Dialysis Quotes

I encourage readers recovering from a kidney transplant to heed the advice of their medical practitioners.

God’s mercy and grace over y circumstances propelled my faith and caused me to experience significant spiritual growth.

There is a cyborg hierarchy. They like us best with bionic arms and legs. They like us Deaf with hearing aids, though they prefer cochlear implants. It would be an affront to ask the Hearing to learn sign language. Instead they wish for us to lose our language, abandon our culture, and consider ourselves cured. They like exoskeletons, which none of us use. They don’t count as cyborgs those of us who wear pacemakers or go to dialysis. Nor do they count those of us kept alive by machines, those of us made ambulatory by wheelchairs, those of us on biologics or antidepressants. They want us shiny and metallic and in their image.

A dialysis patient's life is hard. Laugh harder.

It was in her hand, as everyone’s was these days, as if phones were dialysis machines that could not be out of reach without life-threatening consequences.

You think I don't know how to date? You think the kind of sex I like is like some condition? Like a fucking dialysis machine I have to drag around behind me, making everything into a big fucking hassle?

some accuse hospice and palliative care clinicians of promoting a “culture of death” when we allow dying people to leave this life gently, without subjecting them to CPR or mechanical ventilation or dialysis or medical nutrition.

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.

I feel it’s time to start a movement for equal, non-discriminatory facilities at discos. I ask, why are there no wheel chairs at Titos? Why can’t they have ‘Geriatric Nites’ as well? We could all go there, take off our dentures and have wild time, while sipping our chicken soup. Come think of it, they could also offer a free dialysis with every drink!

It is not a crime to commit First Degree Writing

Maj Thapa rose to the rank of Lieutenant Colonel and served till he retired. He continued to attend almost all the Republic Day parades from 1964 to 2004. Sick and undergoing dialysis for kidney failure in Delhi, Lt Col Thapa would slip in and out of consciousness in his last year. Poornima, who was taking care of him, pleaded with him to not attend the parade that year, but he refused gently yet firmly. ‘When I wear my uniform and go for the parade, I represent my soldiers; those men who fought a war with me. I cannot let them down,’ he told her. Though he could hardly stand for long or even stay alert, he put on his uniform, pinned on his PVC, tilted his Gorkha hat at the perfect angle and went for the parade, remembers Poornima. Through sheer willpower, he managed to stand in the jeep till he had saluted the President. After that, he sat down. That would be the last Republic Day parade he would attend. On 5 September 2005, Lt Col Thapa died of kidney failure. He was 77 years old.

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.

Ah, it’s a tough case: the only relief for her dementia is dialysis, but the thing that keeps her from signing for dialysis is her dementia. A real tough TURF.

Another possible solution would be to think about kidney exchange in a global way. There is virtually no kidney transplantation, and little or no access to dialysis, in places such as Nigeria, Bangladesh, and Vietnam, where kidney failure is a death sentence. Presumably, many kidney patients there have willing donors, but in a country such as Nigeria, for example, where fewer than 150 transplants occurred from 2000 to 2010, that willingness doesn’t do patients any good. But suppose we were to offer them access to American hospitals, at no cost? That may sound expensive, but it wouldn’t have to be—indeed, it could be self-financing. Remember that removing an American patient from dialysis saves Medicare a quarter of a million dollars. That’s more than enough to finance two kidney transplants, as well as postsurgical care and medicines. That money could pay for an exchange between an American patient-donor pair and, say, a Nigerian pair.

National data said it wasn’t just our imagination or where we sat. I soon learned that though Blacks and Whites each made up a third of the kidney transplant waiting list at that time, Whites received every other donated kidney and Blacks received every fifth one, which meant that on average, Blacks waited nearly two years longer than Whites for a kidney transplant. As a primary care doctor at the time, not aware of the realities of nephrology, I didn’t know that two years could mean never having to be on dialysis at all. That two years could be the difference between surviving in body and spirit. Or not.

Robert had been under the care of a nephrologist for years prior to reaching end-stage kidney disease but didn’t hear about kidney transplant as an option until months after starting dialysis. Now in all fairness, few nephrologists would begin a conversation about kidney replacement options before the patient’s kidney function—their estimated glomerular filtration rate or eGFR, how fast the kidneys filter the blood—had fallen to 25 milliliters per minute, and the patient cannot be placed on the kidney transplant waiting list until kidney function reaches 20. The medical world tends to simplify the explanation of eGFR to patients as “percent function,” though 100 percent function of normal kidneys in a young person can be closer to 125 milliliters per minute, so a more accurate and easier-to-understand explanation would be that we start out with about half a cup, or 25 teaspoons, of blood flowing through our kidneys’ filters every minute. Using this analogy, nephrologists usually start talking about kidney replacement options when it has dropped to 5 teaspoons a minute, and a patient can be placed on the waiting list once his kidney function has dropped to 4 teaspoons a minute.

In December 2014, the Kidney Allocation System implemented a new rule that turned the key in the steerage lock: the waiting list date would be backdated to when the patient started dialysis rather than at the time of transplant evaluation. This was an important step toward minimizing the effect of human error on access to kidney transplantation.

But it didn’t go far enough. It didn’t go far enough because most people start dialysis when their eGFR is somewhere between 5 and 10. The difference between an eGFR of 20 and 10 alone can be several years for many patients. Years that could be spent accruing time on the kidney transplant waiting list. Sometimes so many years that a patient could potentially get a preemptive transplant—a transplant without ever having to go on dialysis.

It wasn’t until cyclosporine was discovered in 1976 that the balance between preventing rejection and avoiding infection greatly improved. That plus simultaneous efforts to figure out how to better match donors to recipients and the discovery of newer, better drugs over time has created the current reality in which more than two-thirds of all kidney transplants are still working after five years, while little more than a third of dialysis patients are still alive in that same time span. Some kidney transplants last twenty, thirty, forty, even fifty years.

His eyes weren’t red anymore. His skin no longer had that washed-out look. He had already been happily guzzling ice-cold water from the pink plastic hospital pitcher to his heart’s content. “They told me to drink,” he said, grinning. I grinned back. I was so happy for him. Gone were the days of having to limit how much liquid he took in between dialysis treatments. Now he had a kidney that could pee out any fluid his body didn’t need. He focused on learning about all the new antirejection medications that would keep his new kidney healthy. He was eager to get on with making up for the six years he lost to dialysis. The six years he had to curb his ambition and planning for the future because he didn’t know what the next hours, days, weeks, months, years would bring.

The hope is that our efforts will make eventually as far away as possible. Because once eventually comes, all that is left to do is to try to replace the kidneys with a transplant or dialysis, because we can’t live without Her.

When I think of Mr. Madani now, I am reminded of a joke I heard sometime after I was involved in his care: An oncologist walks into a funeral home, looking for his patient. The casket is closed. He opens it and is surprised to find it empty. “Where is my patient?” he asks the attendant. “I wanted to give him one more round of chemo.” “Oh, they took him to dialysis,” the attendant replies.

Though I wasn’t aware of it at the time, a small but growing body of research supported my intuition. It showed that patients similar to Mrs. Lee—over seventy-five and with serious medical problems in addition to advanced kidney disease—were as likely to live as long without dialysis as with it and often with a better quality of life. This research comes mostly from the United Kingdom, where about 15 percent of elderly patients with end-stage kidney disease die without ever starting dialysis. They have programs in place to provide conservative management—treatment aimed at minimizing symptoms of kidney failure while maximizing the quality of life remaining without dialysis.

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.

As a fellow in the pre-dialysis clinic, what I observed for how to have discussions with patients approaching end-stage kidney disease seemed consistent with the monolithic, unquestioning agenda implied by the clinic name. The response to patient hesitation toward dialysis or outright refusal of it often felt threatening, coercive, even bullying to me. “Start dialysis or you’ll be dead in two weeks.” “You have a responsibility to your grandchildren to be here.

We get paid much more to keep someone on dialysis than to keep them off of it. If we don’t achieve dialysis metrics—like avoiding dialysis catheters or providing a certain dose of dialysis—known to best result in long-term benefits, we are financially penalized. But create a fistula in a little old lady that usually requires interventions to make it work and keep it working and make her stay on the dialysis machine as long as it takes for the numbers to look right, then essentially get a bonus. If we see an in-center hemodialysis patient four times in a month, we stand to make 50 percent more money than if we only saw her once. And the nephrologist really only has to see the patient once each month—if a physician assistant sees the patient the other times, we still get paid. We would have to document a comprehensive medical history and examination over the better part of an hour with a patient returning to clinic twice to see the same money—and good luck trying to justify why that was clinically necessary to do. The second, third, and fourth in-center hemodialysis patient visits can be more like drive-bys—a simple documentation that we (or the physician assistant) “saw” the patient, with no notation of time required. Private insurance companies and the Medicare ESRD program pay top dollar for dialysis care, not clinic visits. It’s profitable to build another dialysis center, but we haven’t figured out how to build comprehensive outpatient palliative care services.

It is our inability to accurately predict when people will die that usually keeps us from preparing patients for death. In one survey of dialysis patients published in the Clinical Journal of the American Society of Nephrology in 2010, less than 10 percent reported that any doctor had ever discussed prognosis with them.

While tools to estimate prognosis among dialysis patients and tools to estimate prognosis among patients with advanced kidney disease are in development, without a crystal ball it is doubtful that any tool will ever have enough precision for nephrologists to feel assured of accuracy for the patient before us. However, since the vast majority of patients and families only have their experience with illness up to the present moment, our clinical knowledge and experiences with similar patients about what the future may hold are invaluable—and should be shared.

Yet published research studies suggest that patients and family members want to be given information about life expectancy, even if prognosis is poor. Others have shown that those engaged in shared (as in with input from their doctor), informed decision-making are more likely to make decisions about dialysis and end-of-life care consistent with their personal values—often resulting in preferences for less aggressive care and more conservative management.

For every five of our dialysis patients, one will die within the year. Yet we often don’t bother spending the time it takes to have conversations about what patients would want their care to be like at the end of their lives. Since dialysis can be a life-saving treatment in many circumstances, we develop a false sense that sudden bouts of illness serious enough to land our dialysis patients in the hospital are temporary when, truth is, dialysis cannot change the reality that the path of kidney failure is a continuous one toward death. A path that is littered with sudden illnesses and setbacks, and recovery is never back to the level of function that the person enjoyed before.

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.

This migration to higher transport property is induced by vascular endothelial growth factor (VEGF), analogous to the pathophysiology of diabetic retinopathy.

Analysis, the International’s online theoretical journal. (Its contributors had nicknamed it Dialysis, because of its insistent theme that everything was going down the tubes.)

She’d gone into kidney failure when I was in high school. Never got to the transplant list, though, because her best friend, Dorothy, stepped in and gave her one of hers. Mom was lucky. She never even had to do dialysis.

Diabetes – the physical costs Hypertension: 70% of diabetics also require medication for blood pressure. Cholesterol: 65% of diabetics require medication to reduce their cholesterol. Heart attacks: Diabetics, even when on full medication, are twice as likely to be hospitalised, crippled or die from a heart attack. Strokes: Diabetics are 1.5 times more likely to suffer a debilitating stroke. Blindness and Eye Problems: Diabetes is the number one cause of preventable blindness in the developed world. Impotence: Diabetes is also the number one cause of impotence. Dementia: Having diabetes doubles your risk of dementia. Kidney disease: Diabetes is the cause of kidney failure in half of all new cases; most people on dialysis are diabetics. Amputations: There are over 7000 diabetes-related amputations done every year in the UK and over 73,000 in the US.

Chronic Kidney Disease Karma Ayurveda is an ancient Ayurveda company which provides many valuable natural remedies for kidney patients which help to keep kidney problem under control.Karma Ayurveda medicine reduces dialysis, frequency at first, and sometime kidneys can be brought to its normal function.

dialysis is therapy has been initiated, the average expected remaining life span is approximately 8 years.

The healthcare institute one of the best paramedical institute in Delhi and provide training paramedical courses. We provide courses like: Emergency Medical Technician, Dialysis Technician, General Duty Assistant, Radiology Technician, X-Ray Technician, Dental Assistant, and Phlebotomy Technician. Get more information visit our official websites.

As described again, the biological basis for the Gerson Therapy is predicated on sodium restriction, potassium supplementation, protein limitation, calorie reduction through avoidance of fat, dialysis of the bloodstream for reduction of electrophiles, macronutrient hyperalimentation, salt and water management, and accelerated metabolism.

Please understand, Conception of a Dialysis Patient (the untold truths), is for those who have never crossed over, and experienced this world first hand. Tethered to a machine for survival, takes an emotional toll, yes on the patient, but family and friends as well. Anyone who draws breath needs to take this expedition. Dialysis patients, unfortunately, know their untold truths, so this may simply be confirmation of sorts, acknowledgement of their not being alone. This is the point of view of one patient, not a physician. I ask that you and others hear our voices. As the creator of the opus, I have firsthand experience. Removed from the machine, with my second transplant of a lifetime, I am certainly blessed. My objective is to open everyone’s eyes and minds, especially those of you who never been tethered to a dialysis machine. From my perception, you will value the emotional charge, and destruction dialysis forces upon patients, and their families. Again, the goal is to enlighten, in a manner that is sure to linger, and have you examining your own predicaments. I so appreciate you passing the word, Please take that breath with us… -Fayton

Please understand, Conception of a Dialysis Patient (the untold truths), is for those who have never crossed over, and experienced this world first hand. Tethered to a machine for survival, takes an emotional toll, yes on the patient, but family and friends as well. Anyone who draws breath needs to take this expedition. Dialysis patients, unfortunately, know their untold truths, so this may simply be confirmation of sorts, acknowledgement of their not being alone. This is the point of view of one patient, not a physician. I ask that you and others hear our voices. As the creator of the opus, I have first-hand experience. Removed from the machine, with my second transplant of a lifetime, I am certainly blessed. My objective is to open everyone’s eyes and minds, especially those of you who never been tethered to a dialysis machine. From my perception, you will value the emotional charge, and destruction dialysis forces upon patients, and their families. Again, the goal is to enlighten, in a manner that is sure to linger, and have you examining your own predicaments. I so appreciate you passing the word. Please take that breath with us -Fayton

If you’re reading this you’re already blessed, not that you’re receiving something special, it’s more that you have the existence of sight aiding you. Take a moment to be thankful for what you’ve received, and I’m not speaking in the materialistic vain, but rather for what we undervalue. Be grateful for your ability to take that first breath every morning, to place both feet on the ground and stand, be thankful… Be thankful for the people in your life right this very moment, and those that communicate with you via the internet. Be thankful for the time already spent on this planet, and for what’s to come. I’d like you to stop whatever it is you’re doing this very second, and take a moment for self reflection. That unexpected jolt of reality that life hit’s us with during a crisis or when accolades are given is powerful. None of that is happening right now, so this is the time to show gratitude, and share a moment with no one else but you. Just take a moment and be thankful. What am I most thankful for?... I’m most thankful for doing the best I can with what I’ve got, because I’m cradled in blessings.

palate is a wall or septum that separates the oral cavity from the nasal cavity, forming the roof of the mouth. This important structure makes it possible to chew and breathe at the same time. The hard palate—the anterior portion of the roof of the mouth—is formed by the maxillae and palatine bones and is covered by a mucous membrane; it forms a bony partition between the oral and nasal cavities. The soft palate, which forms the posterior portion of the roof of the mouth, is an arch-shaped muscular partition between the oropharynx and nasopharynx that is lined with mucous membrane. Hanging from the free border of the soft palate is a conical ¯ muscular process called the uvula ( U-vu¯ -la � little grape). During swallowing, the soft palate and uvula are drawn superiorly, closing off the nasopharynx and preventing swallowed • C L I N I C A L C O N N E C T I O N Per i toni t is A common cause of peritonitis, an acute inflammation of the peritoneum, is contamination of the peritoneum by infectious microbes, which can result from accidental or surgical wounds in the abdominal wall, or from perforation or rupture of abdominal organs.If, for example, bacteria gain access to the peritoneal cavity through an intestinal perforation or rupture of the appendix, they can produce an acute, life-threatening form of peritonitis. A less serious (but still painful) form of peritonitis can result from the rubbing together of inflamed peritoneal surfaces. Peritonitis is of particularly grave concern to those who rely on peritoneal dialysis, a procedure in which the peritoneum is used to filter the blood when the kidneys do not function properly (see page 1048). •

A recent Economist article on dialysis perfectly illustrates the inflationary impact of cost-plus pricing. Since U.S. clinics are paid on a cost-plus basis, they prefer to use expensive drugs rather than cheaper ones. In fact, many appear to order drugs in units that exceed what a standard dosage requires because they can charge the government for the wastage. Quoting a stock research firm, the article noted that many clinics preferred an injected drug with a price of $4,100 a year over the identical drug in oral form, priced at only $450 a year. Not surprisingly, the manufacturer of the oral drug responded by increasing its price above that of the injected version to make it more competitive!

This is precisely why T2DM, unlike virtually any other disease, affects every single part of the body. Every organ suffers the long-term effects of the excessive sugar load. Your eyes rot – and you go blind. Your kidneys rot – and you need dialysis. You heart rots – and you get heart attacks and heart failure. Your brain rots – and you get Alzheimer’s disease. Your liver rots – and you get fatty liver disease and cirrhosis. Your legs rot – and you get diabetic foot ulcers. Your nerves rot – and you get diabetic neuropathy. No part of your body is spared.

What had I been doing at twenty-seven? I took that backpacking trip to Machu Picchu with Zander, went camping a lot. Things I took for granted. Things that wouldn’t be possible on dialysis, that’s for sure.

Human society confers little status on janitors because their position is considered unskilled. The Body [of Christ], however, recognizes that lowly janitor cells are indispensable to overall health. If you doubt that, ask someone who must go in for kidney dialysis three times per week.

Dialysis facilities were another site where vulnerable patients congregated and where the impact of COVID was especially brutal. Dialysis patients suffered a higher rate of hospitalization for COVID disease than any other group in the Medicare program.

I am medically trained in kidney dialysis.

Gratitude is a dialysis of sorts. It flushes the self-pity out of our systems.

Something about dialysis units always reminds me of the film The Matrix—not the part where Neo is able to dodge bullets while moving in slow motion, but the part where people are plugged into the matrix through sockets at the back of their necks. That is more or less how dialysis works, and it seems totally barbaric.

It is truly a miserable process. In addition to being confined to a chair for four hours three times a week, many patients feel lousy during and after the sessions, with symptoms that include fatigue, coldness, headache, and muscle cramps. After dialysis, patients will often spend the rest of that day lying in bed. As many patients have described it to me, dialysis keeps you alive but is no way to live. But then again, what’s the alternative?

Forgiveness is dialysis of the soul.

contamination of foods with heavy metals and include the intentional inclusion of toxic substances in products for mass consumption. “The result is what you see unfolding around you right now: mass insanity, incredible escalations of criminality among political operatives, clinical insanity among an increasing number of mainstream media writers and reporters, widespread infertility in young couples, skyrocketing rates of kidney failure and dialysis patients, plus a near total loss of rational thinking among the voting masses,” he said.

God Almighty hears you...Whether you are on dialysis or not. Get this kidney healing book; Kidneys Restored to Good Health: Healed From Kidney/Renal Cancer, a book by Stellah Mupanduki. This is a good book for your kidney healing, bloodstream cleansing and kidney protection. Keep reading all the days of your life. You breakthrough, you live long..."Yeah, says the Lord God Almighty who heals you everlastingly.

Look, Dad. I’m okay. I like this girl. Everything’s normal. “Only my father,” I say to Tina, “would imagine that anyone could find paperwork arousing.” “What?” Her smile is a touch too wide, a little too faked. “Don’t tell me your media training didn’t cover this, either.” I set the stack of papers on the flat surface of my desk and gesture Tina to sit in the leather-bound executive chair. “What am I supposed to say, then? Come on, baby. It’s a nondisclosure agreement. You’ll like it. I promise.” She gives me an unimpressed look. “God,” she says. “And I thought you were supposed to be a good liar. That’s not how you do it.” She bites her lip and then she leans toward me. Her eyelashes sweep down, and when she talks, she lowers her voice toward sultry. “I don’t know, Blake.” She bites her lip and reaches gingerly for the papers, stroking her thumb along the edge. “It’s so…big. I’m not sure it will fit.” I almost choke. She looks up with a touch of a smile. Fuck. I started this. “We’ll go nice and slow.” I pull a chair beside her and sit down, and very slowly take a pen from the holder. “Tell me if it hurts and I can stop anytime. I promise.” “Be gentle.” I know we’re just joking. I know this doesn’t mean anything. Still, my body doesn’t know this is a show when I lean toward her. I don’t feel like I’m lying when I inhale the sent of her hair. It goes straight to my groin, a stab of lust. “Trust me,” I murmur. She’s sitting in my chair. She’s smaller than me and all that dark leather surrounds her, blending in with her hair. But when she looks up, tilting her head toward me, she doesn’t seem tiny. She pulls the first paper-clipped section of pages to her, glances at the first paragraph, and wrinkles her nose. “Ouch,” she says in a much less sensual tone of voice. “It hurts already.” “It basically says that if you tell anyone anything about Cyclone business, we get one of your kidneys,” I translate helpfully. “How sweet.” She hasn’t looked up from the document. “Do your lawyers know you summarize their forms like that?” “Disclose two things,” I say, “and we get two kidneys.” “Mmm. Playing rough. What happens if I disclose three? You shut down my dialysis machine?” “You get a commemorative Cyclone pen,” I say mock-seriously. “Come on. We’re not monsters.” She cracks a smile at that. She’s not one of those girls who always smiles, and that means that when she does smile, it means something. Her whole face lights up and my breath catches at the sight. I lean in, as if I could breathe in her amusement. But then she drops her head and goes back to reading. When she finishes, she signs with a flourish. “What’s next?” she says. “Bring it on.” I hand over the next few pages. She holds it up and looks at me. “Don’t lie to me, baby. I bet you make all the girls you bring in here sign this.” You know what? I have never before found SEC regulations this sexy. I lean close to her. “No way,” I murmur. “This is just for you.” “Really?” She manages that look of hurt skepticism so well. I reach out, almost touching her cheek—until I remember that this isn’t real. “No,” I whisper back. “Not really. Everyone does sign it; it’s company policy.” “Oh, too bad.” She’s still reading the page. “I was hoping you had a selective disclosure just for me.” Selective, I realize, is a sexy word when drawn out the way she does it, her tongue touching her lips on the l sound. So is disclosure. “I can disclose,” I hear myself saying. “Selectively.” “Maybe you can give it to me in a material and nonpublic place.” I lean toward her. “You know me. I put the inside in insider trading.” She’s still holding the pen poised above the paper. I touch my finger to the cap and then slowly slide it down the barrel until my hand meets hers. A shock of electricity hits me, followed by a jolt of lust.

Yes, dialysis was the miracle. No doubt Ms. Afuta had a different kind of miracle in mind, but dialysis was the only one that was coming. Without it her sixteen-year-old baby girl would soon be motherless. She seemed to be looking at dialysis as if it was the end of her life, when in truth dialysis would just mean her life would be different. No, it would not be perfect. No, it would not take away all the issues that come with a vital organ dying. Yes, it would take time and have its own frustrations to deal with. But the time in between could be filled with life. Family. Friends. Exercise. Work. Play. Travel. Joy. Love. [...] There was no escaping dialysis. If she wanted to survive. If she wanted life.

But when the kidneys do fail, a strange thing happens. Suddenly they don't feel fine anymore. It becomes too much to deny. It's at this point that fear of death overrides fear of dialysis. Dialysis, they come to see, is the thing that will save them.

[...] For me Mr. Madani was a lesson in how peculiar medicine can be. It is a place where we fool ourselves into thinking that we can somehow get out of life alive and where dialysis is a means to no end. It is a place where the teaching of dialysis practice becomes more permissive within a two-year fellowship stint, more variable from nephrologist to nephrologist. Dialysis has gone from a miracle to something mundane but to be avoided at all costs to the thing we Americans-no matter if rich or poor, Black, Brown, Yellow, or White-cling to, because it holds the promise of more time. We-providers across specialties, patients, and families-begin to expect it, feel entitled to it, demand it, and we won't let go of it, even when it doesn't make sense, even when all it really guarantees is more suffering.

As a fellow in the pre-dialysis clinic, what I observed for how to have discussions with patients approaching end-stage kidney disease seemed consistent with the monolithic, unquestioning agenda implied by the clinic name. The response to patient hesitation toward dialysis or outright refusal of it often felt threatening, coercive, even bullying to me. "Start dialysis or you'll be dead in two weeks." "You have a responsibility to your grandchildren to be here." "If you refuse to start dialysis, then you will be discharged from this clinic.

All day long, her small compact body, sweating through one hospital gown after another, had been racked with coughing fits and spasms. Her long black hair, tied into a tight braid, had lashed the pillows like a whip. Her platelet count plummeted, her blood gases revealed she had entered into metabolic acidosis, her breathing became so faint that a mechanical ventilator had to be wheeled in; her major organs began to shut down like dominoes falling in a row. Lungs, liver, central nervous system; when her kidneys failed, Slater had had to immediately put her on dialysis.

The Dutch ruled over an empire stretching from the Caribbean to East Asia, founded the city of New York, discovered Australia, played the world’s best football and produced some of the finest art and architecture in Europe. Everywhere one goes in the world, one can always find Dutch people. A country half the size of Scotland, with a population of just seventeen million or so, claims to have invented the DVD, the dialysis machine, the tape recorder, the CD, the energy-saving lightbulb, the pendulum clock, the speed camera, golf, the microscope, the telescope and the doughnut.

That very month, at the St. Louis Children’s Hospital, two young patients experienced strange and alarming symptoms. As they underwent dialysis, a lifesaving procedure to filter blood for those whose kidneys don’t work properly, the patients’ eyes started swelling, their heart rates escalated, and their blood pressure dropped. These were signs of a life-threatening allergic reaction. Dr. Anne Beck, the director of the nephrology unit, directed her staff to wash out the tubing with extra fluid before hooking the children back up to the dialysis machines. For the next two months, everything seemed fine. But in January 2008, the symptoms struck again. Beck contacted an epidemiologist specializing in children’s infectious diseases who immediately assembled a command center where a team worked around the clock to uncover the cause of the strange reactions. But as more children succumbed and the staff grew frightened, the epidemiologist notified the Centers for Disease Control and Prevention. The CDC immediately contacted dialysis centers in other states and learned of similar reactions elsewhere. As the CDC and the FDA began a joint investigation, their efforts pointed to a common denominator: all the sickened patients had been given heparin made by the brand-name company Baxter, the nation’s biggest heparin supplier. It was a drug that patients took intravenously during dialysis to ensure that they didn’t suffer blood clots. Within weeks, Baxter—at the FDA’s urging—began a sweeping series of recalls, until finally the allergic reactions stopped. Yet

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.

Going to the dentist is about as fun as driving over a beloved pet on the way home from dialysis.