Friday, February 15, 2008

Who's Your Dialysis Daddy?

Ahhh, dialysis. The life-saving procedure invented by a good doctor many decades ago, now perfected to the point where a patient can expect to live longer than ever. Not so long ago a person with renal failure was told to gather their family and say goodbye because there was nothing anyone can do.

So now, thanks to this 3-times-a-week treatment people can live for decades. Some of our patients have been on dialysis 20 years.

Unfortunately many dialysis patients are ungrateful and cranky. The majority of people with renal failure have diabetes or hypertension - a goodly portion of those have both. There is the occasional person who unfortunately blew their kidneys from a drug overdose or a reaction to contrast dye. Still others have problems with their immune system. For those with diabetes and hyperension, often they had been told YEARS AGO that they were heading down the path to renal failure. The problem with renal failure is that for a long time, the person feels fine. They figure that as long as they feel okay, that "stupid doctor" doesn't know what he's talking about. So they chose to ignore it until they woke up in ICU one day after an episode of uremic encephalopathy. In other words, their kidneys quit working, bodily waste built up in their brains, they went cuckoo and they scared the bejeepers out of their families.

Now that that's over, they have plenty of time - approximately 4 hours,3 times a week - to reflect on all the things they could have done to keep this from happening. They go through all the stages of grief - shock, denial, bargaining, anger - well, you know the stages. My two favorite stages are denial and acceptance. When the shit came down they were in shock, and everything they learned about their condition went over their heads. Now that the crisis has passed we can start educating them. I'm all for education, but in this case there seems to come a point of critical mass with education. They finally get enough information and it sinks in enough that now they're pissed.

I love it when they get past this stage and move on to acceptance. Some stay pissed though and those are the ones that I find challenging. They express their displeasure in some not-so-nice ways. Some do it by controlling the details of their treatment. "I must have 12 pieces of tape on my table. I can only have 3 x 3 gauze because the 2 x 2 gauze makes me sad. Stand on one foot, stick out your tongue and spin around twice before you cannulate me." Just kidding. I made the last one up.

Some express it by trying to manipulate their treatment time - often by constantly asking to stop treatment early. Oh, and the excuses they have for ending treatment early! Someday I'll write a book. "I have a flight to catch." Really, where would you be flying to that you have to be back day after tomorrow? "I have people coming over?" And you didn't mention to them that you have dialysis and that you don't get home until X o'clock in the afternoon? "I have a doctor's appointment?" Fascinating. So they only schedule appointments at precisely the same days and times you have dialysis. "I have to go to class." Uh huh. And you never mentioned to the clinic manager that you are taking a class so she could look into changing your appointment day, time or even find another clinic for you that has a chair time available that won't conflict with your schedule? Um hm.

Then we have the hurry-up-and-put-me-on folks. As soon as we open the door in the morning the patient's race to see who will be the first to their chair, because we put patients on in the order they come in. They practically knock each other down trying to be first. One day a patient passed out from low blood sugar on her way in the door. The other patients stepped over her prostrate body to get to their seats.

Some patients are in a hurry because they're smokers and they want to get back outside and smoke. Being a smoker, I symphasize - a little. I wear a nicotine patch during the day so I can wait until I get home to smoke. It takes the edge off. But what I've noticed is that the people who have the least going on in their lives are the most pushy about getting started on time. These patients are going to go home and sit on the couch in front of the TV. The patients who have jobs, children, errands or other activities are more willing to wait for us to get to them, and more tolerant of problems that keep them from getting started - for example machine failure or plumbing breaks. They will curl up in the chair, whip out a magazine or calmly watch television until things are okay again. Meanwhile the people who have absolutely nothing going on the rest of the day will yell at us to hurry up because they're going to miss The Price Is Right - even though they could watch it right there in their chairs.

Then a co-worker of mine told me something very disturbing. She told me that most of the male patients masturbate during treatment.


I have known for a while that most men on dialysis suffer from erectile dysfunction - we can't call it impotence anymore. Usually the circulatory problems leading up to their renal failure also affected their ability to get an erection. It's all connected. So since it's all connected, when we start them on dialysis and their blood starts flowing at a faster rate, it starts flowing at a faster rate EVERYWHERE, including, you know, down there. Once they get on treatment they get the best boner of their lives.

No wonder those fools are pushing old ladies down to get to their chairs. They have a date with the dialysis goddess.

I am not naive but I guess I'm pretty dense. I've been working in this clinic for 2-1/2 years and had no idea this was going on. You might want to ask "License Pending, how dumb could you be that you couldn't see someone spankin' his monkey right in front of you?" Let me tell you why.

All these guys bring blankets with them. Dialysis makes a person cold. When their blood leaves their body and travels through tubing in room temperature air, it lowers their body temperature a bit. We can raise the temperature on the machine to warm their blood, but it only does so much. So most people bring blankets and pillows to make up for what we can't do. So while the guys are all snug and toasty under their blankets, their throbbing member right there begging for attention....well I guess, boys will be boys. I hadn't heard that women experience the same phenomenon. I suppose they do but, being that we are socialized differently, don't feel the need to, um, whatever it is women do to take care of themselves and darned if I can think of a decent euphemism for.

This information both fascinated me and traumatized me. I'm a sex positive person. I'm all for the freedom of sexual expression - in theory. I'm just a little skeeved by the sexual expression of some gnarly old men a few feet away from me. Ewwwww!
Part of me wants to be a looky-loo and see if I can catch them, but my rational side says "no, if you see that you'll ruin it for yourself and never have sex again." So I avert my eyes and go about my business as if nothing is happening.

So I'm in denial I guess. Next is bargaining. I wonder how I will eventually express my anger?

1 comment:

Anonymous said...

Erectile Dysfunction is sometimes dismissed as a mere "lifestyle condition." As a result, there is often a real stigma associated with openly discussing ED. However, erectile dysfunction can lead to a range of serious psychological problems that have the potential to wreak havoc with a person's well-being or relationships.