Rex: Comedy and Tragedy

I observed a hemodialysis session today. Watching the patient get hooked up to the dialysis machine was straightforward enough, but the case was really interesting. As you might expect, the pt has T2DM and CKD, but his kidneys weren't quite bad enough to require dialysis...until he had a MI. He underwent cardiac cath, and they injected him with contrast dye as part of an imaging procedure. The dye caused his kidneys to fail. I always thought that the "risks" section in each Medline entry for a procedure was a little overblown, but such complications really do happen. As a dialysis newbie, he was confused as to my I was there as a dietetic intern. I got to explain some of the nutritional concerns of dialysis patients and how RD's play an important role. I think he'll meet one soon since he'll be starting at an outpatient dialysis center after he's discharged. He's hopeful that it's just short term, though, since kidney function sometimes returns after dye-induced failure. (After all, he said, his crea has already returned to his usual ~4-5 mg/dl!) He doesn't seem willing to change his diet to prevent the progression of his CKD - he actually said during our hilarious and discursive conversation, "You know what I wish I had? A spray can of trans fat. Then I could spray it on all of the foods that used to taste good before they took it out of everything. I used to live on hamburgers and fries, but they just don't taste the same anymore." Whoa. Can you say, "precontemplation"?

In contrast to that experience, I was deeply touched by a woman caring for her partner of 49 years who has rapidly worsening dementia. I stood in the room while she stroked his forehead to calm him, and then we stepped out into the hall to talk about how he was eating. She said he doesn't seem to like the pureed diet we put him on (d/t dysphagia), but she acknowledged that he probably won't go back to solid foods. I had no idea what to say at that moment as she grappled with the long, slow loss of a loved one. I hope she appreciated my attempts at empathy in a professional role.