ARTS & FARCES internet

My original nephrologist, the one that ran the Roseville Dialysis Center, refused to see me at the Saint Paul Dialysis Center, instead sending one of his partners. Competing turf trumps patient care every time. My first and only encounter with the partner would have been humorous if my life wasn’t at stake. He barely spoke English, asked how I was feeling, and said he really couldn’t tell me anything because he hadn’t had time to look at my records.

Time to find a new nephrologist.

Cathy called her contacts at the University of Minnesota and within a week got me in to see the nephrologist that was singly and unanimously recommended. Bless her.

I fired my first nephrologist, but not before he could slip a note in my chart that I needed psychological counseling. He was very concerned that I had missed my appointment at his dialysis center. He was immune to hearing anything negative about his center, waving my comments away in a curiously artificial kind and caring tone.

When Cathy called him he explained, in a kind and caring manner, that she was too close to be objective. Well, I certainly hope my friends aren’t objective about my health care. And as far as that goes, I hope my doctors aren’t either. He explained that he was worried about my attitude and that I should seek counseling.

When I talked to him, he revealed -- again in a kind and caring manner -- that Cathy was disturbed and should seek professional help.

Cathy and I were both indeed disturbed; disturbed about the quality of care at his dialysis center and his lack of being disturbed about it.

"If he had plane tickets he wouldn't have missed his flight," he explained to Cathy trying to draw a parallel between my bailing on his dialysis center and missing a vacation. I never got the chance to use my comeback: "It'd depend on where the plane was headed," perhaps because he knew better than to try that with me.

Dr. Warden, the unanimously recommended nephrologist, was younger than I expected, but he treated me like a human being and actually listened to my responses to the questions he asked. Even better, he spoke to me in a human voice -- not an artificial kind and caring manner. I liked him fine; so did Karen and Cathy. More important, Cathy was relieved.

The next step was to see a vascular surgeon about getting a fistula to eventually replace my catheter for hemodialysis access. Again I relied on Cathy to screen surgeon candidates.

On 27 March 2000 I made another trek to Saint Joseph's Hospital, had the fistula surgery, and was discharged. The surgery was a relatively simple procedure to combine a vein and artery in my left wrist. After several months of regularly exercising my arm, my fistula will mature. At that point, large needles will be placed in my arm and connected to the dialysis machine instead of using the catheter.

One of the hardest parts of dealing with kidney failure was the fatigue, a result of anemia -- a common side effect of kidney failure. My blood chemistry changed drastically when my kidneys failed. My body was no longer able to eliminate the waste products that were produced during the process of converting food to energy. As a result, I was literally out of gas most every day. Nevertheless I continued to work full-time, but I did it making three tracks behind me.

For all end-stage renal disease patients, blood chemistry is monitored regularly. In my case two blood chemistries were especially important:

• Blood Urea Nitrogen (BUN): Indicates kidney function. Urea is formed in the liver during protein metabolism and is passed to the bloodstream to be eliminated by the kidneys.
• Creatinine: Also indicates kidney function. Creatinine is a waste product that is filtered and eliminated by the kidneys.

As you can expect, my BUN and Creatinine blood chemistries were wildly elevated, as shown in the table below.

With adequate dialysis both the BUN and Creatinine levels in my blood would come down to numbers that would be still elevated, but acceptable.