Dialysis Nurse Quotes

Some older or very ill patients may not be suitable candidates for fecal transfer. Colonoscopy is an invasive procedure, especially for those patients who are too ill with other conditions like cancer, heart failure, dialysis, or Alzheimer’s.

In March 2002, the National Academy of Sciences, a private, nonprofit society of scholars, released a high-profile report documenting the unequivocal existence of racial bias in medical care, which many thought would mark a real turning point. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care was so brutal and damning that it would seem impossible to turn away. The report, authored by a committee of mostly white medical educators, nurses, behavioral scientists, economists, health lawyers, sociologists, and policy experts, took an exhaustive plunge into more than 480 previous studies. Because of the knee-jerk tendency to assume that health disparities were the end result of differences in class, not race, they were careful to compare subjects with similar income and insurance coverage. The report found rampant, widespread racial bias, including that people of color were less likely to be given appropriate heart medications or to undergo bypass surgery or receive kidney dialysis or transplants. Several studies revealed significant racial differences in who receives appropriate cancer diagnostic tests and treatments, and people of color were also less likely to receive the most sophisticated treatments for HIV/AIDS. These inequities, the report concluded, contribute to higher death rates overall for Black people and other people of color and lower survival rates compared with whites suffering from comparable illnesses of similar severity.

A 2009 study published in the New England Journal of Medicine showed that almost two-thirds of elderly nursing home patients were in worse shape—either less able to take care of their own basic needs or dead—within just three months of starting dialysis, suggesting that treating such patients with dialysis was in direct violation of one of medicine’s guiding principles: primum non nocere, first do no harm.

Fifteen years ago, Israeli scientists published a study in which engineers observed patient care in ICUs for twenty-four-hour stretches. They found that the average patient required 178 individual actions per day, ranging from administering a drug to suctioning the lungs, and every one of them posed risks. Remarkably, the nurses and doctors were observed to make an error in just 1 percent of these actions—but that still amounted to an average of two errors a day with every patient. Intensive care succeeds only when we hold the odds of doing harm low enough for the odds of doing good to prevail. This is hard. There are dangers simply in lying unconscious in bed for a few days. Muscles atrophy. Bones lose mass. Pressure ulcers form. Veins begin to clot. You have to stretch and exercise patients’ flaccid limbs daily to avoid contractures; you have to give subcutaneous injections of blood thinners at least twice a day, turn patients in bed every few hours, bathe them and change their sheets without knocking out a tube or a line, brush their teeth twice a day to avoid pneumonia from bacterial buildup in their mouths. Add a ventilator, dialysis, and the care of open wounds, and the difficulties only accumulate.

Marilyn was twenty-two and more frightened than he had ever seen her, terrified of motherhood and its ironclad accompanying responsibility—but the minute Wendy arrived, the very second he laid her, squalling, on her mother’s chest, Marilyn shifted. She came of age instantaneously and suddenly she was Wendy’s mom; she was in her element and everything clicked. And he stood there, his eyes filled with tears, a brand-new and unexpected panic roiling in his gut. And it had been the same thing three times over—another girl, another girl, another girl—despite mounting responsibility and the steady accumulation of debt and details and obligations and years, simple numerical age. Each time his wife shifted fluidly into the mother of two, then three, then four; into a homeowner, a bookkeeper, a crisis counselor, a chauffeur. Caring for their house and their children while also tending to his aging father—Richard now declining, on dialysis, and in need of at-home nursing care—to their rambunctious dog, to him. She did this, and the structure of his daily life remained relatively unchanged, and yet he was the one fucking things up. He, on this terrible night, had given her one more enormous crisis, a ten-foot wave of malicious ineptitude. And she—his lovely wife—had cried herself to sleep, landing in a contorted position that would have been funny under better circumstances.