"I twy to sh--, ba aw I do iss fah fah fah" said Mr. P when I asked him about his bowel movements while in the hospital. His medications, his urine toxicity, and having his dentures out, all make his speech almost incomprehensible, but he still tries as hard as he can.
We all feel for him, he came in with a complaint of 2+ months of difficulty urinating, probably expecting to get an antibiotic and go home. When the ER doc suspected a stone, he did an ultrasound. It showed a large mass in the bladder, encompassing the ureters, which is what had been causing his symptoms. He has lost 30+ lbs in the last couple months, and his urine output is now reduced and red with blood and transitional cells. We haven't done a biopsy yet, but all indications point to bladder cancer.
We attempted percutanious nephrostomies twice, trying to restore flow past the obstruction, with no success. With his renal function getting worse every day, we've decided to transfer him to New Orleans, where they have a much larger caseload of this type. While we're waiting for a bed, we'll give him dialysis to "polish him up."
Despite his condition, Mr. P has been quite pleasant to work with. I've learned a lot from him. Following the case has given me a window from which to learn renal disorders, but, more importantly, has affected me on a personal level. His prognosis may be poor, but treating him and giving him the best care we can is making life better not just for him, but for us as well.