Dialysis Risk – Trade Off for Chance of Home Dialysis Therapy

Monday 2014-03-17

There is a price to pay for everything. It is also true in gaining the right doing home dialysis therapy.

Monday, 17^th March the associate professor K called out my name when the receptionists left and the door to the clinic closed, I was the last patient there. While I was waiting I overheard the receptionists talked about what a busy day it was, all in all 75 patients were seeing that afternoon from 1:30 to 4:30.

In order to clearly and succinctly state my things I prepared him a note earlier, former experience told me the doctors are always pressed for time, generally the duration for each consultation last 15 minutes.

The associate professor skipped through my note, but I doubt the sharpness of his scanner. His memory didn’t go beyond the 1^st paragraph and was oblivious of its contents which he showed clearly during our consultation.

I also showed him some graphs of my past months treatment and result which include my urine since Sep 2013 after I was diagnosed, my weight, detailed treatment and test result which was printed on one page easy to read and compare with explanatory notes to particular figures.

He brushed off my charts, saying having urine is fine but it’s not everything; told me to watch my weight while my chart clearly showed that it had never been an issue. I told him my UF was zero, he was surprised. I said the nurses were giving me 200ml saline that morning and advised me ingesting more salt and sugar; as for the test results he said he had them all and dismissed my chart. I told him mine is all on one easy page, I didn’t tell him that he didn’t have all my results as I was moving around and some centres didn’t belong to the hospital system he’s working in, some of my result didn’t show on his computer, I carry them personally. Since he clearly had no interest there was no need wasting time telling him that; I did catch his attention briefly when I explained the treatment chart, that how the different hours and the pump rate came about.

He told me that middle and large toxic molecules need longer time to be rid off. Since he has most of my blood and urine results I didn’t dare to mention that I’ve been losing large amount of protein and sugar through my urine and inevitably toxin of similar size and weight.

The fact that after doing longer hours for the two weeks before I saw him, all my figures became worse which he failed to mention or explain. Either because things didn’t go his and his subordinate, the training manager’s way, or he too, being one of the persons who could read one set of test result only; My urea before my dialysis carrier started in Sep 13 was 32.4mmol/L, 31^st Oct 2013 when I did 3 hours twice weekly was 16.8, 16^th Jan 2014 at 3 hours three times weekly 17.5 and 17^th March 3hours and 45minutes three times weekly was the worst of all at 35.6mmol/L.

Immediately after consultation each Monday the doctors would have their weekly meeting, he told me that during our consultation and kept on looking at the door, as I was his last patient of the day he was clearly extremely pressed for time.

All other doctors when they examine me physically would listen to my chest front and back while asking me to deeply breathe in and out a few times. The associate professor did it in super speed, even before I finished breathe in and out for the 1^st round, his stethoscope already left my body.

When I asked him whether my medication needed adjustment, his answer was negative saying everything stayed the same. But he wrote out my prescription 2 out 3 with reduced quantity – the doses were wrong. His mind was already in the other room where he was expected at their weekly meeting.

In spite of all these, the consultation was not a total lost. He did dose out 4 hours of dialysis for me instead of what I was told through his subordinate, the training manager of their initial intention of raising my treatment from 3 to 5 hours.

When consultation was over, he asked my permission to keep all my charts and note, he was impressed by the blood result which was all in one convenient page created for a layman such as me. The note he showed particular interest and reluctant to relinquish which took us a tug of war for me to get it back, his hold on it was very tightly. The note was to help me communicating my things easier, communication was done, its purpose served. I knew he didn’t read it through, he knew he didn’t read it through, but I did give him my other charts.