From “The Decision”
I mention bladder spasms above because of something that happened to me and because of experience with my patients whose prostate I have removed. The bladder is in essence a very large and strong muscle. Any manipulation of the bladder, including removing the prostate and then placing a catheter, can cause bladder spasms. A catheter is necessary after removing the prostate because you have separated the bladder from the urethra by removing the prostate, and the catheter allows for the drainage of urine while the new connection between the bladder and the urethra heals. This usually takes 7- 10 days, which is why you have the catheter in the length of time you do after surgery.( Please see the previous diagram of the prostate removed.) I have had several patients, one of whom was a friend of mine, tell me that the most painful part of the whole surgical experience was wearing the catheter and bladder spasms. This particular patient mentioned this fact to me at the time of his hospitalization and then asked me why I had not told him about it ahead of time. I told him it did not happen often, and, if it did, we had medicines, B and O suppositories in particular, to handle it. I remember listening to him discuss this issue, but I don’t remember it making an impression on me to the extent that I began warning patients about it or taking other precautions to keep it from happening. A bladder spasm is very painful. If you have ever seen a professional football player collapse on the field because of a muscle spasm in his thigh, you then have noticed how they grimace in pain and have to leave the game. A bladder spasm is very similar to this, a very painful contraction of the bladder muscle that causes excruciating pain at the bottom of your abdomen. When I woke up in the recovery room after my prostate was removed, I experienced a bladder spasm first-hand, and it was the most horrible pain of my life. I am a wimp when it comes to pain related to dental work, but otherwise I am pretty good with pain. I have had three significant knee injuries with sports and subsequent surgery for each, so I know pain. Instead of waking up peacefully, feeling happy that my surgery was over and I was safe, I was in intense pain. I found myself having an ongoing dialogue with the recovery room nurse, who I believe was trying very hard to help me, about how badly I was hurting and the need for more pain medicine. She said, “You’ve already had 100 mg of Demerol.” “Yes ma’am, but I am still hurting. May I have some more or something else? I may need a B and O suppository or maybe a couple of Levsin S.L.s, do ya’ll have those?” After she put in the suppository to no benefit, she then brought me two sublingual Levsin S.L.s. The Levsin S.L. should dissolve immediately under your tongue and give almost immediate relief, but mine just sat under my tongue like little bricks and got stuck there, negating any benefit they might have had. I ended up having to chew them up into big chunks and then swallow them whole, just to get them out of my mouth. I continued hurting the entire time I was in the recovery room, and finally I told the nurse that the “100 mg” of Demerol she mentioned was “just a number” and that I needed more. I am sure that this remark came across as condescending, and she was probably thinking that I was just another one of those wimpy doctors who “can dish it out, but can’t take it,” and make bad patients; I may have been. After about 45 minutes of me hurting and asking for more pain medicine, in walked my doctor. “John, are you hurting?” “Yes, I think I am having a bladder spasm that will not break, and it is killing me. Is there something else you can do?” “What would you recommend, John?” Between groans I told him, “Well they’ve tried Demerol, Levsin S.L., and a B and O suppository, but nothing has touched this pain. How about giving me some morphine?” My surgeon looked at me somewhat puzzled as I writhed around clutching my lower abdomen and said, “Morphine, John? For a bladder spasm?” “I don’t care what you give me, I‘d like this pain to go away, please.” He said he’d order more pain medicine for me, and as he was leaving he said with a smile, “John, I had a good day.”(This is exactly what I wanted to hear.) I said, “Thank you for what you have done for me.” He ordered additional medication and the pain gradually went away about an hour after I returned to my room. My surgeon may not have appreciated the degree of pain I was experiencing. Despite my patients telling me for years how painful bladder spasms were, I did not fully “feel it” until I had one. My wife said she was fine throughout the whole process of my cancer journey until she saw me on the stretcher upon returning to the room, moaning with this bladder spasm. She said she had never seen me in that much pain. After the pain went away in the room, it never returned. Later my wife asked me if I thought I would be a better, more caring doctor now that I had been though this surgery and in particular this bladder spasm ordeal. I told her that as a rule I was fairly sensitive to patients’ needs already and that my experience probably would not make much difference. About two weeks later and now sporting a condom catheter with a leg bag on underneath my scrubs, I am checking on a patient in the recovery room whose prostate I have just removed. I am wearing a condom catheter because the amount of urine I was leaking filled a diaper in less than an hour, and a prostatectomy usually lasts two. As irony would have it, the patient is having a bladder spasm, and as I arrive he is clutching his lower abdomen and pleading with the nurse to give him medicine for the pain. “He has had 100 mg of Demerol,” the nurse says as I approach. He tells me this while indicating by his facial expression that he thinks the patient either has a low pain tolerance or is just pretending to be in pain to get more pain medicine. I saw myself lying there. “I am not as interested in the number of milligrams of medicine he has had; that is just a number. I am more interested in the relief of his pain; please give him more until his pain is gone.” I stayed in the recovery room, and he got more medicine until he was comfortable. The point of the above story is two-fold. For one, I am a more sensitive doctor having had this surgery and all the things that went with it, from being told the biopsy had cancer to dealing with the surgical aftermath. More importantly for this section of the book, I am making a point about luck. Don’t forget the role the luck factor plays in how well a decision pans out. There is no way to predict if a surgical patient will have bladder spasms or, for that matter, any other potential complication. I was unlucky in that regard and for no reason. A well thought-out decision, qualified doctors, and a little luck are what I am hoping for for you. At every step of your treatment, no matter what you decide to do, there is an opportunity for your situation to go well or not. There are issues about your anatomy, your cancer, your doctors, and how your body responds to treatment that cannot be predicted. You need to know this and be aware and prepared for the possibility of things not going precisely as planned.