My Human Pearls

When I first wore my necklace, I made sure the new bead was discreetly hidden under my shirt collar.  It would have blended well with the others.  But it was uniquely mine and I didn’t want to share it just yet.  Plus I had worked so hard to harvest it.

It was my gallstone, my human pearl.

From childhood, I’ve always been curious about what goes on deep within.  My curiosity led to a career as a pathologist, where I’ve had the privilege of looking at others’ organs – yards of intestines, slabs of lungs and liver, uteri and ovaries removed at surgery.  But let’s face it, by the time a pathologist gets up close and personal with an organ, at the very least it has lost its spunk, its verve, its joie de vivre.

As I slogged my way through a busy day processing chunks for microscopic review, I nurtured a delusional idea that my own working organs would stand out, have a flash of personality that would pique interest and draw a crowd.  They were as much a part of my individuality as anything on the outside.

I probably had a gallstone for years, harmlessly bobbing on a sea of gooey green bile, but now it had wedged itself into the tiny duct connecting the liver to the small intestine.  An episodic boring pain had turned continuous.  I knew surgery was inevitable.  My gallbladder had to come out.

The surgery seemed like such a nuisance – it was a routine procedure, requiring no va-va-va voom surgical heroics, more akin to removing a rotten tooth, only the gallbladder is inconveniently located and required more than a strong arm and a pair of pliers.  However, besides my troubled gallbladder, the surgeon would see everything in working order – my smooth and glistening liver, my humble and rumpled spleen in the upper left and coils of shimmering intestines with quaking contractions snaking down their length.

I was jealous of the surgeon.  I wanted what he had – a peek under the hood.  I realized my interest in human infrastructure might not be widely shared, but I wanted a memento.  Here was my chance.  I could ask the surgeon to let me have my gallstones, much the way children keep their baby teeth.  The gallstones were mine.  I had made them.

At this point, I had segued from the world of pathology to the arcane world of health insurance and knew firsthand of the horrifying waste in our system, of unnecessary emergency room visits, unnecessary tests, unnecessary hospitalizations, stalwart gatekeepers.  I to be the role model of efficiency, to show how it could be done.  I was determined to bring this surgery in on time and under budget – after all I was expecting 38 family members for Thanksgiving the following week.

I called my internist to schedule an abdominal ultrasound to verify my stones.  I figured I could get that done by midmorning, and then, ultrasound in hand, somehow find a surgeon willing to pop me onto his OR schedule.  I never got past the first gatekeeper.  The receptionist said that the doctor wouldn’t order an ultrasound until he had seen me, and he could not see me that week.  I heard the snap of gum as she said, “Honey, just go to the emergency room.”  Over budget immediately.

As expected, the ER doctor told me that the first step was an ultrasound.  As the orderly wheeled me off, I realized that from my selfish perspective, entering the health care system through the ER was very efficient.  I didn’t have to call around to make a radiology appointment, find parking, wait in the office or find a surgeon.  Not only was I going directly to ultrasound, but I was being pushed in a very comfy gurney with crisp white sheets and a toasty blanket.

The technician moved the transducer across my stomach.  “That’s a big stone,” she said, pointing at a fuzzy round object casting a huge shadow.  “Look at that inflamed wall – you’ve got yourself a hot gallbladder.  Needs to come out right away.”

That was the moment I decided to let it all go, stop trying to be totally self-sufficient, stop trying to find meaningless work-arounds and economies.  It was time to become a patient and be grateful for our crazy health care system that allowed me to waltz into an ER and announce, “Here I am, let’s take it out.”

I overheard the ER doctor telling a prospective surgeon that I was “really nice.”  I was flattered but knew I was falling into the classic doctor/patient relationship where the stricken, vulnerable patient ingratiates herself to the life-saving surgeon so he’ll do a better job with a sharper scalpel.  When I timidly asked about the experience of the surgeon on call, the ER doctor told me that he would have no qualms about letting this surgeon slice up his own family.  Sounded good, but also like the sales tactic stockbrokers use, e.g. “this stock is so great that I even bought some for my Mom.”

As I waited for the nurse to set up the IV, I tried to work on the Sunday New York Times crossword I had brought to fill the inevitable idle moments.  This puzzle always has a quirky theme, and one of the big breakthroughs is the AHA! moment when I crack the theme.  The pain made concentrations difficult.  I let the pencil drop, laid the magazine across my chest, closed my eyes and listened to the comforting beeps and hums surrounding me.

The nurse casually asked, “On a scale of 0 to 10, where is your pain, if 0 is no pain and 10 is the worst pain you could possible imagine?”  This was a standard question, just a box to check on my chart.  The nurse wasn’t even looking at me to assess visible signs of pain, a clenched jaw, white knuckles as I gripped the bed, or a dewy row of perspiration on my upper lip.  It was entirely up to me to self-rank.

The question seemed very tricky, one that required careful deliberation.  First, the worst pain imaginable was only limited by my ability to conjure up agonizing scenarios.  I remembered a gruesome scene in the movie Casino Royale, where a naked James Bond sits on a caned chair, except all the caning has been removed, exposing vulnerable and dangling body parts.  That would be a 10.  I could never self-rank my pain as a 10 because there must always be something worse.  I wanted to give a credible pain rating to let the staff know that I was the best kind of patient – not stubborn and stoic but not a hysterical malingerer either.

My quest for my gallstones was getting complicated – much harder than I’d thought.

The nurse returned holding a syringe and once again asked me, “Okay where are you on a scale of 0 to 10?”  This time she looked at the crossword lying on my chest and I imagined her thinking, “How bad could the pain possibly be if this woman is doing a crossword?”

I was tempted to defend myself.  “Look I can always knock off the Sunday puzzle, takes me about an hour at most.  Well, maybe I can’t get some of the smaller words, but I ALWAYS get the larger theme words, without any Wikipedia or other lifelines.  Every Sunday.”  Then I would hold up the blank puzzle and show her, “Look I haven’t made any progress.  I just can’t focus.  Trust me, the fact that I can’t do this puzzle is a better testament to my pain level than any moaning or groaning.”

A compelling argument from my point of view, but one that would only resonate with other cruciverbalists.

I wanted to ask, “How do most people rate their gallbladder pain,” and then pick something in the mid-range – I’ve never wanted to be an outlier.  I juggled all these factors as the nurse wielded the syringe of blessed relief.  “I guess my pain level is about six.  Does that sound about right?”

This strategy hit the right notes.  The nurse squeezed the plunger.   In a flash of morphine-induced clarity, my AHA moment burbled up before me.  The crossword theme consisted of a word starting with the letter “a” followed by a double consonant, like the word “affair.”  The trick was to drop one of the consonants to produce two words with a new meaning.  “Affair” would become “a fair.”  The pre-morphine clue I had been struggling with was “mechanic’s task.”  Now the answer was obvious, written on the insides of my eyelids.  I thought of evening attire, dropped the “t” to produce “evening a tire.”   Boom!  I’d done it, solved it.  I flushed with pride.

As I was wheeled into surgery the next morning, I thought about all the gallstones I had seen in my career.  Some were truly beautiful, a polished green color.  Many had interesting shapes, smooth and round or crazily multi-faceted.  I hoped my large stone would be one of the pretty ones.

The surgeon stood over me, cap on his head, face-masked, gloved hands held upright.  “Are you ready?  Shall we do it?”

“Yes, but I have one request.  Please let me have my gallstones.  Don’t let the pathologist throw them out.  I want them.  They’re mine.”

He nodded and waved to the anesthesiologist.  In a flash they snagged the gallbladder, using instruments inserted into four small incisions.  A day later, I strode out of the hospital, down one expendable organ and looking like I’d won a duel with an ice pick.

At home I sat at my desk and looked at the two stones the surgeon saved for me.  One was a quarter of an inch in diameter with a concave surface from nestling up against another stone.  The other was the size of a jawbreaker, perfectly round, the alpha stone.  It was beautiful, artistic, a rich green color studded with white cholesterol crystals.  I had a necklace containing a similar bead made from a deep greenish black resin, the type of color catalogs give ridiculous names to – summer seaweed or midnight forest.  Perhaps catalogs could use “gallbladder green” as their newest provocative color description.

Those stones wer my human pearls, like the oyster who turns an in irritation to a thing of beauty.  I decided to incorporate my large pearl into my necklace.  The jeweler was suspicious at first, but then I pushed the plastic cup across the counter top.  “Wow, I see what you mean, that’smreally pretty.  Never seen anything like it.”

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