CT: negative.


MRA: negative.


Labs: negative.


Surgeon's report: negative.


Stacey's extracurricular activities: negative.



Everything: negative.



Except for Stacey's report. And that distended bladder. Mike's too young for his bladder to have forgotten what to do.

I take a drink, eye the pizza, think for the briefest of moments about my lower esophageal sphincter, and close the pizza box.



It's there. The clue is there. I just need to know it when I see it.


I take another drink.


Back in high school, I was agonizing over a French paper late one night while my brother was home from college. I was so engrossed in the paper I didn't hear him come in my room, and almost jumped out of my chair when he came up behind me. He didn't say anything. He just put a beer on my desk and walked out again. At first I was furious -- condescending pedantic slug -- and I almost threw it down the stairs after him, but I drank it instead and grudgingly saw his point: as I started to relax, the French came more easily. It was the only kind of help that he would have offered and that I would have accepted.


And now here I am, thirty years later, sitting up in my office, drinking something a bit stronger than my brother's beer, wondering what my ex's husband's neurogenic bladder is telling me about what's wrong with him.


Neurogenic bladder.

I'm not wrong. Stacey's not wrong. Something's up with this guy.

I mentally review the pathway: Normal voiding essentially is a spinal reflex that is modulated by the central nervous system (brain and spinal cord), which coordinates the functions of the bladder and urethra. The bladder and urethra are innervated by 3 sets of peripheral nerves arising from the autonomic nervous system (ANS) and somatic nervous system... The micturition control center is located in the frontal lobe of the brain.... When the sympathetic nervous system is active, it causes the bladder to increase its capacity without increasing detrusor resting pressure (accommodation) and stimulates the internal urinary sphincter to remain tightly closed. The sympathetic activity also inhibits parasympathetic stimulation. When the sympathetic nervous system is active, urinary accommodation occurs and the micturition reflex is inhibited....

Sympathetic nervous system... stomach pain... paranoia....


I point the remote and start the OR video again. The loops of bowel surge and roil under the surgeon's probe. Innervation. The clue is there, I just have to see it.


Rewind. Play. Stop.


Play. Stop.


Play. Stop.

Play. Stop.

I lean forward.

Rewind. Play.


What's that?








credit: Choe and Mardovin, Neurogenic bladder