Nonfiction / Health
Date Published: June 5, 2025
metaphorical, sometimes literal, and occasionally they hit you directly in the
kidneys.
you needed—for pain, philosophy, and the Dirty Rotten Bastards known as
kidney stones.
board-certified Urologist and Navy Veteran with a sharp sense of humor and a
well-loved copy of Marcus Aurelius’s Meditations, this book is equal
parts medical manual, philosophical deep-dive, and brutally honest pep talk.
From ancient Greek tragedy to Zen detachment, from Schopenhauer’s
existential gloom to modern pain meds that actually work, Dr. Kalorin arms you
with science, insight, and just the right amount of sarcasm to help you endure
the worst pain imaginable—and maybe even grow from it.
you’ll discover:
● Why kidney stones hurt so damn much (hint:
it’s not just the jagged edges)● How to suffer like a
philosopher—or just survive like a human● What Stoics,
Buddhists, and Navy SEALs can teach us about pain● How to stop
these unholy invaders from ever coming back
you’re mid-attack, recovering, or just preparing for the day your body
decides to throw a mutiny, The Philosopher’s Guide to Life, Suffering,
and Kidney Stones offers clarity, catharsis, and some much-needed
laughs—because if suffering is inevitable, we might as well face it with
wisdom and a plan.
settle in (writhing optional), and turn the page. You’re not alone!
EXCERPT
Comedian Jim Gaffigan once described passing a kidney stone as “giving birth to a Lego—through your junk.” Actor and writer Kevin Murphy said, compared to passing a kidney stone, “Being gut stabbed with a dirty spoon in a prison cafeteria is less painful.” Joe Rogan put it another way: a UFC fighter can take inhuman punishment, get “ripped to the gills,” and still push forward in the octagon—but a tiny kidney stone will drop him like a sniper.
But here’s the thing, suffering isn’t new. Since the dawn of civilization, humans have been getting absolutely wrecked by pain and asking the big, existential questions: Why me? What cosmic sin did I commit? And dear God, how do I make it stop?!
Throughout this book, we’ll take a philosophical and medical journey through suffering, spanning thousands of years, to see how humanity has tried to understand and endure it. Along the way, we’ll discuss kidney stones, or as I prefer to call them—DRBs (Dirty Rotten Bastards)—including why they form, how they create ungodly amounts of misery, how to (hopefully) pass them, how to remove them if they refuse to move, and strategies to keep these evil little demons from ever returning.
So, slap on your metaphorical philosopher’s robe, stroke your imaginary Socratic beard, and get ready to get your learn on. Because if we have to suffer, we might as well do it with some wisdom—and maybe a few good painkillers.
Existentialism, Nihilism, and Kidney Stones
In the previous chapter we looked at the ancient origins of the philosophy of suffering and the scientific basics of why stones form. But make no mistake: your stone formed because the universe hates you. Well, not you specifically, it hates all of us. This leads us to our next category of philosophic examination. We’re going to jump from the ancients to the moderns, who don’t blame anything for your stones. But first, we’re going to take a look at the physical cause of your suffering – or in layman’s words, why the hell it hurts so much.
How Stones Cause Pain and Suffering
Do you remember the basic setup of the urinary system? The kidneys filter your blood to produce urine, which collects in the hollow part of the kidney. From there, the urine gets pushed down through the ureter into the bladder, where it’s stored until we feel the urge to urinate.
Well, Kidney stones cause pain when they block the flow of urine, meaning they only become symptomatic when they attempt to pass out of the kidney. When someone says they have a painful kidney stone, they’re actually dealing with a painful ureteral stone—because that’s where the real trouble begins.
Stones typically form in the hollow part of the kidney, often attaching to its walls. While they remain in place, urine can flow around them, so they usually cause no pain—many people don’t even know they have them. As I often tell my patients, “I could have 20 stones in my kidneys right now, and as long as they stay put, I feel fine.” The problem arises when a stone breaks loose or a fragment detaches. Once free, the stone is carried by urine flow into the renal pelvis, which leads directly to the ureter—and that’s when things go downhill.
Contrary to popular belief, the ureter isn’t just an open drainpipe—it’s a conveyor belt made of muscle. Like the heart, it contracts rhythmically, generating peristaltic waves that push urine from the kidney to the bladder. This happens all day, every day, and we never notice—until a stone gets in the way. When a stone enters the ureter, it disrupts these delicate coordinated contractions, triggering intense ureteral spasms—which is where most of the pain from kidney stones comes from. Many people assume the pain comes from the stone scratching or cutting the ureter, but in reality, it’s the ureter spasming around the obstruction that causes the agony. If your thigh muscle spasms, you can stretch and massage it for relief. But if your ureter spasms, there’s no way to stop it since it’s an internal muscle, you just have to endure the unbearable pain, writhing in agony until the wave finally passes. So, when someone says they’ve got a painful kidney stone, it would be more accurate to say they’ve got a painful ureteral stone.
If the stone is small enough, the ureter will do its best to push it downward—kind of like a snake trying to swallow an egg, only far less graceful and way more painful. The problem is that the ureter is a tight squeeze, starting around 3 mm wide at the top and narrowing to just 1.5 mm near the bottom. It can stretch, but it doesn’t like to—and when it does, it throws a fit. The bigger the stone, the more it stretches, and the more it stretches, the more it spasms—cue the waves of agony that feel like your body is staging a rebellion from the inside. However, size alone doesn’t determine pain level—it’s more about how tight a person’s ureter is and how much it spasms when confronted with a stone. I’ve seen people pass 10mm stones with moderate discomfort, while a tiny 1.5 mm stone has caused excruciating pain.
urologist and founder of the Kidney Stone Center in Raleigh, North Carolina,
one of the highest-volume kidney stone treatment centers in the nation. Over
the past decade, his team’s dedication to patient-centered care has
placed the center in the top 1.5% nationally for stone treatment volume.
With
over 20 years of experience specializing in minimally invasive surgery and
kidney stone management, Dr. Kalorin has seen firsthand how painful and
life-disruptive kidney stones can be. His mission goes beyond
treatment—he is passionate about empowering patients through education.
By helping people understand why kidney stones form, how pain develops, and
what prevention truly looks like, he believes patients can reclaim control
over their health.
That philosophy led to his book, The
Philosopher’s Guide to Life, Suffering, and Kidney Stones (but Mostly
Kidney Stones)—a blend of practical medical insights and timeless
philosophical wisdom. Drawing from thousands of patient conversations, Dr.
Kalorin translates complex medical science into approachable, often humorous
lessons about resilience, suffering, and the human condition.
clinician, teacher, and philosopher, Dr. Kalorin writes with the conviction
that knowledge is the most powerful tool in medicine—and that even
life’s sharpest pains can reveal deeper meaning.
