Miklos had surgery scheduled for his recurring bladder cancer. Because he has difficulty with the office procedure, he was scheduled for a short stay hospital procedure. That way, he could be completely anesthetized for the surgery, rather than only have local anesthesia.

Before the surgery, he had multiple visits to check on his health — a check with his urologist, a perioperative check with an EKG, a stress test, and a general check-up with his primary care physician. He passed them all with flying colors.

We arrived at the hospital early in the morning, and Miklos was sedated before he was rolled to the operating room. The surgery went smoothly, with no complications (Dr. Lieb is an outstanding urologist).

Miklos returned to the room after he regained consciousness, and after he rested a bit and had his vital signs checked, he was discharged and we went home.

Then the problems developed. Miklos had insisted that the catheter be removed immediately after the procedure. The staff should have determined that he could urinate without the catheter. He couldn’t.

He slept the rest of the day, and refused any food and resisted water. The next day, he got up, but didn’t get dressed. His caregiver tried to give him some soup for lunch. He took three small bites and went back to bed. He refused water because he felt that his bladder was already full. He went back to bed and tried to sleep.

About seven o’clock, he came down stairs and insisted that he needed to be taken to the hospital because he was in so much pain. He was admitted to the emergency department. By this time, every movement, no matter how small was agonizing. He was catheterized and given an IV.

His first blood work came back. He was so dehydrated that he had gone into kidney failure. His X-ray indicated that his bladder was so distended that it was compressing his other organs. His bowels were impacted both because of the dehydration and the compression from the bladder. The liquid in his catheter was dark red, much more blood than urine.

I have probably given much more detail than anyone needs to read.

Of course, Miklos was admitted to the renal ward of the hospital. There is a catch twenty two, of course. Miklos obviously needed a great deal of pain medication, but the medication increases constipation. The hospital staff had a hard time working out the balance.

He had been admitted early Saturday morning, and on Sunday morning, he seemed to be improving. He was still catheterized, and but there was much less blood. His kidneys were once again functioning normally. He was still constipated.

At this point the staff got the balance wrong. In order to ease the constipation, they didn’t adequately control the pain. He was moaning and groaning and sometimes screaming so loudly that he could be heard throughout the whole ward. We begged for attention.

By three o’clock, he was praying to be dead because the pain was unbearable. He asked if someone could shoot him in the head. My daughter speculated that his pain tolerance may be lower than average because of remembered trauma. Everyone’s favorite patient was cursing the CNA because his pain was so intense.

I will continue this tomorrow.