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My Pain Was Well-Treated in the ER; Its Cause Harder to Find

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Joshua Johnson is KQED Public Radio's morning news anchor.  (KQED News photo)
Joshua Johnson is KQED Public Radio's morning news anchor. (KQED News photo

By Joshua Johnson

"You will not apply my precept," he said, shaking his head. "How often have I said to you that when you have eliminated the impossible, whatever remains, however improbable, must be the truth?"
--Sherlock Holmes, admonishing Watson, in "The Sign of the Four" by Sir Arthur Conan Doyle

My back hurt like hell.

I thought I'd slept on it funny -- twisted my body into a pretzel in my sleep and woke up with a stinging pain in the left side of my back -- and I even hit the gym that day, training through the pain.

But even a big, tough guy like me couldn't endure a night of restless sleep, writhing in pain. By Friday morning wonder had turned to fear: the stabbing spasms sat right above my kidney – and just a few weeks ago my doctor had told me of some lab results about kidney function that he had said we should keep an eye on.

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I contacted my doctor's office, but they couldn't get me in.

Midway through my shift, I completed a newscast, grabbed my bags and drove myself to the ER at UC San Francisco.

The doctors and nurses there treated me with kid gloves: easy, since there was no one waiting at the ER early on Friday morning. I told them I had severe back pain -- eight on a scale of one-to-ten -- and suspected my kidneys were the culprit.

They jumped right on it. I got blood tests, a urine test, an ultrasound and a CT scan. They all ruled out kidney problems. Other than the pain in my side, I had no other symptoms: no cough, no congestion, not even a sniffle.

"About 50 percent of the time," one of the doctors told me, "when a patient presents with abdominal pain like this, we don't know what causes it. It just goes away on its own."

That, and an IV dose of dilaudid, were a relief.

But when I got home I kept puzzling over my pain. Where did it come from? The ER staff might've been content to call it "one of those things", but I wasn't. What could it be?

And then, it hit me, with all the blinding obviousness of Mr. Holmes's admonition to his sidekick.

We eliminated kidney problems as impossible, based on the evidence. But my back was hurting.

That's it. My back. The pain was IN MY BACK.

Duh! BACK PAIN!!

I had just increased the weights on a specific machine and realized what I likely had was a severely strained muscle.

The next day, I went back to UCSF's ER. The physician's assistant who took care of me agreed my back was clearly injured and prescribed painkillers. Then one last thing before I went on my way:

"Sometimes they call you afterward and ask you how your ER visit went," the PA said. "When they do, you should let them know what happened to you."

I was surprised that the E.R. team did not figure out it was my back that caused the problem. But Dr. Bob Wachter, chief of UCSF's division of hospital medicine, said that the first task in the E.R. can be to "rule out all the bad things." That's what was happening with all the tests -- the doctors ruled out all those bad things that could have been causing my pain.

While there are diagnostic tests for a kidney stone or a kidney infection, Wachter said, there's no test for a pulled muscle. After having determined I wasn't having a health crisis, the team told me that in these situations, there's often no apparent cause. For doctors, that becomes a communication challenge.

"That takes some explaining," Wachter said, "to make sure the patient feels satisfied that they've been listened to and diagnosed as well as science allows us to."

Since we originally published this story, a number of people have commented that I should have played more of a role in my own treatment. After all, I'm the one who lifts weights, and I know that weightlifting can strain muscles and cause pain.

I'm relieved now that my pain is gone and, at least for this nagging issue, I have an explanation.

Editor's Note: This story has been updated. An earlier version did not include a reaction from UCSF. KQED regrets the omission.

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