Dialysis

Dialysis is a sobering place. And in the last several weeks it's come to stand for irreversible illness. I see people tethered to the area, unable to escape even for a few days, because on Monday they have to be back hooked up to the dialysis machines. Those lines connecting them to machines filtering out the toxins that threaten to be so deadly.

I guess I should start by telling you about the patient that has triggered my feelings towards that windowless room at the ground floor of Akron City Hospital. I first met Jane in the emergency room at 11pm one night when my team was admitting. I had just finished another patient's admitting orders when my senior resident got a call about her. "Umm... while I finish up this paperwork, take a look at her lab values and see what you think!" When residents have said this before, they usually mean some subtle lab difference that I'll never pick up on, so I was surprised when the Creatinine level of 21 jumped out at me. Normally, Cr is below 1 and I honestly didn't know it was possible for someone to have a level that high! I quickly glanced at the patient's age and looked over the list of other diseases she had, completely expecting some 90 year old lady with diagnosed (yet uncontrolled) end stage renal failure. But no. Jane was 51 years old and had no diseases that she had been diagnosed w/ or was being treated for. By her own accounts she had always been healthy. As I began to take her history and she told me her story, I learned that she had had a workup at the other major hospital in Akron which had proved to be inconclusive, and Jane, frustrated, stopped following up. I stood there in her room as she told me about her symptoms, the stress of a recent job loss, and the frustration of her persistent nausea and vomiting. I was in the suffocating ER as Jane laid in that inhuman excuse of a room, partitioned off from the next patient by 3 curtains protecting her privacy. As the word "dialysis" was stated as a likely possibility, I was there to watch the the instant reaction on the face of Jane and her daughter.

I saw her the next morning as resident after resident, and attending after attending visited her to talk about her prognosis. I observed the light slowly drain out of her eyes throughout the morning as she approached the catheter placement. And I visited her nearly every morning of her 10 day hospitalization. You've never felt so much peace as you walk into a room. Here was a woman with deathly low kidney functioning telling you how important it was for her to wash up every morning and "get ready for the day" so she could continue to feel human through this all.

And when she started dialysis, I went there to get her history morning after morning. I talked about how her body was responding and listened to her lungs and heart as the dialysis machine whirled on and on in the background--pumping blood in and out of her body as she lay there confined to her bed as that machine worked to keep her body from shutting down.

But I'll never forget that one conversation. I was pretty annoyed that morning, and I had 2 hours to see just one patient. But Jane was that one patient. I headed down to dialysis to do my usual check in. By this point she was only in the hospital to wait for medicaid to kick in and we really were doing nothing more than dialysis to manage her medically. But I still went to say hi. And I asked her how she was really doing. I find that's quite a different question that "how are you doing this morning?" And she answered me. I leaned against the counter in that crowded little space as Jane poured out her heart about the devastation of the diagnosis. How one day she was healthy with a job and a life and a future, and the next she's tethered to Akron and to dialysis. How will she work when she needs to be in that windowless room 3 days a week? Her dreams of "someday getting around to traveling" are over. She's here. Her health has now become her life. Her renal disease now dictates all of her activities and functioning.

I was, in short, humbled by this conversation. Here was a woman who was independent. Who lived life. Who had a family, had a job, and functioning completely as her own person. And yet she wasn't beyond disease. It made me re-evaluate how I live my life. It reminds me of my own conviction that I never want to wake up one day and realized that I've forgotten to live. I want to live. I want to love. I want to invest in relationships. And Jane reminded me that nothing is certain. That there are no guarantees in life.