Ten Minute Procedure

by Paula Plog

Day 1:
In March, I was 84 years old and I have been in good health all my life, well, up until two years ago. I really did not feel bad, but slowly I found it harder and harder to catch my breath. I was a smoker for many, many years, but gave that up because the doctor said it was bad for my health.

In April, the doctors saw some shadows on my chest x-rays. They told me I have lung adenoma (which they tell me is another name for lung cancer.) They took me to surgery and took out the upper part of the lung. Then, because they did not get all the cancer, they sent me for radiation. That burned me and guess what, I still have lung cancer. So they said we should try chemotherapy, but the stuff they used made me so sick and tired. My arms are bruised from my elbows to my fingers. Chemo made me so sick I refused to take any more treatments.

Lately I have been dizzy and incredibly tired. It wears me out to just get out of bed and to dress myself. Sometimes I have to sit down so I don't fall down. I have to be pushed in a wheelchair because if I should fall, it takes four grown men to get me up (that has happened before). Since coming home from Tabitha, I have had to lean on my wife and kids more and more to help me take care of myself. This is getting to be very hard on them.

Today the doctor says that my kidneys are only doing about 12 percent of the work they should and that is down from 24 percent from a few weeks ago. He says that is why I am so tired. He said the kidneys will never get better; in fact, they will just keep working less and less. He said we could try dialysis--whatever that is. He suggests that we (my wife, daughter and I) watch a video that explains what dialysis is and how it works; then, we can take a couple days to think about what we saw. Even then, he says that it will take a couple months before I start feeling better.

After watching the video, it seems like my options are: 1) drive to Lincoln three times a week to be attached to a machine that will do the work my kidneys don't do; 2) they can put a tube in my stomach and four times a day I will have to drain fluid out and put more in; 3) do nothing. Each option has its drawbacks.

Hemodialysis will mean three times a week someone will have to drive me 30 miles to Lincoln and wait for me while I am hooked to a machine for four hours. Surgery will have to been done so the doctors can make a vein big enough to poke two needles into every single time I have dialysis. One needle will let blood be drawn out and the other will put the filtered blood back in.

Continuous ambulatory peritoneal dialysis would mean I will have to have surgery to have a tube put in my abdomen. My family and I will have to learn how to hook a bag of fluid to that tube, let the contents drain from the abdomen, then let another bag of fluid drain into the abdomen. I don't think I can do that myself. My wife and one of my sons will have to learn how to do this so they can help.

My wife asks what will happen if we don't do dialysis. The doctor says that I will die. He says that I will feel worse and worse and one day, I will go into a coma and die. My wife wonders how long this will take. The doctor does not know for sure but he says it is unlikely that I would live a year. He says, most likely, we are looking at three to six months.

The doctor recommends that if I want to try dialysis that I have a surgeon put a tube in my neck - he calls it a permacath so I can be hooked up to the machine and that we try hemodialysis for two months to see if I start feeling better and to give me time to think about hemo versus CAPD.

Tomorrow the surgeon will put that tube under my collarbone and they will hook me up to the machine for a couple hours to make sure it works. I didn't get much time to think about that. I think I am sicker than anyone is willing to admit.

Day 2:
My son and my wife brought me to the outpatient surgical clinic early 5:40 in the morning. After filling out all the forms, they took me back to a little room, gave me a gown to put on, and started an IV. The nurse said the doctor would be in later. Surgery to put the catheter in is at 7:30. When the doctor came to get me, he said this wouldn't take long, about 10-12 minutes and I'd be back in the room where my wife, one son, and three daughters are waiting for me.

I am taken to a cold operating room where I am put on a skinny little table. Two people tuck my arms under some blankets and plastic things. They tell me that is so I don't reach up and contaminate things while the doctor is doing surgery. Another person shaves the hair from my chest, then covers it with some cold brown stuff. Somebody puts a tube with little plastic prongs in my nose. Another person lays towels across my chest, arms and face. Then they put more stuff on my chest and over my face. It is hard to breathe.

The doctor tells me I will feel a prick and a sting. I wouldn't call it that. It hurt. Then I feel pressure and lots of poking. I can hear the doctor talking. He is upset because he does not have the kind of guide wire he wants. He asks for another one. It is too short. He asks for another one. He pokes and it hurts so the lady at my head said she would give me more stuff for pain. I can't see anything because my head is still covered and it is still hard to breathe.

Now the doctor is poking on the other side. That really hurts. I ask for something to help the pain. I can hear the doctor ask for another catheter-a long one. I have lost track of how many he has tried now. All I know is that when he pushes, there is incredible pain and he does not understand where it is hurting. They will not let my arms loose so I can point. I ask for more drugs to help with the pain.

The doctor now says they cannot put the catheter in my chest; they will put it in my neck. They take all the stuff off my chest, shave the side of my neck, and the doctor asks another man to put in a "central line". I do not know what that is. All I know is I am cold and I need to urinate. There are six people in the room. I tell them that I need to pee and the doctor asks if I can wait a few minutes. I don't think so.

I do not know that my blood pressure has dropped to 55/35. I do not know that the doctor is frantically pulling the drapes from my body and is shaking me, trying to get a response. This time, I do not feel the cold as my gown is cut away and my body is scrubbed with Betadine from my chin to my groin. I do not feel the frantic but futile attempt to start another IV in my arm. I do not feel someone put in a Foley catheter. I do not hear the doctor order six units of blood, saying there is not time to cross and match. I do not know instead of six people, there are now 40 people scrambling. I do not hear the saw that opens my chest; or feel the rib spreaders they are using so the doctor can see where all that blood is coming from.

I do not know that they have taken my family to a private waiting area or that someone asked a chaplain to meet with them. I do not know that the PA student who was at the doctor's office yesterday and who came to watch the procedure is in the corner, praying that God will take care of me, as this 10 minute procedure has now taken over three hours, and I still don't have a catheter for dialysis access.