Author’s note: This essay is dedicated to all the dialysis patients, past and present, at the University of Iowa Hospitals.
I first saw MG in the clinic because of high blood pressure, coronary heart disease, and kidney cancer. Many years later, her kidney function failed. We then trained her and her husband to perform hemodialysis, a process of cleansing blood, at home. Over the years, unrelated to her kidney failure, she had breast cancer, bleeding stomach ulcer, large intestinal rupture, and abdominal infection. She had many surgical procedures and was repeatedly hospitalized. Because her husband is her dialysis partner and went through training in our unit, I came to know him rather well. He is an Iowa farmer, grows corn and soybean. He is tall, well built, and distinguished looking, but quiet. I remembered many times when she was in the intensive care unit, he would come to my office, worried, tired, and stumbling. He needed someone to steady him for a moment, and I was that person. He would talk, not knowing whether she would make it or not, and I listened, answering his questions occasionally. Miraculously, she always bounced back!
A “Happy and Animated” Patient
Today, I saw MG in the clinic. She told me that she is doing fine. Her strength is improving, her appetite better, and her dialysis is going well. This woman, sallow-looking with short and thinning hair and deep furrowed lines around her eyes and mouth, having been through what she had, is scheduled for yet another surgery to take down her colostomy and reconnect her large intestine.
But for the meantime, she is happy and animated. She talks about her children and grandchildren. She keeps her house, cooks, does needlepoint and embroideries, walks her dog, and tends to her garden, and most amazingly, she plans and anticipates holidays and family get-togethers with zest and eagerness. She is full of life amidst such vulnerability to death.
I marveled and asked her about the source of her strength. She credited her husband and her children, whose love and steady devotion sustained her. The couple had been married for more than 40 years. They work the farm and raise their children together. Their bond is “high-energy” and unbreakable. The fact that she is religious and has faith in God helps.
An “Unyielding Determination”
After seeing her, I thought about my other dialysis patients, especially the young ones. I have deep empathy and tremendous respect for them, for what they have to endure to stay alive, and for their unyielding determination to maintain a life with grace and laughter against much adversity. They have kidney diseases that we cannot cure, so we use machines to cleanse their blood and medication to attempt to normalize their internal milieu.
At least three times a week, [these patients] have two large needles inserted into their blood vessels to pump the blood out for cleansing. They are hooked up to the machine four-to-five hours each session. Their fluid intake is limited and food ingestion is restricted in many ways. Needle sticking is unpleasant, but they quickly learn to bear the pain because the alternative is unacceptable.
Bravely Facing a Precarious Life
Time spent on dialysis is long, 12-to-15 hours a week, plus transportation between home and the dialysis unit; or setting and cleaning the machine if they perform the treatment at home. And, frequently, they feel tired and fatigued after treatment because of the rapid shift in body chemical composition and change in fluid volume. Many of them are in the hospital a lot of times for repeated infections or clotting of the bloodline, or for heart disease and shortness of breath.
Life is precarious for them. Outwardly, they rarely whine. Within themselves, there must be times when they asked: “Why me?” But they pretty much submit themselves to destiny and ingeniously integrate dialysis, unwelcome as it is, into their lives.
Patients, Family, and Friends
I take care of a young girl who goes to college. She not only takes a full course load, but also participates in extra-curricular activities. I have a patient who works full-time as a pharmacy assistant, who also does her household chores, including yard work, and finds energy to knit and crochet during dialysis. I have a woman patient whose husband left her when she started dialysis. At that time, her children were toddlers; now the children are college graduates. All these times, she was on dialysis and single handedly glued the family together. I know of a patient who uses his dialysis sessions to listen to music that he would otherwise not have time to do so. We have patients who successfully raised families and pursued difficult careers while getting dialysis treatment for many decades.
I would be remiss if I did not mention the families. Without their unwavering commitment and love, life would have been much more difficult and, at times, impossible for some patients. Everyday, they make complicated arrangements to accommodate their loved one’s dialysis schedule. For some patients, family extends to a large circle of friends who are available to help in transportation and household chores and, of course, emotional support.
“Enormous Inner Strength”
I do not think my patients are stoic because they do feel the pain. They are not oblivious to the seriousness of their illness, yet they seem to possess enormous inner strength and serenity to maintain some sense of pleasantness for themselves and their families.
In his Auguries of Innocence, William Blake wrote:
“To see a world in a grain of sand, and heaven in a wild flower,
Hold infinity in the palm of your hand, and eternity in an hour.”
These passages describe perfectly the profound innate philosophical adaptation of my patients. They understand that humanity blends harmoniously with nature, that human illnesses are unavoidable calamities, and that life and nature continue despite these occurrences.
Having taken care of many patients for more than two decades, gone through drenching anxieties with them when they were very ill, and witnessed their resiliency in recovery, I believe that they truly can fit infinity in their palms and eternity into an hour. They are cognizant of the transient nature of life on earth, and they do not dwell on what they have lost, but learn to count the blessings of what they have.
They taught me that, despite many imperfections, there is a lot to celebrate in life.
About the Author
Victoria S Lim, MD, was born in China, grew up in the Philippines, immigrated to the US in her early 20s, and received medical training at the University of Pennsylvania, the University of Michigan at Ann Arbor, and the University of Chicago before coming to Iowa City, IO. She practices nephrology and internal medicine with zest, enthusiasm, and compassion. Her research consists of endocrine and metabolic complications associated with kidney failure. Dr. Lim is currently Professor of Medicine in the Nephrology Division at the University of Iowa College of Medicine. This article originally appeared in the Iowa City Press-Citizen and is reprinted with their permission. For more information, log onto: www.press-citizen.com.
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