Dialysis

They say it's different for everybody- the symptoms of End Stage Renal Failure (ESRF). I remember laying in bed at night wondering what would happen. I remember thinking I might feel my kidneys 'POP!' inside of me. Dr. Cline assured me that my kidneys wouldn't 'pop.'

Dr. Cline: "It's a gradual process. You might start feeling logy, or have a lack of energy even after you've slept. You might feel nauseous, you might lose your appetite or you might start throwing up after you eat. You might experience fluid in your lungs so if you have difficulty breathing, go to the emergency room right away!"

I like Dr. Cline. He seems to know everything about kidneys, and he knows a great deal about a lot of other things too. He treats me like a human being first, and one of his kidney patients second.

When Dr. Cline asked me if I ever had trouble breathing, my response was typically the same- "My breathing is OK except for my allergies. Man, they are getting bad. This stupid cough..."

My blood work indicated I should have been on dialysis a year sooner than I was, but I showed very little symptoms, so the doc kept me on diuretic pills to keep the swelling in my feet and ankles down. They got really swollen because I was eating too much sodium and my kidneys weren't filtering it out so the salt would settle in my lower extremities. It scared the crap out of me. One night I could barely fit my foot into a sneaker. Dr. Cline adjusted my pill intake and told me to call him if I experienced anymore "changes." I was also on a sodium restricted diet which wasn't that thrilling to begin with, but after a week of no salt, food began to taste good again.

The fistula in my arm was developing nicely. The operation was performed on my left inside elbow (the part where your arm bends) and the vein was puffing up. You could see the blood pulse with your eyes and if you put your hand over it, the vein throbbed in a powerful rhythm under your fingers. Pretty cool! I had the operation in October 2009 and the target date for the vein to be fully "built up" and ready for use was February 2010. Just in time...

For the last week of January, my brothers Rob and James took me on a road trip to Las Vegas, where we spent 3 days and 2 nights of absolute hilarity and Vegas-style adventure. I can't describe a lot of what we did because you know the saying... 'What happens in Vegas...'

Still, I probably should have started dialysis BEFORE we went because I suddenly experienced almost all of the aforementioned symptoms before we left. I lost my appetite, my face was pale, I had no energy, my feet and legs were swollen, and I felt nauseous. Plus, I noticed I was hardly using the restroom. In Vegas, I couldn't walk more than a few feet without feeling worn out. My breathing was interrupted constantly by a deep cough. There was one morning when we walked a few miles in the hot sun that I knew without a doubt that I needed to start dialysis as soon as I got back.

The time for dialysis was here! So now what?

We got back from Vegas and I called Dr. Cline's office first thing the next morning. The receptionist said Dr. Cline was out all week but she would page him for me. I went in and did more blood work. From the results, and from my new symptoms, we decided it was time to get me on the machine.

They set me up at a center close to my home called South Mountain Dialysis. A nurse from the clinic named Leslie called to inform me they had one time slot available- Monday, Wednesday, and Friday at 6:00AM. She also explained that I would probably be there between 3 to 4 hours each day.

For my first visit, I would only be on a dialysis machine for 2 hours. The next day, I would be on it for 3. Kind of like baby steps until I was able to handle the full 3 1/2 hours.

Jake: "Will I be able to go to work after a treatment?"

Leslie: "Most of our patients don't work. They are retired so a lot of folks just go home and sleep because they tend to feel drained afterward, like when you give blood. There is a nurse here who calls it "The Washing Machine Effect." But it all depends on how YOU feel. Everybody is different."

I scheduled my first day of treatment off of work and went to the center. The building is located down the road from a newly developed business district, across the street from a Lifetime Fitness Center. There is a large open area to the north of the building and a big mountain of dirt to the south. I heard from one of the tech's that they have been building the mountain of dirt for over a year and there is no completion in sight. Who knows what it will become?

Before I continue, it should be known that I feel at home in hospitals, Dr.'s offices and the like. Being diabetic since the age of 3, I've spent my fair share in the care of medical professionals so I admire the dedication and genuine care more of them provide. I like doctors and they seem to like me. Win-win!

On the morning of February 9, 2010 - I walk through the sliding glass doors of South Mountain Dialysis for the very first time. A lovely receptionist named Rosemarie sits at a sliding window, busy with paperwork. She looks up.

Rosemarie: "Hi! How are you?"

Jake: "I'm good. How are you?"

Rosemarie: "Well, I'm doing OK. How can I help you?"

Jake: "My name is Christopher Jake Cordova and I'm hear for some dialysis."

Rosemarie: "Oh, OK! Let me get a nurse for you. Come on through the door there and we'll get you going."

I open the door and smell a combination of hand sanitizer and cortisone cream. If I take a few steps to the right, there is a metal weigh station equipped with a rubber grip bar, a digital readout in kilograms, and a small receipt printer.

This is where Leslie meets me.

Leslie: "So, you're Jake! It's a pleasure to meet you in person. Let's start by getting your weight and then we'll get you settled in."

Jake: "Sure."

I weigh myself and print out a receipt.

Leslie: "You'll want to weigh yourself when you first get here and then before you leave. That's how we know how much liquid to pull."

Jake: "Every time?"

Leslie: "Every time."

To the right of the weight machine is the main room of the center. It is a perfect square with large open windows and clean white walls. There are brown leather recliner chairs alongside 3 of the walls. Next to each chair is a machine about 5 feet tall and 2 feet wide. There are plastic tubes coming out of the machine and the front is an array of 2 spinning wheels, buttons, a stationary swirling tube and blinking lights. This is the dialyzer.

Leslie has me stand in front of a chair while she slips a white cuff over my right arm. She wraps a blood pressure sleeve over the cuff and takes my blood pressure electronically. The result flashes on the dialyzer machine. Next, she uses a stethoscope to listen to my chest, my back, and my fistula. Finally, she examines my feet for swelling. (They are pretty swollen.)

Leslie: "Oh, I should have told you to bring a blanket. You can get pretty cold when you're on dialysis because the machine lowers your blood pressure. Do you want to just use your coat today and bring a blanket in next time?"

Jake: "Nah, I'm always warm so I think I'll be OK."

A technician named Diana sticks a thermometer in my ear. Diana is a spunky woman, always laughing, always encouraging. I learn very quickly that one of the patients has a nick name for her. "Sassafrass!"

The technician's responsibilities, as I understand it, is to prep the dialysis station before I arrive. She sets up the area with the required supplies- tubes, needles, band aids, alcohol swabs, gauze, etc. She is also in charge of sticking me with needles.

Diana is wearing a white lab coat, a clear plastic face shield, and rubber gloves. (The outfit of "Sassafrass!")

I sit down in the chair and Diana checks out my fistula.

Diana: "Whoa! You have a great fistula. Whoever did this knew what they were doing. Look at that!"

Leslie: "Oh that will be so easy to access. You won't have any problems. Who did it?"

Jake: "Dr. Wirthlin-"

Leslie: "Oh yes! He always does a good job. You are lucky."

Jake: "Thanks."

Diana wipes my arm down with a cleanser.

Diana: "OK, we're gonna start you out with smaller needles and work you up to the big ones."

Jake: "Does the size of the needle make a difference?"

Diana: "We can pull more fluid faster with the bigger needle but we'll start you out small for a few weeks, don't worry."

Jake: "I'm not worried about needles. I've been a human pin cushion for 32 years. HIT ME!"

All 3 of us laugh and then Diana places a needle into my fistula vein just above where my arm bends. Blood enters the tube and stops about an inch from where Diana poked me. I watch the blood pulse in time with my heartbeat. It goes out, like it's going to fill the tube but then goes back down in time with each beat.

Jake: "Wow! That is kinda cool."

Diana: "Yeah, it's neat to watch, huh?"

Jake: "Yeah!"

She tapes the needle in place against my arm with a piece of white skin tape by placing it over the puncture site, then she folds a second piece of tape and maneuvers it under the needle to keep it in place.

Diana: "How does that feel?"

Jake: "Not bad, not bad."

Diana: "Ready for the 2nd one?"

Jake: "Let's do it!"

Diana: "OK. 1-2-3..."

The second needle goes in about 2 inches above the first. The same blood pulse rhythm happens and I gaze in fascination. After taping the second needle up in the same manner as the first, Diana flicks something on the end of the tubes and they fill with my blood.

Diana: "Still OK?"

Jake: "Yes."

Diana: "OK."

She connects my tubes with the ones coming out of the machine, then she pushes a combination of buttons and I watch as my blood travels out of the bottom tube into the machine. Simultaneously, saline solution travels from a bag hooked up to the machine through the upper tube and into my arm via the higher needle. After awhile, when the machine has done it's thing, the saline solution is replaced by my blood, now clean from being treated through the dialyzer. It is a technological marvel!

Jake: "I guess you can't be afraid of blood if you want to work here."

Diana: "You get used to it. Do you want a pillow for your arm?"

Jake: "Sure."

She hucks a pillow under my arm and tells me to try and keep the arm as still as possible during the process. A-OK! Then she leans my head back and the recliner transforms into a one-person chair bed. My feet fly up slowly and I am practically laying on my back.

Diana: "Comfortable?"

Jake: "Yeah."

Diana: "All right."

She hands me a TV remote. I look up and notice there is a TV set suspended in the air above each chair. In the center of the room below the TVs is a rectangular desk area with multiple openings where the nurses and techs punch data into the computers and listen for alarms from the machines, or requests from the patients. I should mention that most of the patients there are old. Some of them are fast asleep with sunglasses over their eyes and big warm blankets or sleeping bags draped around their bodies. Some complain about everything, some chat, some read books, some watch TV. I typically play online Texas Hold-Em poker on my laptop and sleep. Or I flirt with the techs. Or I crack jokes with Diana.

Diana: "Here is a list of the different channels. We don't get all of them, but we get most."

Jake: "Cool!"

Diana: "Yeah, it's pretty cool. Do you need anything else?"

Jake: "I think I'm good."

Diana: "OK. Holler at me if you have any trouble./"

Jake: "All right."

Diana goes to the station in the center of the room. Suddenly, Leslie rolls a little chair on wheels nest to me and sits down. She holds a clipboard and a pen. We go over a list of my current medications and vitamins. She makes sure she has an updated list of my doctors, my emergency contacts, and my phone numbers. Before she leaves, she briefs me on leg cramps...

Leslie: "You have to let us know if you start cramping. Usually, people will feel a twinge in their feet or in their toes. You might think it will go away, but it won't. It will turn into a cramp and we don't want that, so if you feel the twinge, holler at us and we can shut the machine off for awhile. OK?"

Jake: "No problem."

Leslie: "Are you sure you don't want your coat?"

Jake: "Nah, I'm alright."

Leslie: "OK..."

She also goes to the center station and I am left alone in the chair. I decide to flip through the channels. After awhile, I stumble on a program called HOT NUDE BABES 3 [UNCENSORED.] I click on the channel but only get a blue screen.

Jake: "Awe man!"

Diana: "What?"

Jake: "Why don't we get this channel with HOT NUDE BABES 3 [UNCENSORED?]"

Diana: "Ha ha ha! Can you imagine how these old guys would react if they look over and see you watching HOT NUDE BABES On TV? You'd give 'em heart attacks! They'd be all sleeping and then look over and- WHA?!? Ha ha ha."

Jake: "Ha ha! Awesome."

Some time passes and I feel like I should be doing something other than just sitting there. I look around at everybody and try to imagine what they've been through. Is everybody in here diabetic? Is there anybody else my age? I spot one guy who looks like he might be in his 30's, but he too far away to strike up a conversation.

Suddenly, without warning, my body temperature drops. It's a cold unlike anything I've ever felt because it's coming from the inside of my body, not the outside. I shiver, and when I see Leslie walk by, I ask her if she'll put my coat over me. She does.

After two hours, I am finished. No cramps on the first day, but they will come. Diana takes each needle from my arm and I hold a wadded up cotton pad over the puncture site. After several minutes, she asks me if the bleeding has stopped. I peek under the pad and see the tiny needle mark with no leakage.

Jake: "I think so."

Diana: "OK."

She puts a bunch of tape over the pads and advises me to keep it on my arm until I go to bed. But then she adds that some people take it off after a few hours. It all depends on the person.

Leslie walks me to the weigh station and reminds me to weigh myself before I leave. I don't remember how much I weighed that first day or how much weight I lost, but I do remember taking off my clothes that night and staring down at my feet. I hadn't noticed all day, but there below me on the ground were my feet, my ankles, and my legs in their natural un-swollen size. The dialysis machine had pulled all of the extra sodium from my body. Unbelievable!

When I walked out of the clinic that first day, I got into my car, clutched the steering wheel and held back a fierce cry. It was a cry of relief because my first experience with dialysis wasn't as bad as I thought it would be. Shoot, it was nothing I couldn't handle. The people here were cool and yeah, it kind of sucks to wake up early 3 days a week, go to dialysis and then go to work, but hey... it beats the alternative- death.

I felt drained, but energized at the same time. It's a weird feeling. Kind of like you want to sleep, but you are also restless and eager to go out and do something!

After my second treatment, I lost my cough. For the past two years I thought I was suffering from terrible allergies, and I was, but the deep cough that I experienced on a daily basis was actually a symptom of fluid in my lungs due to kidney failure. Now, because of dialysis I can breath freely. The color is back in my face, I have more energy, and I don't feel nauseous anymore.

I feel healthier than I have in years. Bring on the transplant!