Kidney Failure Humor

In Seattle with my friend Becky last week, we hit the Barnes and Noble in West Seattle, where I found the complete New Yorker cartoons book on the sale table: $9.99 for the book and accompanying DVD with ALL 73,000 plus cartoons that ever ran in the New Yorker. Of course I snatched it up.
Rick was reading it this morning and came across this George Booth cartoon, which, Rick said, he could really relate to.
He then made a copy of the cartoon and added himself to the picture – and you see the result here.

The Next Steps

Rick writes:
1/11/20, Monday
The long-awaited meeting with Dr. Oliver and Dr. Pham went well, with Doc Oliver in her usual cheerleader style. “You look fine! You're doing just great, you guys!” Then she upped my heart meds to two in the morning and one at night because my B.P. Was 170/90. Since she took us in early we had an hour & 45 minutes before our/my appointment w/Dr. Pham so we grabbed an early lunch at IHOP.
I've been having some annoying discomfort from the Hickman catheter – sharp stinging pains punctuated by dull oppressive aches – for about a week and a half now. Dr. Oliver removed two sutures around the exit point. They weren't necessary any more so maybe that will help. She had to dig kind of deep to get one of them loose. She also built a small fire under the Polyclinic folks to get cracking on externalizing the peritoneal catheter and starting up the classes for using it. We made a tentative date for our next visit to her office on Feb. 10th.
Once we got to Dr. Pham's, the ultrasound technician took me in and got some pretty good readings on the progress of the maturation process currently taking place upon the vein they connected to the artery on my fistula. At its widest point (which is at the arterial connection itself) the blood flow is moving at the astounding rate of 4 meters per second! By the time it reaches the narrowest point, up by the biceps, it's down to .53 meters meters per second (blood pressure at Dr. Pham's was 150/83).
Dr. Pham set the date for externalizing the peritoneal cath on Feb. 8th or thereabouts and turned me over to Trish, her surgery scheduler. Trish was apparently the recipient of Dr. Oliver's small fire earlier today and wanted me to appear for surgery at 05:30 a.m. On the 8th, same being scheduled for 07:30 since I am to start P.D. School on the 9th and will need 24 hours to purge myself of the effects of the anesthetic before starting class!
One thing I'm not clear on is whether they'll remove the Hickman catheter at the same time; also looks like we get to re-schedule the 2/10 appointment w/Dr. Oliver.
Today's most delightful coincidence: as we passed the Bethlehem Steel foundry on the West Seattle freeway, one of the “cloud factory” smokestacks blew a perfect smoke ring into the sky, a good eight feet in diameter and at great velocity!

Favorite anonymous quote of the week:
“He has the strength of character to refuse to learn from past mistakes.”

What Would You Name This Decade?

Rick writes:
12-31-09, Thursday
The last day of the aughts and the last day of the year nine which as far back as February began to hint that it was going to be a real gall stone of a year for us.
And so it has been, but in an odd turn it paradoxically redeemed itself in many ways as well.
Newspaper pundits, casting about for a pigeonhole name for the first decade of the 21st century, have so far come up with the Big Zero but only out of a sense of frustrated disappointment.
Well, they've got a whole year to come up with something really appropriate and I submit they should not go it alone. This is a democracy after all. They should put it to the populace: initiate a contest and pick the best entry at the end of the year.
How to name a decade that began with a horrific terrorist attack and ended with a series of bailouts? Any combat pilot can testify that's a poorly planned sequence of events, like closing the barn door after the horses have escaped.
The Barn Door Decade. That's my entry.

Niki Calls; Rick Dreams

Photo by Niki McBride, taken on her cell phone "looking north" from Highway 97, some where near Weed, California, perhaps
Rick writes:
12-21-09, Monday
Niki McBride woke me up with a phone call from Tule Lake on Hwy 97 through California. She and Dan are headed for L.A. to see Heather and Tule Lake reminded her to give me a call. Ha! Cool!
Mary's note: and a bit later when I checked email, I found this photo from Niki
Back to Rick:
12-22-09, Tuesday
Got up late - fooled by a dream which kept insisting that I had a day off today from dialysis. The voice of reason kept trying to penetrate my mistaken dream state, without success until finally something yelled, "Get yer ass out of bed and go bleed!

Rick is Thinking Deep Thoughts

Photo: Rick is in stitches
12-16-09, Thursday
Today Jean brought in a Power Point program on her laptop, getting down to the nitty-gritty on the subject of getting on a kidney transplant waiting list. Since it appears that, due to the issue of bladder cancer, I will have to wait a minimum of two years to become eligible, there's no time like the present to begin working my way through the details. Apparently the details will probably easily take that long to deal with.
So here I've been thinking about getting back to work once I get rolling on the peritoneal dialysis program, to what degree I don't know. I need to get together with my colleagues at D#19! Peritoneal dialysis I can do at home will make returning to work possible but somehow I don't believe I can ever reliably go on call again, at least without help from Armin and Keith. They've been on call every other week since Oct. 5th when I lost my kidney functions.
Without going back to the on-call list, I won't be of much use to WD #19. The kidney center pointed out that my miserable condition assures me of medical coverage forever but an income will be necessary too and social security will only be about $1,000 per month.
It's true I've been looking forward to some kind of retirement for almost 10 years now, but I'm no different than any other working stiff at this point – at least throughout the economic train wreck that the bankers and politicians have gifted us with I've been one of the lucky ones to keep my job. Trouble is, now I need to choose between that and my life which doesn't look very promising to me or my loved ones on a pauper's income.
Well, the Kidney Center certainly understood my concerns and bless their blood-cleansing souls, they're behind me all the way. It's just that I have to be the one to make the decision.
The sensible decision is to spend the rest of my life in the hands of the medical industry and the insurance that makes all that possible – to become dependent on retirement, disability, and welfare.
It's just hard for me to toss out 40 years of working for a living. The folksinger in me says, “It makes a long time man feel bad.”

Rick's Version of the Last Two Weeks, Part 2

Dec. 5, '09 sat.
04:30 My guts feel like they're going to fall out. Everything hurts like hell. I can hardly move. This could be the day that dialysis kills me off while trying to save my life.
10 days to heal! 8 more to go!
Drew went down sick with a cold yesterday. What wrecks we all are!
Oh yeah – almost forgot. Temperatures have dropped into the low 20s and the roads are iced up.
By golly, I'm glad this week is over! I've been not looking forward to it for quite some time now.

Dec. 6, '09 Sunday
7 days to go. The dressing over my peritoneal catheter is only about 2” x3” and like the one over the fistula, is a piece of absorbent adhesive that's stuck to the area over the incision like an abalone to a rock! I can't imagine how it can be removed except by amputation.
At any rate it feels like both dressings actually have nerves which tingle and tickle maddeningly when even a breath of wind blows over it. Maybe I'm naive to think the PD cath will ever quit hurting (like when I cough or sneeze).
Sigh. Let go. I must continue the practice of learning to let go.
Still, as I examine the fistula on my left forearm, I notice they didn't bother to shave off any arm hair before placing the death grip adhesive dressing. That'll be fun to rip off when the time comes.
Somewhere in my worst nightmare I hear them saying, “Don't worry. You'll be under general anesthesia when we do that.”

12/7/09
Mary writes: 25º at 8 a.m. Dog has been FED. There are two open cans of dog food in the refrigerator.

Allysan writes on sticky note: “Deer LOLO I HOOP YOU GET BEDr: From Allysan”

Rick writes:
12-7-09 Monday (cont.)
6 days to go and I'm counting every minute. Morning is the time I dread the most since that's when it's time to purge the lungs. It's already becoming less painful for the belly muscles to cough or sneeze or even laugh.
Having yesterday and today off is a wonderful reprieve. We were even able to put up the plastic Christmas tree yesterday while Allysan was here so everything worked out just great! Today Mary had to go to Tacoma for a root canal job so I'm just hanging out around the house. Cindy came over to volunteer a house cleaning and wouldn't take no for an answer.
Rick:
12-8-09 Tuesday
Hi, Love – I'm off to West Seattle. Pup Pup went outside and I fed him breakfast.
5 days left in the marine engineer-approved healing schedule and it actually is feeling pretty good at this point. I still have to hold my belly to support it when I cough or sneeze but the general overall effects become less drastic every day.
I went up to get the paper and noticed the dome light was on in my truck – the door wouldn't shut for some reason – so my battery was dead! Fortunately noticed it while there was still time to deal w/it.
Seize you later,
Love, Yr. R
Mary: What kind of God allows these things to happen? I'm off to sing at the nursing home – wearing a low cut blouse and freezing. Hope all is going well on your Big Adventure.
Love, M. also too yesh

12-9-09 Wednesday – Today's paper predicts that there will be only a 4º difference between the high and low temp for that day (41-37º; Low – 33º
We're off to see Dr. Oliver and Dr. Pham to see how my latest body piercings are doing.
If they don't decide to tear them out and start over again, I'm 4 days away from the 10-day marine engineer approved healing time. Doing pretty well, too, except for an opiate-induced case of constipation. Snarl!
(Here there is affixed to the notebook page the large pink “WED” sticker, next to which Rick has written “30 years and counting...”)
These are “screening tags.” In the parking garage at each one of the clinics we go to, there is a screener standing in front of the elevators who asks everyone entering the building if they have “a cough, a fever, or sneezes.” If the answer is no, you get a screening tag that means you're not contagious. If the answer is yes, you get a screening tag and a paper mask to wear while you're inside.
Dr. Pham removed the bandage on the fistula and PD catheter so I can see what they did now. It turns out she did shave my forearm before putting on the bandage and they actually both came off pretty easily.
Dr. Pham grabbed me right away as soon as I got there and breathed a sigh of relief when she saw the fistula incisions.
“I worried about it all weekend,” she said. “I had such a hard time getting the connection to feed right. The artery was so deep...” She breathed another sigh of relief. “...but it's good. A strong, vigorous pulse.”
She patted my cheek. “You're my hero!” she said.
Prior to seeing Dr. Pham, we paid a visit to Dr. Oliver who also said everything looked great and we discussed training for me to use the PD catheter, if I was comfortable with taking that step (which I am).
So, we made appointments @ Dr. Oliver's for Jan. 11, '10 @ 11:20 a.m. And Dr. Pham for Jan. 11 @ 13:00 for an ultrasound scan and 13:45 for Dr. Pham herself.
I don't know what the 13:45 appointment will be for but today I discovered my PD catheter is completely buried underneath my belly epidermis and will need to be surgically extracted before I can put it to use.
Another owie for me.
Also mentioned that I've been encouraged to get on the kidney list but I understand the requirements are pretty demanding & I may not qualify. Dr. Oliver said, “Oh no, you'd be a great candidate except for the bladder cancer issue!”
Well, I'm sorta in remission at the moment, I think. She said I may have to be in remission for at least two years but she would double-check on that.
12-10-09 Friday
I'm off to Water District # 19 (for the first time this Volume*) to talk to a lawyer regarding a long standing leak we fixed on Dockton Road last August.
Mary took the Honda to Burton Shell to have the front brake pads replaced today.
*This Volume of the table top diary. We just started Volume 6.
12-11-09 Sat. Morning temp. 28º w/clouds
Last day of dialysis for this week. Two whole days off. I might need them, too. The weather forecast is dithering between rain and snow. The warm-up period is supposed to start rolling in tonight when the warm jet stream arrives from California and starts mixing it up with the cold arctic air that's leaked into the state through the Fraser River Valley for the last 10 days or so.
For now, all is quiet and shrouded in clouds. Not a breath of wind.
On Wednesday the 9th, high and low temps for today were predicted to be 37º-33º; actual high & low today 37º-30º.
From an article in today's Seattle Times: SUB UMBRA SEDE = “sit in the shade.” The motto of the principality of Seborga, courtesy of Prince Giorgio Carbone I, R.I.P, Nov. 25, 2009, aged 73 years.
12-15-09 Tuesday
Oh, this is sad. Drew's Ibanez guitar, his favorite, the one he's had since high school, was stolen at one of his gigs last weekend.
I drove myself in to Di-Alice's Restaurant today since I'm feeling so perky and all these days. For the last several days the weather reports have been hedging their bets, saying snow is on the way or maybe snow with rain or maybe just rain but when I headed out this morning it was 48º and definitely raining and looking altogether northwestish. The great Northwet has returned.
My left hand and forearm has slowly been transforming itself into someone else's appendage, growing larger and larger. Actually, it would be more accurate to describe it as swollen. Although my fingers have stayed the same size, the knuckles on my hand have all but disappeared, the wrist and forearm have thickened and hidden all the formerly visible veins except the one which is now being fed by the artery which is now connected to it via the fistula. That vein is now about the size of a soda straw and pulsing like it has a life of its own. It pulses and vibrates like an electric wire with every heartbeat. The base of my thumb has increased in size and is sore to the touch.
Once the fistula has “matured,” i.e., inflated to accommodate the increase of blood flow supplied by its new arterial connection, it will be ready to use as a hemodialysis connection to replace the Quinton catheter to the jugular vein in my chest. I'm still fairly clueless as to how this is supposed to work except that it looks painful. Some of the other patients have theirs used every time they come in and it seems to take about half an hour to 45 minutes to access it and get it working. I don't like the looks of it. When I arrived this morning there was a blood trail from the front door, through the waiting room and into the dialysis room (about 25 feet) where a patient's fistula had popped as he was exiting the facility. BRRR!
When I got home, there was good news. Drew's Ibanez was not stolen. He sent a flood of emails to all the groups that played at the gig last weekend and got a flood of returns, including one from the stage manager of the event who said he had Drew's lost guitar locked up in the office. Drew drove over this evening and brought his baby back home. YAY!

Rick's Version of the Last Two Weeks, Part One

Rick's Writings from the TT Diary, 11/28 to 12/15

Mary's prologue: the last two weeks have been busy in the extreme, so I'm 'way behind on my typing duties. So hunker in for a good long read, and here's the words from Mr. Tuel, Himself, with the occasional odd note from other family members:

11-18-09, Saturday
The week coming up will end off with me sporting no less than three alien devices warming their way through my arterial/venous/peritoneal systems and spaces. I guess I've been looking forward to peritoneal dialysis because it would get us off the hypodialysis machine ($974 a pop Editor's note: yes, but it is covered by insurance) and away from having to rely on the ferry boats and their continued depleting expense.
Jean has been pushing me toward getting on the kidney transplant list instead, something I hadn't been thinking about much.
12/2/09 Wednesday
JD writes: “JD FED JIVE :-) NOW JD IS GOING TO WANDER AROUND :-p”
Rick picks up:
Dialysis today & yesterday. Murderous leg cramps yesterday. I'm still limping today.
Tomorrow is fistula and peritoneal dialysis catheter installation. Not looking forward to this but some good news came today. Pathology report on bladder biopsy came in today. It is NEGATIVE (which is good)!
Dec. 3, Thursday – Slice & Dice Day
I spent Tuesday & Wednesday at the N.W. Kidney center piling up hours in the chair in preparation for today. For the fistula & peritoneal dialysis catheter surgical procedures. Doctor Pham wants potassium blood levels to be neither too high nor too low – or else they've been known to scrub the job on the spot & re-schedule until all is put right.
Woke up @ 04:00 with a beautiful pre-dawn full moon shining gloriously through the bedroom windows. This lovely display had to stand in for my usual coffee & breakfast which I couldn't have prior to surgery. Sighh...they want you on the table hungry and dehydrated for their procedures.
Since I'd been up at 04:00, they also got me fairly sleepy and, after lab work & I.V. Insertion, they wheeled me into the O.R. @ 12:45 and before I knew it, I regained consciousness in post-op almost instantly. Miraculously, in that brief period of time, the fistula & P.D. Catheter were in place. Even more miraculously, after that brief instant, the nearest clock said it was now 14:20. They wheeled me into my very own room on the 11th floor with a lovely view of the Cascades and foothills. Room 1162, phone number 215-XXXX. I highly recommend it!
Mary and I had a late lunch together and I decided to stay the night, just to be on the safe side. I fell asleep at last, much the same as I woke up this morning, a beautiful full moon rising in the east and and shining in all its glory through my 11th floor window. It ascended into the darkening eastern sky from behind the shelter of the Cascades while I absorbed a Philly sandwich and a quart of ice water.
04:00 once again, Friday, Dec. 4th: I didn't stay asleep for long and, hours later, here I sit wondering where the quart of ice water went. Why don't I have to pee?
There's a new innovation for preventing blood clots from forming in the legs of bedridden surgical patients – inflatable cuffs are strapped to the ankles that fill with air and empty out about three times a minute. The problem is that one can't get any sleep with them on.
So – I'm not sleeping and I'm not peeing.
Meanwhile, as time goes by I get these pain spasms from the P.D. Catheter site as well as throat pain from the breathing tube that was in my throat during the surgery. Sips of ice water are soothing but I'm still wondering where that water is going.
06:30: My RN (Barb) had her assistant Weyni walk me around the the floor to try and get my cancer-free bladder to give up its secrets. Weyni also did a bladder scan and it revealed there was about 350 Ccs in there, although I have absolutely no urge to purge. Neither do I have the ability.
Barb and Weyni had to go deal with the rest of the floor but they called Dr. Pham's office before they left. Dr. Pham sent one of her staff, Minday, over to pay me a visit. Mindy said the bladder issue was likely due to the anesthesia. Should clear up in about 24 hours. Then she checked my fistula and gently placed two fingers over the arterial connection. “Ooh,” she said, “it's beautiful. You can feel it vibrate.”
She showed me where to touch it and although I couldn't feel a vibration, I did feel a strong steady pulse rate right where they connected the artery to a vein.
She put her stethoscope over the artery and let me listen. The pulse was loud, deep, resonant and rhythmic. Coolest of all, I can put my wrist up to my ear and hear it pulsing steadily away, like a propeller on a ship, echoing through the water.
07:00: Surprise! Doctor Oliver dropped by and checked out the fistula and the P.D. Catheter. Her face broke into a broad grin.
“They're beautiful,” she said, beaming.
I sort of shared the moment and did not say: “They hurt like hell and I can't pee.”
After Dr. Oliver left I tracked down the floor nurses and suggested a Foley catheter by they felt it would all resolve itself on its own.
08:00: The new RN on duty is Helen. She lives on Vashon, somewhere in Burton. She told me to order some breakfast and drink more water so that's what I did.
Mary called around 10:00 to say she was on her way in to pick me up. I went out to the nurse's station and told Helen at which point she relented and agreed to empty me out with a Foley catheter before discharging me.
Phew. What a day. Or rather, what a couple of days.
(Here he affixed the label he was given when he entered the hospital on Thursday, which said: “I was screened on Thursday,” and below that he wrote, “...and I've been screaming ever since.”)
(This is only about half of what he's written. TO BE CONTINUED.