Another day at the blood laundromat
Dialysis keeps people with kidney failure alive, but at a cost
Dawn along a charmless stretch of Mystic Avenue in Medford, a suburb of Boston. Past a used car lot, a nail salon, a laundromat, a Jiffy Lube, and warehouses stocking electrical, roofing, and plumbing supplies. Finally, a low, freestanding building, Fresenius Kidney Care’s Medford dialysis center. We arrive just before 7 a.m. after an hour’s drive from Boxborough in the autumn predawn darkness.
“There are closer medical clinics, but they’re worse,” my cousin Harry Roberts explains as we pull into the parking lot. “They’re a cross between a medical clinic and a bus station.”
Harry is here for dialysis, the three-hour, five-times-a-week blood filtration and cleansing that keeps him alive by doing the job of his faltering kidneys. And I’m here visiting from Chicago because … well, it’s complicated. We’re mishpocha, as our people say. Family. He’s in a tough situation or, rather, he and his wife are in a tough situation. So I’m helping. By driving, for instance. Dialysis wipes you out. The last thing you want to do when it’s done is fight your way through Boston’s nightmare traffic for an hour, with its madness-inducing roundabouts.
A dozen signs scattered around the facility encourage home dialysis, reminding patients of the comforts of home. Harry had been doing his treatments at home, but that still requires jamming yourself with needles before running a complex medical device. For three hours at a time. Five days a week.
Image credit: Weston Wei
Plus, conducting dialysis at home puts pressure on spouses or other loved ones, who are not usually trained medical professionals. Harry’s wife actually is a trained medical professional — a hospital pharmacist. But years of caring for Harry had started to grind her down. That’s why Harry started to go back to Fresenius — to give her a respite, the relief that all caregivers must have. And why I’m here, the cavalry, helping out.
Harry settles into a beige faux leather recliner designed for durability rather than comfort, while a nurse in blue scrubs contemplates Harry’s left arm. “OK, so we’re going in here, and here. We need two dull needles.” At first I think he’s joking. Dull needles? Counterintuitively, dull needles hurt less, sliding into the scar tissue “buttonholes” created by years of dialysis, while sharp needles have a way of carving a new, painful path. Though the dull ones still hurt. The nurse helps with what Harry sometimes calls “the stabby-stab part.”
“Eh, ehh, ehhh,” Harry says, voice rising in pain as the dull needle is pushed in. “No pain, no gain,” says the nurse, brightly, clipping the clear tubing together. The lines go red with Harry’s blood. “Good job!”
“Pain is just weakness leaving the body,” says Harry, playing along.
To his left, a NxStage hemodialysis machine. A beige cube about a foot wide, it’s a glorified filter that takes his blood and removes the toxins — molecules of uric acid, for instance, are much smaller than red or white blood cells, so that waste passes through a membrane while the blood cells don’t and return to the body. The machine thrums.
About 3 million people worldwide are on dialysis for kidney failure. They are the lucky ones, because millions of other people need it, can’t get it, and so die of the raft of medical problems that come with untreated kidney disease. If your kidneys can’t remove waste, it builds up in your body, poisoning you. If your kidneys can’t pass liquid efficiently, fluid also builds up — your lungs fill. You literally can drown, slowly. It’s a bad end.
But dialysis kills you too, only more slowly. The human body is not designed to have all its blood drawn out and then pumped back in on a regular basis. It puts strain on the heart. Low blood pressure can lead to agonizing muscle cramps. Blood clots form. After five years, more than half of patients on dialysis in the U.S. are dead. As of my visit, Harry has been on dialysis for three years and suffered a series of medical crises. The clock is ticking.
His kidneys were ruined 20 years ago after he was diagnosed with stage 4 colon cancer. The doctors told him to go home and get his affairs in order. His condition had a five-year survival rate of less than 10 percent.
Instead he fought it. He has a lot to live for: two fantastic daughters to watch grow up, a wife he adores, a career he’d like to get back to. So survive he did. But chemotherapy is notoriously hard on kidneys — the chemicals that destroy tumors take their revenge leaving the body. The cancer was gone but replaced by kidney failure. I thought of Indiana Jones in Raiders of the Lost Ark. You escape being crushed by the giant boulder, only to come face-to-face with an Amazon tribe’s poison darts. Thanks, fate!
What he really needs is not a lift to Mystic Avenue, but a new kidney. Honestly, I wasn’t wild about stepping up to give one of mine. Selflessness is not a defining characteristic in our family.
But someone had to, and if that someone was me, well, OK. I filled out the potential donor form. A year passed: Nothing. The donation network is notoriously inefficient. I reapplied. Massachusetts General Hospital spat me back. Nope, not you. They don’t say why. Mass General turned down at least six potential donors for Harry: myself, his wife, sister, daughters, friends.
If anybody reading this wants to give Harry a kidney, let me tell you, I’ve interviewed a number of kidney donors, and they uniformly insist it’s the best thing they ever did. Hands down. I asked one if she had any regrets, and she said her only regret was that she couldn’t give the other one too. If you ever wanted to be a hero and save a life, this is your chance.
Until then, dialysis. The machine thrums — thwip, thwip, thwip, thwip. The hours pass. Harry dozes.
Sometimes his left leg twitches — muscle spasms are common. We enter into the fourth hour. “The home stretch!” Harry enthuses. Finally it’s time to unhook and go home. “He did great, fantastic, not a single alarm,” says the nurse, fussing with the machine. I ask what he’s learned from years of administering dialysis to thousands of patients like Harry. He thinks. “Just like most things that suck, it’s your attitude toward it,” he says.
Can’t argue with that. Though if we want to argue, we can do so when we come back tomorrow at 7 a.m.
Neil Steinberg is a columnist for the Chicago Sun-Times.
This story originally appeared in the August 2024 issue of Rotary magazine.