Swiping my ID card the doors of the hospital dialysis unit clicked open. After four
years the click of two doors unlocking and automatically swinging imprinted on my
nerve endings. The sound made me startle just a millimeter. Behind those doors was a
row of beds with patients dialyzing. Some as always for years, some just starting
and totally freaked out. Behind those doors the nurses were swift and strong. The
would casually set up and hook up a medusa of lines and wires. They would trouble
shoot alarms and complaints. They were accustomed to treating the not-yet-dead. The
patients that enter the dialysis unit have organ failure chronically or acutely but
the inherent truth of their admission meant they were flirting on the edge. These
hospitalized patients in the hospital dialysis unit were just stable enough for a
marathon run on a dialysis machine but not well enough to join the walking world
outside … These doors said that about them.
I enter. As soon as I walked in a lady in Bay 6 opened her eyes and yelled. “Get
that bitch out of here! Get away from me you bitch!”
My heart was stabbed. Stacy. I know her well. She is demented and her husband takes
her to dialysis. I have cared for her for 3 years. Her husband and her have
repeatedly told me they want a kidney transplant because the co pay for dialysis and
the gas to get to the treatments are too costly. It amounts to 120 dollars a month
in co pays and gas. Transplant will rectify this barrier in life.
The transplant center has a board that meets to review each candidate. Months ago I
was called and asked about Stacy’s capacity because the team felt the husband spoke
for her often, too often. I told them plainly that Stacy was demented and unable to
process executive decisions nor understand the complexity of dialysis except to come
and sit. She was cognitively impaired. Her husband managed it all. He also had low
insight though and I shared their motives for transplant being to “save money”. The
reality was understood; post transplant care is arduous and expensive. There’s no
end to the up keep. Those days in three years you lost funding for anti rejection
“You bitch! You told them not to transplant me! You awful bitch! What is this?”
Stacy screamed as she tried to yank her needles out and lunge at me. “What’s going
on in here?”
A Russian nurse with a thick beautiful accent stepped to Stacy’s side. She knew me
well and in my defense with others listening she said, “No, no Ms. Stacy. Dr. Robey
is a highly respected doctor.”
No one has ever said I was highly respected. The climate in medicine was changing
under my feet and doctors where not outwardly highly respected. Those expressions
seemed archaic and when said seemed strangely overkill. Despite the rigors and costs
of all kinds to become a physician, highly respected seemed too overstated an
emotion. Doctors were becoming “well regarded” or even “fine people”. The demotion
was making it an even playing field to set up the coming displacement of duties and
pay cuts for “value”. It was working. I hardly felt worthy of “highly respected”.
Right then though I was tearing up and felt more like a killer. I felt like I had
hurt someone deeply and that pain tore through my thin veil of authority and pride.
I was then suddenly mad and betrayed. I was mad the transplant center may have told
Stacy “We have spoken to your doctor and she has expressed concerns and we are now
not listing you.”
I left the room to find a phone. I had to know if my report done in good faith had
been turned to knives branded with my good name.
I dialed the transplant center misdialing twice.
Past the operator and department secretary to the transplant coordinator I ran. I
finally had someone on the phone.
I recanted the trauma of hearing Stacy’s perspective and I tore in.
“I have to know, did the team ever express to her that I somehow was the sole
determinant? Why did you all call me for my insights? You meet with the patient and
spouse over months each with a role and each with time. Anyone in a short time can
ascertain that she is not capable, they are not capable of the complexity of
transplant. Transplant would not make a better life for her or them. I have been
there to keep her alive because I care. Your center is done with your assessment and
she returns to me to continue THIS journey. She is here. I am here. She is now
calling me her killer!” I could not contain my blood. I was so frustrated and
beaten. I felt I was left to pick up the pieces. I was blamed and I knew I had been
betrayed by my left arm.
I was reassured no one would do such a thing.
I hung up. I called the husband and calmly tried to find out what was really the
impression. He calmly said they were told I had recommended no transplant. They were
seeking another doctor.
I apologized and then exited softly. I just didn’t want to fight anyone. I just
wanted to do what was most right.
I left the hospital an emotional zombie. I was unsure my role. My motives had been
twisted. I was unsure what team I advocated for.
Several months later I was covering for a partner and happened upon Stacy dialyzing
at a unit. She was thinner watching cartoons then switching channels to a soccer
match. I said hello to her just to be kind. She said, “Do I know you?”
Being a shield from disease is hard. The front line is brutally honest and
humiliating at times. We are the front line to tough news and bad outcomes despite
best efforts. We are humanity’s shield asked to protect and serve. We serve not one
or two objectives but many at once. We ask ourselves and each other to not be self
serving. We must continue to be stronger than that which kills humanity.
Be a shield against all that harms the weak even if it kills your own integrity and pride.