Keystone Specialists

Philly suburbs, visiting family. You had said screw it. You weren’t going to be sad this time. It’ll have been 15 years since she died. Enough. This year, we celebrate her. The stomach ache started on the way down.

It’s now day three. It’s now midnight. You’re now not sleeping on the couch in your sister’s living room because the pain that you won’t admit having is keeping you up. You can’t get comfortable. Not possible. 

Your wife runs out to the 24 hour pharmacy for TUMS, but you both know better (you put your shoes on). Remember, it’s called the ED now, not ER. Rebranded. A solid distraction, to focus you on erectile dysfunction instead of pain, but still, you don’t want to go barefoot.  

Here’s how to disorient people upon entry into the ED: don’t staff it. Works every time. We made it! Emergency care! Are…did we come in the right door?

You did. And not a single employee in sight.

Wait five minutes, ten. Guy walks out: “You need to be seen?”

The other option: in the middle of a freezing January night, your wife turns to you and says, “Hey, hon? Want to see if the ED lobby is airing Friends reruns?” And you’re like, “Fuck yeah, then we’ll see if they have any rooms available.” (The irony: medical dates will become a thing for you, buuuuut more by necessity.)

ED protocol: they check you in very efficiently, setting the expectation that man, things are moving now. Then, you wait. Then, you run to the bathroom. You puke. You dry heave. You debate pulling the cord by the toilet to see if there’s an ED inside the ED.

Four hours later, five, boom! You’re seen.

What it means to be seen: imaging confirms appendicitis, but also, your left kidney’s been holding out. They call it a lesion. That sounds like a cut maybe? Your kidneys are 40, just like you. You figure they look close enough, everyone’s got something. No rush, they say, see a urologist when you get home, no biggie.

And finally, opioids!

Post-op. In the room: the newly de-appendixed, his wife, his father.

The Nephrologist strolls in: “What brings you here today?”

(Today: fifteen years to the day that your mom died at 51. A snowstorm threatens now, just as then. Her death unexpected and in the hospital. If this feels over the top to you, keep an eye on your dad’s face when the Urologist crashes this celebration of life.)

“I just had my appendix out?”

She’s confused, her and her clipboard with your medical notes aggressively not on speaking terms.

“And they found a lesion on my kidney?”

“Oh, you need a urologist.”

Like they said. But they also said: no rush. Is this foreshadowing?

Cost of 3-minute Nephrologist: $185. You know because you’ll receive several letters to help you treasure those minutes. In fact, you’ll be terrific pen pals for the next year and a half. They’ll even send you a Happy Appendiversary bill on the exact right date! 

The Hospitalist (9 minutes later): “I’m Dr. John Fucking Elway, hospitalist. I’m the quarterback of the team because sports metaphors. I don’t do anything per se, but my smile? Huge. Demeanor? Eager beaver.

“You’ll have painful urination tomorrow, but I’ll neglect to file paperwork for the lab test. It’s true! You’ll have whizzed in a cup for nothing, but who needs dignity when there’s breath like mine? Can you guess? Cinnamon. And the mouth feel, mmmp.

“You’ll see some specialists today. It’s nothing, literally. Like that nephrologist. Whatever they say, add 5 cc’s of salt and call me in the morning, am I right?

“My serious face. It’s only temporary, but notice the sparkling eye contact. You need anything, just ask for Dr. Donovan McNabb, got it? This is me not winking as I turn to leave.”

The Urologist (3 minutes later, curtain whipped aside): “About that cancer on your kidney. I’m a surprisingly effective fire hydrant, only douchier. No need to thank me. I have the best science inside my brain, which is huge, like my dick, which probably feels like it’s crammed inside your ear right now. Oop! Here comes the science.

“Odds that lesion means tumor? 100%. Chances you’ll lose your kidney? Positively. Isn’t this great? Statistics for lay people.

“You’ll remember this about me: I have the facial hair of the recently pubescent. And yet: 80% chance it’s cancer. In other words, totally cancer.

“Have you seen it yet? Your lesion-tumor cancer baby? Gimme your number. Texting….texting….annnnd it’s off, you got it. Now, look, make your hand like a fist. That’s your kidney, here’s the golf ball. Believe that.

“K, pull your johnny up, let’s see what you got. Ooof, skin bridge from your circumcision. Unh uh. We can clean that right up.

“Listen, when you get home, go somewhere they do a lot of these. Nephrectomies, not circumcisions. Maybe you’ll keep your kidney after all. Who knows. Look, I’m out. I got a hoagie and a stack of 70’s porn on VHS waiting for me back at my house, which is huge. You feel me?”

Later, in Boston, when the post-kidney-surgery infection has arrived, just before they puncture your skin to corkscrew a tube through the thick of your back to drain a fluid they’ll never identify, the nurse who sedates you will be so enthused to learn the two of you share a birthday. You’ll be grateful for her excitement in a way you’ll never understand. You’ll hope it wasn’t just the meds or Sinatra crooning in the corner.