4/29/25

 Ethan had his biopsy today. We arrived at the hospital at 7:00 am. They took Ethan back and had me wait in the waiting room. Ethan was nervous that they were going to make him do this procedure with anesthesia. He did NOT want this.

Once his IV was in, he was in a gown and had signed his consent forms, they had me join him. There was a question about on of the medications he was taking. It was a newer medication that Ethan had forgotten the name of. No wonder, it was hydrochlorothiazide. Say that three times fast.

Once it was time to take Ethan to the biopsy room, I headed straight for the cafe. It was after 9 am and I was hungry.

I got a sandwich for Ethan when he was done, and one for myself. I sat at a table in the cafe, pulled out my computer and started working. I heard a song playing. Hey…I know that song! It was my phone ringing. “Strong Hospital” was calling. Oh god! That can’t be good.

I answered it just in time for the person to hang up. Damn it!!!!!! As I was trying to find the number that called, my phone started ringing again. It was Ethan’s doctor. He asked me where I was.

“I am at the cafe!” I said

“Do you want to watch the biopsy?” He asked

“Yes please!” 

“Good! Grab me a coffee and meet me by the entrance to the ER”. He said

I packed my things up lightening fast. He was waiting for me and escorted me down a hall into a room with Ethan.

“Where is my coffee?” He asked I told him I wanted to make sure he had a steady hand for the biopsy. I like this guy.

I put my things down and the doctor was telling Ethan and myself that he had two assistants today. They were both nurse practitioners. One was in training.

They used the ultrasound to visualize the kidney and the different parts. Luckily, I understood what I was looking at.

They pulled up the kidney on the ultrasound and you could see the capsule of the kidney which is the outer layer of the kidney. The doctor verbalized that the trick is to get more of the cortex of the kidney. The cortex is the part of the kidney that has the glomeruli which is a fancy way of saying the structure in the kidney that filter out toxins from the blood.

The medulla is the part of the kidney that helps the urine concentrate. With kidney biopsy the cortex is the star of the show. They want to see the structures filtering the blood. This will help them figure out how to help Ethan save some of his function.

As Ethan’s kidney was on the screen, it was very similar to some procedures we have to do with animals. 

They took some measurements of Ethan’s kidney and depth of kidney to figure out how far they needed to insert the biopsy punch. They call it a punch because it is like a small straw with a needle hiding inside of it. When they get the sample, the needle peek-a-boos out quickly and forcefully and retreats back into the straw.

The straw portion had measurements on it too so that the doctor can accurately measure where it needs to be placed.

The doctor explained that he didn’t want to insert the needle over Ethan’s scar and advised to get the sample for just off of where his scar was. This is because scar tissue can be more difficult to penetrate. It’s hardened.

The doctor explained that they should push on the straw portion just enough to see a dent form on the outer layer of the kidney. Once they see that dent, they could get the sample.

They injected Ethan with lidocaine around the area of where they were going to poke him. There was a pathologist in the room with a microscope to examine the edges of the tissue they collected to make sure the sample was viable.

When everything was all set to go, two samples were collected and the pathologist wasn’t quite happy with them. Everyone in the room including Ethan and myself was encouraging the girl in training to collect the third sample. “Come on, show them how it is done.”

She collected the sample beautifully. The pathologist said it was a great sample and didn’t need to repeat. Third time is a charm. 

I asked the pathologist if I could look at it under the microscope. She pointed out how you can tell the sample is from the cortex and not the medulla. She helped me visualize what they look for in these biopsies.

“Ok doctor, it’s my turn to get a biopsy of Ethan’s kidney. I am confident I can get it.” I held my hand out for the biopsy punch.

“I would lose my license because that is unethical.” He said

What a stupid rule. I know I could have done it. I joked with him that he didn’t really need a license anymore. Who really was checking those? Ha! Stupid rules!

Ethan and I enjoyed the group of people doing his biopsy. They were relaxed and you never had to guess what was going to happen next. They made Ethan feel comfortable too. He was participating in the conversation and was in a decent mood.

It was a cool experience to watch. I was proud how Ethan handled it.

We then had to go back to the surgical center recovery area. Ethan had to lay flat for a few hours to make sure he wasn’t going to bleed out or do something Ethan-like to throw a curve ball.

They also had to monitor his urine for signs of a kidney bleed. Everything checked out and the two of us were home by 2:15 ish. We sat outside on the front porch and enjoyed the weather for about 2 hours. I was working. We were watching the dogs enjoy the outdoors.

Ethan was watching the weather system move across the nation. He was watching for tornados. We also were taking note of the behavior of the ants in a nearby anthill. Man, ants work their butts off.

We had an uneventful rest of the day.  Ethan has a little scab in the biopsy area which he says doesn’t hurt. His kidney doesn’t have any nerves so the poking of the kidney doesn’t hurt either. This kid is a rock star!