A Pee-culiar Situation

Joyce Hoffman
The Tales of a Stroke Patient

September 26, 2012

An excerpt from my book, "The Tales of a Stroke Patient":

I had a hemorrhagic stroke (bleeding in the brain) and my brain wasn't giving the signal to urinate (pee, in the common vernacular just about everywhere). In other words, I felt the urge, but nothing was coming out. Urinating is just one of a myriad of things to which I have never given any thought. This scenario is a common one: you have to urinate, you go, you wash my hands--or not, and that's that.

But two weeks in, I still hadn't urinated yet. Some people believe if you hold urine in your body for twenty-four hours, you'll die. Well, I don't know about that, and I'm writing this blog, so rest assured, I am still here. So let me fill you in on the urine and how it was extracted from my body. Two methods were used: the Foley catheter and straight catheter. There is a difference between the two, but they have the same outcome: they both drain urine from your body so you can be a happy camper until the next time.

The first kind, the Foley catheter, as it is called by nurses everywhere, was the bag method which they used on me for ten days when I first entered Rehab X. The Foley method was discovered by Frederic Foley, a surgeon working in Boston, Massachusetts, in the 1930s, when as a medical student, he saw the need. (I wouldn't mind if my name was associated with most things, but a urine bag isn't one of them. Just sayin').

Only a registered nurse, a nurse practitioner, or a doctor was able to insert the Foley. I had an RN do all of it. By day, the Foley method required a tube, held in place by a balloon filled with sterile water, going from the urethra and emptying the urine to a bag which was secured on the leg by using elastic bands. The bag easily fit under my sweatpants so I wouldn't embarrass myself just in case it became overloaded.

The Foley bag was dumped into the toilet when it was time to empty it. At night, a second type of drainage bag, called the down drain, was used. This device was hung on a hook under my bed. (I had nightmares about the down drain and its exploding to flood the room. But actually, the down drain worked just fine).

After ten days, I went to the second method--the straight catheter--because popular wisdom said the Foley bag was contaminated. I have no idea whether it was, but I didn't need a contaminated anything to make the situation worse. The straight cath, as it was called, was a method similar to the bag method--the tube going from the urethra and emptying in a vessel--but it came as a pre-assembled kit, containing primarily iodine swabs to clean the area, a catheter tube, and gloves, all of which was sterile. The vessel into which the urine emptied wasn't sterile. It didn't need to be. And the LPN, as the leader, and the CNA, as the assistant, would do the honors.

The trick was to insert it at just the right spot, if you get my drift, but so many tried and missed, evidently not following the anatomical landmarks. I allowed them three tries and then I would request a new team. The first time I went to straight cath, the doctor prescribed Flomax, ordinarily used by men whose bladders leaked or had difficulty getting started. I was in the latter group with the men.

"We've had good results with women if they have slow urination," the doctor said. But I didn't even have a trickle when I went to the bathroom. The drug, which I deemed the miracle pill, was still not working after three days, and if I had to return to the Foley method, I considered breaking out of Rehab X.

So I was on the straight cath and Flomax and still nothing. On the night of the third day of straight cathing, I had doubts about whether the straight cath would work. I also had a brand new team of an LPN and a CNA. The LPN was toting a flashlight.

"We're here to straight cath you. My name's 'Vy' and hold very still." I got in position.

"What's that flashlight for?", but I knew already.

"For this CNA to help me see." I was terrified. I couldn't move if I wanted to. I was panic-stricken because she had a little flashlight and couldn't see without it.

With the CNA's help in holding the flashlight, 'Vy' tried once to get the urethra identified and she missed, even with the flashlight. She tried a second time and said, "Whoops." Missed again. But this time, she didn't want the CNA's help, put the flashlight between her teeth, and got to where was supposed to get right away. Good thing, because I had rules, you know, and with three strikes, you're out.

I think it was the horrible, little flashlight that put me in the mood, and maybe it was the Flomax doing its job, but in the morning, I urinated on my own. And I've been going ever since. Rarely, but sometimes, terror and panic can be a good thing.