100 Days of Dialysis – Part 1
Its been nearly a year since I have been on Dialysis. Two sittings per week meant about fifty weeks; since I was on 3 sittings per week for the first few weeks, I hit the 100 dialysis sittings in about 11 Months.
When I heard I was going to be put on Dialysis, I thought my life was over. I might have a few more years to go and I am actually looking down the canon waiting for fire. That scene changed really fast. The first and second dialysis sessions were administered under ICU conditions, but the 3rd session was the one that changed the scene. I was taken to the Dialysis ward and immediately could sense a change in the atmosphere. There was a sense of normalcy, an air of familiarity and an indication of things working as per routines and schedules. This was completely in contract to the ICU conditions, and made it that much easier.
Vasuki sister as I call her, is the supervisor of the day shift and an ever-smiling face. Much of her patient related job responsibilities are about providing special attention to the new patients. This includes technical duties like cannulating the young fistulas and monitoring patient reactions and responsiveness to the dialysis; and, a bigger role that she plays is of being a counselor. Her attitude and enthusiasm flows through to the patient and we start feeling emotionally a litter better just by her presence. Don’t worry I’ll write about her in detail later on, maybe throw in a little selfie too.
The experience as one can expect has been surreal. Hard to accept at first, trying to deal with ‘eventual-istic’ thoughts, and finally embracing the new lifestyle and start moving again. Its been a ride, and when I look back, or rather look at it from a ‘100 days’ perspective a few things stand out.
- Hospital Protocols
- Core Competency
- Patient Entitlements
- Life and Death
The rest of the topics are technical observations and a little lite hearted. Life and Death seems to be the hardest topic to talk about, so let’s get that out of the way first. Let’s take time with the other topics.
Life and Death
The night I had my first Dialysis, there was an announcement. “Attention! Attention! Code Blue in Dialysis 1, Repeat! There is a Code Blue in Dialysis 1” I didn’t know what it meant but I would find out soon.
It must have been around 10 PM in the night. There were just 2 nurses in my ICU, the M-ICU, and there were probably 4-5 more nurses in the C-ICU and N-ICU. There was 1 doctor in my ICU and probably 2 more in the other two ICUs. One of the Doctors from another ICU was hanging out here, and maybe trying to flirt with the Doctor in my ICU when the announcement came. At a moment’s notice, they ran! The 2 doctors ran like they had just heard gun shots! They ran for their lives! Or rather ran for a patient’s life.
In about 10 minutes, phones started ringing non-stop and I could make out that there was going an admission. In fact, it was clear that the patient who had just been called a Code Blue was being brought into the ICU. The nurses immediately got busy and started readying the bed, setting up equipment, loading doses into syringes and making way for the patient. The patient was stretchered into the ICU and there were about 6-7 people around the bed. The ICU nurses also joined the group. There was a big fat nurse, who was the shift lead in the ICU, he started doing the compression technique CPR to thrust start her heart back, but it wouldn’t budge. The patient’s BP was falling, and the pulse was dipping by the second. They had already shocked her once in the Dialysis ward, they shocked her again! I had just seen these sequences on film, but when I actually heard them yell out clear! I couldn’t help but turn my head towards the new patient’s bed. That’s when I found out that It was a woman. She must’ve been in her late 50s or maybe even 60. The BP was rallying around 40-50 systolic. They put her on a ventilator and inserted a central line. It was about 11 PM in the night now and she had become unresponsive. Alive, but barely.
The ICU staff had phoned up her doctor who incidentally happened to be my doctor too, and he actually came down to the hospital at that hour! He saw the patient, spoke with the ICU staff, summoned the Dialysis staff and tried to hold a small scrum and understand what had really happened. He spoke with the family, asked them to get an emergency admission and made it clear to them that the situation was very critical, and they couldn’t say anything with certainty for the next 12 hours. For those in scrubs, it had become clear, she wouldn’t survive the night.
I was woken by a nurse at 5 AM for the first pricks of the morning. Blood was drawn and I went back to sleep. In an hour I was woken up again for a sponge bath and change of cloths and sheets. I went back to sleep. Shifts changed at 8 AM, and the day time ICU registrar walked in. At around 12 noon, his voice casual, but making deliberate eye contact with the junior doctor and the shift lead, he said ‘I’m declaring it at 12:30’. The ‘it’ was the dialysis patient from the previous night and declaring was pronouncing her dead.
I was a little scared, for 2 reasons; 1, I had seen someone slip into death, and 2, the lady had just come to the hospital for a routine dialysis sitting and ended up dead, could it happen to me too when I start my dialysis?
Since then, about 5 people have passed away from among my dialysis buddies. Three of them from Dialysis 1 and two from Dialysis 2. Luckily none of them died in front of me. There were cases when some patients developed complications and were sent to either the ER or the ICU, and in some cases went on to get admitted to the hospital, but none among these have died.
My biggest blow came in the December of 2019 when a close friend passed away. He was a normal, healthy, vegetarian, non smoking, non alcoholic 30 year old. Like everyday, he bathed himself and walked out of the bathroom, took out his phone but soon fell to his knees and passed way. When his father found him, the towel was still soaking bath water and his body was still warm. They said it could be an SDC – sudden cardiac death due to unknown reasons. All of us, were taken by shock and couldn’t respond to the news. I was hit the hardest by the sight of his parents who were inconsolable. That night was particularly hard for me, because I constantly heard the haunting cries of his parents and given my proximity to death, more and more versions of ‘eventualis-tic’ thoughts came up in my mind. Luckily, I have been taught coping mechanisms and more importantly, I have friends to hear me out.
The deaths at the hospital somehow don’t emotionally bother you as much. Maybe its because of the professionalism of the hospital staff that rubs off on the patients and their relatives. We talk of the deaths, both with the staff and with other patients since the deceased had been a fixture in our daily lives. Because of the fixed routines and schedules, most of the patients and the relatives endup befriending each other and maintain a cordial relationship. So even after the death of the patient, when the family ceases to be in our daily lives, it almost feels like a whole family just got wiped out of our relationship radar. Its strange, that 1 death means the end of 4 or 5 people from our circle, but it happens.
Not all is bad though, there have been 3 successful transplants this past year and those patients do pop in at the hospital occasionally with treats and greets for the nurses and doctors. They also stop to say hello to the patients as well. Transplant is the other end to the dialysis saga, the longer end to the story – but the happier of the two. Fingers crossed I can write about that soon.