Yea Though I Walk Through The Valley of Dialysis

On the Cross of Calvary Jesus said, “My God, my God, why hast thou forsaken me?”  I will not pretend and cannot understand what my Savior went through that day.  However, to be perfectly honest, a part of me is crying, “forsaken” as I enter the dialysis clinic for the first time.  Publically, as a pastor of a small church in Jefferson City, Tennessee, I appear brave and full of faith.  Privately, I feel like a grasshopper caught in a spider web; I am kicking, but that is about the extent of it.

I enter the medical dialysis clinic in northern Knoxville with enough apprehension that if it were water, it would flood the valley. My knees are not shaking; my voice is not quaking; but my heart and spirit are doing both.  For me, it feels like it is the worst of times.

On the other hand, I know God is with me; I know my church fellowship is praying for me; I know I have the love of my family.  There is a great feeling of blessing that warms my heart.  I hear a small voice I am very familiar with saying, “I will be with you at all times” (Hebrews 13:5).  I have trusted the LORD through many valleys, and the valley of dialysis is no different.

My wife and I sit in the waiting area of the clinic. We wait. Then, my name is called and we are ushered back into a little office area where insurance and such things are checked. Even with insurance, dialysis is very expensive. I am sure it is well over $50k/yr. We have received some help, so I am not sure of the exact costs. I will include some links later that will aid the readers in understanding the costs.

From this office my wife returns to the waiting area while I am escorted into this large warehouse of dialysis’ bays. I am told to stand on a set of weight scales. I position on the designated spot and watch the scales ascend till they reach my weight. The nurse records my weight. This weighing determines my “dry weight,” which is the weight I should leave the clinic with after dialysis.

The procedure of dialysis I am about to have is called “Hemodialysis”. In hemodialysis, the patient's blood is pumped through the blood section of a dialyzer, exposing it to a semi-porous membrane. This cleans the blood, and the cleansed blood is then returned via the IV track back to the body. My nephrologist recommends this procedure to me. My other choice would have been another procedure called “peritoneal dialysis.” In peritoneal dialysis, a sterile solution containing minerals and glucose is run through a tube into an abdominal body cavity around the intestine, where the peritoneal membrane acts as a semi-permeable membrane. The fluid is left there for a period of time to absorb waste products, and then it is drained out through the tube and discarded. (For more information see the enclosed links section of this hub).

My nurse tries to keep me calm by making small talk, and it seems to be a pleasurable alternative to the anarchy of my mind caused by the newness. There is just something unsettling about the thought of being hooked to a machine that sucks your blood. She is a very pleasant, slightly heavy set, lady with a great sense of humor. Her jovial manner helps me chuckle as we walk to my assigned station. The dialysis machine looks like a big medical box on wheels; I see tubes protruding from its middle like arms, and there are displays on top and various dials, and the dialyzer tube on its lower side. The nurse, with tongue in cheek, calls the dialyzer my new artificial kidney. It is all quite overwhelming.

At this point I am looking, indeed desperate, for some solace. My apprehension is not of fear, but the dread of doing this three times a week, four hours at a time for possibly the rest of my life. Then, one of the patients speaks to me as if he knew exactly what I am feeling. I am later to learn the lasting value of the friendship of this Christian brother who calls himself Raymond. Here it is that God steps into my heart with this “angel” unaware. This is what he is to become for my situation. I begin to talk to the patients around me, and immediately I feel a member of this special social network.

My nurse takes my hand and observes my fistula.  The fistula is the means of access to the blood in my body.  Several months ago, my doctor told me I would need minor surgery to make an access area for dialysis.  The fistula is an enlarged vein in your arm or leg, which is formed by a surgical procedure of turning a vein around on itself to create a much greater blood flow than normal.  After that surgery I was supposed to squeeze a tennis ball over and over with my left hand to cause my vein to grow.  My vein is still not large enough.  My nurse complains that she will have to use smaller needles.  Funny thing, those needles don’t look that small to me!  Actually, dialysis intravenous needles are quite large and I never get used to them.

I look around and see several patients who do not have fistulas. Some are using a central venous catheter.  A central venous catheter is a tube inserted either into the chest, or the jugular vein in the neck. This Central Venous Catheter allows high volume access to your blood supply. 

The amazing thing is, that even in the midst of tubing, machines, a score of busy nurses moving from station to station and a myriad of other sounds and movements, there is a certain calmness, and dare I say pleasant atmosphere in the chaos.  Friends made, prayers prayed, and time shared with others offer the solace I need.

A technician (I think) calculates from my weight how much fluid she might need to pull and or replace to my blood. She has the nurse record such and sets the dials on the machine. With my agging (I'm a horrible cut up) my nurse’s and my mouth run like two released runaway balloons, and I don’t mind. She is actually very pleasant, and laughter is good medicine. She then checks my blood pressure, both standing and sitting. Things are working like clockwork and I can tell she has done this thousands of times. She begins to wash and sanitize the area where she is about to inflict pain. She scrubs the fistula, dries the area and changes gloves. She now prepares my access with alcohol, and I am ready to be ‘stuck.’ Two needles are inserted into my fistula. One needle removes blood from the body for cleansing and filtering by the dialysis filter, and the other is for the incoming blood that has been cleansed.

There is pain, but it is not unbearable, and it is short-lived. Once the blood begins its flow from and into my body, I feel nothing. What a relief. Now, I have a four hour wait. There is time for a nap and a lot of small talk. I even watch a little TV and read. This part is rather pleasant. It is a good reprieve from the race car pace of our society. This is a special time, and I silently talk to God, relax, and think, “If I can take it, I can make it!”

There are also some other things that happen during this time. A dietitian comes by for a visit. She relates how important it is for a dialysis patient to restrict the use of fluids. The reason is the more you drink, the more fluids they have to remove through the dialysis machine. When massive amounts of fluid have to be removed, leg cramps set in and blood pressure drops, which can be very dangerous. She also relates my need to reduce potassium and other things in my diet, as these can still build up and even lead to death. They check blood often. She also relates that the dialysis filters out many nutrients my body needs and they may have to replace them through supplements.

My 4 hours are up. My nurse, still gabbing, removes my needles, tapes me up, gives my blood pressure a final check, has me weigh once more, smiles and says, “See you in two days.”

As I travel home, I discover I can still drive. This means that next time my wife will not have to bring me. I praise God. It is not the end of the world. I even discovered that I am able to witness in this place. I praise God for new friends, and a life that is not over. For the LORD is with me even in the valley of dialysis.

Pastor_Walt