted with Elavil, and just what it was phagocytes did, and yet I could remember the poem the stunted guy behind me in creative writing wrote about electrical high lines, and what the professor said it lacked, and how I believed the high line guy could have done better, and how I remembered the way the folk music professor crossed his legs and fingered his guitar when he explained that the scarlet ribbons in “Scarlet Ribbons” weren’t ribbons at all, but bright blood on a child’s fractured head, and I thought of the lung puffing and falling, and I said if I can conjure these things so easily while I stumble over drug interactions and hematocrits, perhaps I ought to write instead. I took to talking about this. Overfrequently, apparently, because one day my girlfriend said, “Why don’t you stop talking about it and do it?”

  And so I did.

  There was much to learn, but much less to unlearn.

  I wonder if Heraclitus would dare tell the prisoner he was not stepping in the same river twice. A lifetime of days between those tan concrete blocks? Sounds like the same old river to me. Still, our little visit must have been a diversion. I imagine he chuckled with his roomie later when he described catching me in my unease. It was a fair cop. But as he leaned in and grinned, I slid the needle in and drew out what I needed. When I stepped out of the prison, it was cold and windy, but the waning light seemed to propose an answer.

  2000

  Rock Slide!

  When Men’s Health ran this piece about my first-ever kidney stone, they decorated it with a John Manno photograph of a big jagged rock jammed in a cheap plastic funnel. Exactly.

  In the end, what I remember most is how I would find myself peeing hopefully. I’d stand there over the bowl, with my little strainer in one hand and me in the other, and I’d be thinking, This time…maybe this time. And then I would finish, shake loose the last little drop, and nothing. Over and over again, five, six…ten times a day, for eleven days, from February into March, I’d peer into that strainer with the cheated pout of a little boy who finishes his Cracker Jacks and finds no prize.

  I had a kidney stone in me, and I wanted it out.

  The stone struck on a Tuesday evening, somewhere along I-94 just east of Minneapolis. First came an upper-abdominal twinge, similar to gas pains at dawn (of the sort precipitated—I’m from Wisconsin—by excess bratwurst at bedtime), except that no amount of twisting or turning would break it loose. Then it seemed as if my right kidney had been run through with a superheated knitting needle. I was veering in and out of my lane, gasping like a scuppered carp. Struck by this delusion that a hot bath would dissipate the pain, I careened to a motel. I’m certain the desk clerk pegged me for a meth fiend—I was pallid, shivering, and rolling in sweat as she ran my credit card—but she worked quickly. I staggered to the room, filled the tub full blast and stripped out of my clothes.

  By now, based on my experience as a nurse and an EMT, I had pretty much self-diagnosed. One in ten Americans will experience the joy of kidney stones, and the pain I felt was my secret handshake into the club. I dropped into the steaming water and—drawing on my knowledge of anatomy, physics, and desperation—assumed a bizarre position calculated to roll the stone back into the kidney. (When Ben Franklin’s kidney stone blocked his bladder, he used to stand on his head to pee.) After about fifteen seconds of lying in scalding water with my butt hoisted above the Plimsoll mark, I ran up the white flag and dialed 911.

  On a pain scale of 1 to 10, kidney stones consistently ring the bell at 10. A mother of three who had a kidney stone once told me, “I’d rather give birth three times—in one day!” The pain is focused, relentless, and inescapable. I pride myself on a certain blue-collar hardiness and Scandinavian stoicism, but by the time a paramedic arrived, I was flailing around the motel room bed spewing effenheimers. “Bet it’s a kidney stone,” said the paramedic. “Morphine?”

  “Oh, yeah,” I hissed.

  While he slid the needle in, I puked into a bag. Puking is a classic kidney-stone symptom, caused by overstimulation of stomach nerves. The morphine helped, but I was still twisting like a bug pinned to a board when they strapped me to the cot. In Woodbury, Minnesota, a nurse in the Woodwinds Health Campus E.R. gave me another bump of morphine, but during a CT scan the pain came stabbing back. The nurse pushed a drug called Toradol. Sweet relief. I dozed until the E.R. doc woke me. “It’s fairly large, as stones go,” he said. “It’s borderline whether it will pass on its own.” The next time I woke, my father and brother had arrived to retrieve me and my car. The nurse handed me a bottle of Percocet and a screened funnel. “Strain your urine,” she said, “and save the stone.” I tottered out the door, paused to puke in the parking lot, and set out for home.

  I spent the week at my parents’ farmhouse in Wisconsin. Now and then the pain would outdistance the Percocet, and I would try anything—hot baths, microwaved hot packs, incessant pacing—to distract myself until the drugs caught up. Once I was crawling out of the bathtub when I was swept with nausea. I scrambled for the toilet. Hearing the scuffle, my mom burst in to check on me, and so it was that at the age of thirty-seven I found myself buck naked on all fours, head in the toilet, puking at the feet of dear old Mom. She’s been a nurse for forty years and was unfazed, but a guy hopes for a little dignity.

  The Percocet beat most of the pain and gave me freaky dreams. But it also made me more pukey, and since I couldn’t keep anything down, I began to fall behind on my fluid intake. Not good when you’re relying on hydraulic forces to flush a stone. On day three, the knitting needle woke me with a vengeance. Back to the E.R. “You got Toradol?” I asked. They did. By this time I was peeing thimblefuls of what appeared to be scorched corn syrup. They kept me overnight, pumped me full of fluids and sent me home with Compazine to treat the nausea. Because long-term use of Toradol can affect kidney function, the doctor was reluctant to prescribe the pills, but I promised to use them only during peak pain moments. One kidney stone, three days, and I had become a craven junkie.

  And so I pounded fluids and waited. I’d go an entire day without pain, then zing, it would be back. The stone was moving through the ureter toward the bladder. It was almost even with my hip bone. I took my little strainer everywhere. I carried it in my coat pocket, wrapped in a plastic bag. In public restrooms, I’d go into the stall (you really can’t stand at a urinal in the Farm & Fleet peeing through a funnel and expect to escape arrest or injury), and I’m sure when people heard the crackle of the plastic they thought, Drugs! Perversion! Then there was the problem of rinsing the thing off. I resorted to feet checks and strategically timed dashes. Kidney stones are all about drugs and furtiveness.

  Researchers have identified nineteen distinct types of kidney stones.

  “Twenty, actually!” says Michael Rentzepis, M.D. He is a urologist in private practice. Nine days since the first attack and still no stone, so I was referred to him for a consultation. Dr. Rentzepis is young and trim. He has the large glasses and eager demeanor of your classic science geek, which I find to be a comfort, doctorwise. “A new variation has just been discovered!” he says. Excitement has drawn him right to the edge of his chair.

  “Well, now,” I say. “That’ll be the talk of the annual urology convention.”

  “Oh, yes,” says Dr. Rentzepis. He’s lit up like a grade-schooler describing the new teeter-totter. “It’s just like adding another element to the periodic table!”

  Bless his heart, my urologist is a geek for renal calculi.

  “Let’s look at your CT scan,” says Dr. Rentzepis.

  I was once arc welding the underside of an equipment trailer when a molten pearl of slag dripped into my welding gauntlet, lodging against my fingernail. The pain was astounding. Flinging everything, I yipped and scooted from beneath the trailer like a poodle suffering a buttful of rock salt. On the CT
scan, the kidney stone is an incandescent dot amid all the halftone grays. I think immediately of the molten slag droplet, sliding lazily through my ureter, burning white-hot until it finally plops into the watery bladder and the pain stops.

  “The stone is right at the end of the ureter,” says Dr. Rentzepis, pointing at the bright dot. “Almost out. Trouble is, a stone of this size, it’s about fifty-fifty whether or not it’ll pass on its own.”

  “What are my options?”

  “Generally,” says Dr. Rentzepis, “you want to let it pass. Although removal procedures are straightforward, you can have complications.” He pulls out a comic book: Understanding Kidney Stones. On the cover, a golfer clutches his back, his sweaty face gripped in a rictus of pain. On page ten, a man is reclining in a tub while shock waves blast his stone to bits. Lithotripsy. Relatively painless, but the truck-mounted portable unit isn’t due in town this week. On page twelve, a doctor inserts a tube in the patient’s back, blasts the stone with ultrasound, and plucks out the fragments, a treatment reserved for stones over one inch in diameter. My stone is big, but not that big. Another series of illustrations demonstrates how staghorn stones—huge things with spikes and projections—require surgical removal and a four-day hospital stay. “I’ll put a ureteroscope in your urethra, through your bladder, and up to the stone,” says Dr. Rentzepis. “I’ll pluck the stone with a little caliper-like device.” No incisions. But right up the old main line. “Then we’ll probably need to put a tube in the ureter for a few days, to keep it from swelling shut.”

  “Do you have to go back up there to get the tube out?”

  “Oh, no,” says Dr. Rentzepis. “We tie a string to it. After a few days, you come into the office and I’ll pull it out.”

  “Umm…let’s give it another couple days.”

  I was caught completely off guard when it finally happened. I was visiting friends. We were leaving to see a band, and I had run upstairs for a quick filtered pee. Urinating through a sifter was second nature by now, and my mind was somewhere else when—boooiing!—there was a sudden rubbery back pressure, my urine flow stopped dead, my bladder expanded, then, Clack! and I was peeing effortlessly again. You know how sometimes if you turn the faucet off too quickly the pipes rattle? There’s a term for that. It’s called water hammer. When that kidney stone hit the homestretch, I had my own little water-hammer moment. And now there it was: dark brown, rock-hard, and the size of a chokecherry pit. I had a sudden urge to call friends and hand out cigars. Instead I rinsed the stone and looked at it closely. It was studded with tiny nubs and felt like sandpaper. I got a little creeped out and light-headed then.

  I went to my follow-up appointment. No sooner had he closed the examining room door than Dr. Rentzepis turned to me eagerly. “Did you bring it?” It was like in third grade when Vinnie Boscoe wondered if you’d brought the fart cushion. I pulled the specimen bottle from my pocket and held it up to view. The stone rattled against the plastic. Dr. Rentzepis’s eyes widened.

  “Oh my God!”

  Can I tell you what pride it gives a man to produce a thing in this way and have a board-certified urologist say, “Oh my God!”? I averted my eyes, flushed with aw-shucks pride. Just as quickly, I drew back.

  “I bet you tell all your patients that.”

  “Oh, no,” he said. “That really is a big one. Stones of that size, we usually have to go in after them.”

  I was glowing.

  Dr. Rentzepis has known patients to mount their stones in resin. He made me turn mine in. He sent it to a lab to be crushed and analyzed. It was 80 percent calcium oxalate and 20 percent calcium phosphate. The most common sort. Based on that information, he says I have to drink twelve glasses of water a day for the rest of my life, basically to keep my system flushed, as recurrence rates run about 80 percent. (“Once a stone thrower, always a stone thrower,” said my regular M.D. when he visited me in the E.R.) I’ll also drop in for an abdominal Xray now and then, in the hope that we’ll catch the next one earlier. Before we hit the “Oh my God” stage.

  The French essayist Montaigne wrote that kidney stones left him feeling great intellectual clarity. No sign of that so far. But I have noticed changes. I try to drink more water. Where I used to tolerate tales of childbirth with a sort of deferential politeness, I now find myself nodding in solidarity. And when I looked across the median of I-80 during a recent road trip and saw a westbound semi emblazoned with the words American Kidney Stone Management, I got so misty I nearly left the roadway. Somewhere out there someone else was gasping like a scuppered carp, and here, apparently piloted by angels, was a white Kenworth, its hood ornament aimed at kidney stones everywhere. Sweet, sweet relief, hammer down.

  2002

  Life in the Fat Lane

  I knew writing an article like this without upsetting someone would be a tricky proposition, Several months after it hit print, I was at a family reunion. One of my aunts, whose metabolism is stacked against her, approached me. “I saw your ‘fat’ article when I was checking out at the grocery store,” she said. “I had to buy the magazine to see just what you had to say.” I looked at her like a cornered dog who spots someone approaching with a rolled-up newspaper. “I think you did all right.” She smiled. “It didn’t seem like you were picking on anyone.” I began to breathe again. Never mind literary critics in ivory towers. It’s aunts at reunions who can cut your career short.

  You look like you’ve put on some weight. Think I’m rude? Insensitive? Sorry, but the experts and their numbers back me up. Diane Dresel is the Coordinator of Health Management Resources at Midelfort Clinic in Eau Claire, Wisconsin: “We have an epidemic of obesity going on,” she says. Obesity is defined as weighing 20 percent more than your ideal body weight, and things are especially heavy in Wisconsin. “We are trend leaders in obesity,” says Dresel. “Although, I think we did drop to number two in the nation last year.” To make matters worse, during winter in Wisconsin, most of us eat more and move less. Extra weight tends to stack up like snow in a supermarket parking lot, with one significant difference: Come springtime, the snow melts. Not so the accumulations of adiposity.

  Of course, it isn’t just the obese who fight the wintertime bulge. Ever since I got within a fork’s length of thirty, I’ve had an on-again, off-again relationship with an extra ten pounds. I don’t obsess about it, but I do check the bathroom scale out of the corner of my eye now and again. I have been blessed with a metabolism that up to this point, at least, can be harassed into service, commandeered into burning away the winter’s belt-line buildup. But when it comes to people who eat too much, I have empathy—which, as any therapist worth their weight in diplomas will assure you, is more important than sympathy. Because I love to eat. Oh, I eat my vegetables, and fiber is my friend. But nobody is a bigger fan of the empty calorie than yours truly. If it comes packaged in crinkly plastic, I’ll eat it. If the sugar content hovers in the range of “pure cane octane,” give me two. If artificial flavor is involved, so am I. And chocolate? Forget it. I’ve eaten enough chocolate in the past two years to double dip the Bloomer water tower like a big ol’ marshmallow Easter egg.

  And so, I have been approached by the editors of this magazine to address the problem in print. I’m sure they trust I will lend some sort of insight, tap some hidden source of knowledge, come up with nifty pun-intensive sidebars the likes of “Ten Surefire Weighs (wink) to Drop Pounds Without Lifting a Finger.”

  I wish. I’d be on a national book tour so fast it would make your bathroom scale spin.

  Oh, it’s not as though you don’t have options. Wisconsin may lead the way to the buffet, but the obsession with thinness is a national one and it has spawned an industry eager to slim you down. Trouble is, no matter how honest they may be, somewhere along the line they all tend to have a ring of the snake oil salesman about them. According to one brochure, from a national weight loss organization, “…most diets allow just limited foods, and they don’t teach you how to stay in control once you�
�ve lost weight.” Of course, this begs the question: Do they offer a diet that allows unlimited foods? Read on, and it sure sounds like it: “Our Fat & Fiber plan offers remarkable flexibility for those of you who need the freedom to eat just about anything, anywhere.” Really. Well, make mine funnel cakes at the fair. More from the brochure: “…eat the foods you love while you follow our plan.” Hmm. The foods I love—does your plan include chocolate-covered cherries and cheddarwurst?

  When they’re not making statements that stretch credulity, weight loss organizations often lapse into a fog of euphemisms. I’ve memorized a few, and intend to use them the next time I order breakfast at the local café: “And a lovely good morning to you, Cecille. Listen, as of this morning I am on a quest to make better food choices through problem solving and goal setting. I am seeking net physique enhancement.

  “That being so, I am concerned with portion control and wish to avoid calorically dense foodstuffs, as well as significant fat sources. So whaddya got?” After a moment of silence, during which you could hear a fat-free corn curl drop, Cecille will probably shove a plateful of cheezy hash browns my way and say, “Here. Eat this. You’ll feel better.” And you know what? I will. And that’s the problem. We love this stuff. It does make us feel better. That’s what the dieters, dieticians, the diet centers, the weight counselors, the unsalted Styrofoam chips, are up against. We know we should eat more fresh vegetables and less fat. But when’s the last time you turned on the football game, kicked back the recliner, popped the top on a mineral water and proceeded to gorge yourself on celery sticks? Can you imagine tailgate parties at Lambeau Field featuring fiber? People arriving three hours before the game to fill galvanized stock tanks with ice water and mixed veggies? Stuffing down rice cakes and apple slices? I didn’t think so.