Over the course of my life, I have known a handful of people who were “on dialysis”. If I am being honest, I really didn’t know much about it. I knew that a machine did the work of failing kidneys. I knew that these people disappeared for a few hours every other day. I knew that they complained A LOT. That was about it. Generally, the “on dialysis” people I knew were old and in poor health anyway, so it was no surprise when they died shortly after being “on dialysis”. For the benefit of past me, or those of you that are in a similar boat, this is what it’s like to go to dialysis. For the purposes of this article, I am talking about hemodialysis. I did peritoneal dialysis for nine months, and that experience is its own story.
First I waited in the hospital for three weeks for a chair in a clinic to open up. They finally gave me a commitment in writing for MWF 4:45-8:15. Two days into treatment they threatened to give away my chair because I was late. I am never late to anything ever. They had changed my time to 4:05 without telling me. I bitched and they basically told me to accept the time or go die somewhere. So not a great start.
The clinic is located in a strip mall that is ancillary to a giant defunct shopping mall in an extremely sketchy part of town. If one looks up the crime statistics for this area, the results are just a 75 -font flashing red “NOPE”. 22% of the time that I pull into the parking lot, there is an emergency vehicle of some kind blocking the exit as they wheel out a patient on a stretcher. I maneuver around the emergency vehicles and pull open the opaque mirror doors.
I am immediately met by a waiting-room television screaming a cable news channel. There are always at least two people just sitting in the waiting room who look like they missed their date with the reaper back in 2016..I ring the bell as there’s never anyone at the reception desk and a voice asks over the intercom who I am like it’s a 1920s speakeasy. I state my name and that I am there for dialysis, just so they know I haven’t mistaken the place for a burger joint.
The clinic itself is a freezing cold, vast expanse of open space. There are lines of vinyl movie theater-style reclining chairs with a nurse’s station in the middle that reminds me of Bentham’s panopticon. Just before the nurses station is a large scale, built to accommodate wheelchair and non-wheelchair patients alike. This scale is a hugely important part of the process we’ll discuss more a bit later. First let’s talk about the people one might find in a dialysis clinic.
The patients are largely a reflection of humanity’s poor decision making. Yes there are normal and even successful people who suffer from renal failure and need dialysis to survive. However, these people are the minority in my clinic. .Most of us are noncompliant diabetics, drug users, convicted felons or others that have chosen to dishonor the gift of life for one reason or another and are now paying the piper with complete renal failure. There are always patients wearing orange jumpsuits accompanied by armed corrections officers. One time I even saw a patient with leg shackles.. I have no idea what that dude did, but he was clearly dangerous.
The medical staff is basically a pyramid. A lot of techs that are basically the equivalent of CNAs at the bottom. One or two LPNs that do the mid-level work, one RN that is like second in charge, and one RN who is the Supervising Attendant. All of these people are super nice once I could get them to stop pronouncing my name as “Mitten”.
The chairs are placed in rows, about 5 feet apart. There’s a $250,000 machine plunked in between the chairs. The experience reminds me a lot of flying on a plane. One never knows who is going to sit next to you and what they are going to say. Except there’s no drink service, and I am on this crazy plane for 10.5 hours a week, and many of these folk are way more fucked up than your average business traveler.
So the whole process works like this: after hospital dialysis and a referral with a nephrologist, a “dry weight” is established. The “dry weight” is what a patient would weigh if their kidneys were functioning normally. Basically, kidneys filter toxins out of the body and release them as urine. When one’s kidneys are dead, this filtering does not take place and urine doesn’t generally leave the body. The process of dialysis does two things: 1) It cleans the blood 2) It removes this fluid in the form of “ultrafiltration”. This fluid is, for all intents and purposes, piss. Basically, we are all sitting in recliners pissing and getting our blood cleaned for $1000 per treatment.
I walk into the clinic at 4:05 whether I like it or not, survey the fuckedupedness that is the clientele, say hello to as many staff members as I can, and step on the huge scale. The difference between my weight that night and my dry weight is the amount of ultrafiltration that needs to be taken off. Just by hooking the main-line catheter I had surgically installed in my chest up and setting the machine, they can take off anywhere from zero to a little over 11 pounds. Sounds pretty simple, doesn’t it?.
Here’s where things get rotten in Denmark. When everything works perfectly, the day after dialysis feels kind of funky. I feel like I worked out a little too hard. It is generally more difficult to focus. I could almost always sleep. However, it’s generally not too bad. I can function. As long as I eat right, exercise, and never drink more than 22 ounces of fluid per day.
Sadly, things almost never go perfectly. As many of you know, I have always been chubby – somewhere between clinically obese and morbidly obese, depending on what kind of life I am living. This makes my dry weight a moving target. If my dry weight is 115 and I come in weighing 120, clearly they need to take off 5 kg, right? Not if I ate like a moron and gained a kg. This is how something like that generally goes down:
I sit in the chair and hook up. The first three hours go great. I watch television on my phone, chat with friends, and joke around with the staff while avoiding idle chit-chat with the convicted murderer next to me. The four pounds of piss come off without issue. Suddenly, the bucket is empty, but the machine is still trying to suck a kg of fluid out that isn’t there.
The body’s response to this phenomenon is cramping. Everyone’s cramps are a little bit different. Mine always go the same way. First, my calves (which are surprisingly muscular compared to the rest of me) begin to writhe and twitch. This does not hurt and the nurses think it’s cool. Then my feet get tired of being in their natural position. I instinctively want to point them, but doing so makes my calves cramp. Then my hands lock up and literally stop working. Finally, whatever muscles are under the bottom of my ribcage lock up. This is usually when I call for help. The antidote for this is turning the machine down and injecting saline into the line.
Last night I was overweight. I had been dumb over the holiday and indulged in the sharpshootery plate way too hard. However, I knew that my BMI was maybe approaching 35. I don’t know how tall Mayo clinic thinks I am, but if my dry weight sends my BMI over 35, I am no longer a candidate for kidney transplant. I was starting to cramp, but I knew that I couldn’t admit it because they would adjust my dry weight, possibly killing my chances for a transplant.
I tried to tough out that last kg. I felt all the familiar signs. I ignored them. I started practicing all the shit I normally do to manage pain. I went somewhere else mentally as my calves started to cramp harder. Finally, it went too far. My legs locked up as though I was being shocked by a huge amount of electricity. I screamed out as my body seized. The pain was unspeakably horrible. I can’t even describe it. I drenched my clothes in sweat as my blood pressure dropped precipitously. I could feel myself starting to lose consciousness as the Supervising Attendant got to my chair. He turned the machine off and pushed fluid. It was too late.
Wave after wave of Earthshaking cramps rocked my legs as I screamed swear words. Eventually the pain subsided a little bit and I could move again. I stayed on for another half an hour at minimum strength to get the appropriate amount of cleaning done before they unhooked me. They had to help me stand up. Once my standing blood pressure passed they sent me out to my car. I drove home with my legs still shaking.
I woke up this morning and was super sore. I wondered if I would be able to stand. I did, but the effects of last night were clear. I felt completely horrible all day, but I made it through work. I made it through the gym. I didn’t eat or drink anything stupid. My dry weight should be back to normal tomorrow night. I hope.
The moral of this story is that if I ever become an evil medieval emporer, my main method of torture is going to be over-dialysis. Also, when a guy from a giant company calls you about online security, be nice. It’s possible he tried to kill himself the night before with hemodialysis.
That, my friends, is what it’s like to be “on dialysis”.