A story in two parts.
Warren was born with a stenotic or “pinched” ureter (the tube that carries urine down from the kidney to the bladder), which was diagnosed in utero through ultrasound. This congenital defect didn’t appear to be troublesome for him, but he had to undergo quite a few ultrasounds as a baby just to make sure all was well.
Last winter, Warren started feeling like he had to pee all the time. He would finish using the bathroom only to return a few minutes later. He began waking up in the middle of the night, every night, to use the toilet. Thankfully, there were no bed-wetting incidents or any other accidents, for that matter, but the increased frequency during the night and day was a little worrisome.
We had taken him to a urologist here in town when he was about two, just to make sure everything was still going alright with his plumbing. The doctor said then that the ultrasound seemed fine, though he could still see the stenosis, or slight closing of the ureter. No symptoms then meant we could assume he was faring well. Come back in a few years to re-evaluate. The recent behavior suggested that the time had come to visit this doctor again.
In March of 2011, I took Renny into the small waiting room that displayed copies of Car & Driver, Sports Illustrated, and AARP on the end tables and, over the reception desk, a great big wooden welcome sign burned into the shape of a horse. This was no pediatric environment. This doctor saw 60-year-olds with prostrate troubles more than 6-year-olds that couldn’t hold it for more than 5 minutes.
But in some ways, I think this was good. After another ultrasound, he escorted us into his dark wood-paneled office and we sat down in front of his large desk which proudly displayed a plastic replica of the urinary system. He told it to us straight, with a fair sense of humor.
He suggested we first start with behavior modification. Translation: get him to hold it longer. Alright, maybe I wouldn’t allow myself to get caught up in Warren’s frenzy to make it to the bathroom. What else?
He also said that, based on Warren’s history and current findings (ureter still stenotic), he wanted Warren to have further testing, this time a more extensive form of radiology, a cystography, to see if the urine was flowing back up into his kidneys.
Fine, we’re no strangers to medical imaging and had even been to this particular lab before with Warren, only it was for chest x-rays for the 4 separate times he’s had pneumonia thanks to his viral-induced asthma. (Do we ever get a break from the medical world??) We would discuss the results at the follow-up appointment.
Getting Warren to agree to medical procedures is not as horrible as it is with Maddie, but it’s still not easy. He is not what I would call a brave soul, so he worries about anything that might cause him the slightest amount of discomfort. He asked me if the procedure was going to hurt. I told him I didn’t think so. He seemed fine with that answer, which makes me feel terrible about how it all went down.
He willingly walked into the waiting room of the lab with me on the day of his testing. He cooperated in removing his clothes and putting on the awkward medical gown with the gaping hole in the back. He calmly followed the technician who has worked with us on several occasions and can only be described as Kenneth Parcell from the show “30 Rock.” Same face, same accent, same sunny disposition.
“I hope we don’t have to see you again,” I said warily to him after finishing the chest x-rays Warren needed the last time he had pneumonia a few years back.
“Oh, you don’t mean that!” said Kenneth with a cheery grin. “You just mean you hope you see me under better circumstances!”
I should have known. I should have known. I read about the procedure beforehand. Nothing about urinary catheters has ever been pleasant. Ever! But I’ve had them before and haven’t experienced too much pain. I just figured it would be the same for Warren. So when Kenneth the Technician came in with the Radiologist and explained to Warren that they were going to put a tube into his urinary opening, fill his bladder with fluid, take a picture, and oh yeah, he had to hold his urine in until they said they were done, he fell apart before they even could prep the area.
Crying and wailing, he didn’t resist but the entire lab could tell that he did not approve of this procedure. Poor kid. I could only imagine how awful it felt. But he tried his best. Me hugging him tight and telling him it would just be a bit more, Warren protesting loudly, the Radiologist frantically working to finish the scanning, and Kenneth saying they were almost done, it was quite the spectacle. I didn’t think it could get much worse. Until it did.
With the two of them encouraging Warren to hold on just a little bit longer, I could see they were finally nearing the end. Kenneth told him that as soon as they were finished he could pee right there in the tube, the final part of the testing which would show if any urine was backing up into the kidneys. Suddenly, Warren wailed out that he couldn’t hold it any longer and Kenneth told him to go ahead and let loose. And so he did.
For whatever reason (it was too small, it wasn’t properly inserted, what have you) the tube did not do its job. Before anyone even knew what was happening, Warren was peeing like a race horse and it was spraying all over the place, with distance. I think he even hit the back filing cabinet on the other side of the room. I was out of the line of fire since I was by his head. Kenneth, on the other hand, was not as fortunate. He got the majority of the blast.
I could not have been more mortified. I gasped out a desperate apology on behalf of my son who was lying there in long-awaited relief. Kenneth’s sunny disposition dimmed only slightly as he told us not to worry about it while blotting his medical scrubs with some paper towels. The radiologist smirked and said these things happen. Not to him, though. He was standing behind in the clear.
We high tailed it out of there as fast as possible. As Warren changed back into his clean, dry shorts and shirt, I knew I didn’t have the courage to ask if Kenneth had spare clothing ready for such an occasion. I tried not to make eye contact as we left the dressing room and headed down the hallway to the exit.
But the good news was Warren was not experiencing urinary reflux. Kenneth could personally attest to this fact.
More testing would be needed but not until he was closer to seven. He’d have a whole year to think up a way to top that scene.
Today, almost exactly a year later, Warren went in for the second test, a urogram (a CT scan that looks at the entire urinary system using an iodinated contrast fluid). Same radiology clinic. Different technician. This time Colin took him.
He did amazingly well. Even though he seemed nervous about getting an IV started so they could inject the contrast fluid into his blood stream, he fully cooperated and only whimpered with minimal tears this time around. He even got to put his dad on the CT scan table and use the controls to put him into the “doughnut.” I’m sure that experience, coupled with the Priesthood Blessing of comfort Colin gave him the day before, helped keep him calm. He was rewarded for his bravery with a trip to McDonald’s to get a Shamrock Shake.
We don’t have the results of this latest test back yet. We still have to return to the equestrian-themed urology office and discuss the findings. Hopefully, the news will be good. And hopefully he won’t have to undergo any more radiology tests.
I’m sure that’s what Kenneth the Technician hopes for all the time.