Bob's Blog 8-2-14: Change the World, Just Don't Change My Chair

Bob Here.

A while back, when I was still doing in-center hemodialysis treatments, I asked my attendant to shift the angle of my chair.

She gave me a look that was one-part confusion and two parts annoyance. It wasn't that busy in the center, but since she couldn't see any obvious reason why I needed to change the angle of my chair, she probably assumed that this was part of yet another of my thoughtless, imprudent, ill-advised, reckless, rash, irresponsible, ludicrous capers that I was known to use to pass the time on one of these seemingly interminable sessions.

Not that it wasn't logical, or even expected, of her to think this way. The previous week, I got in one of those moods and intentionally dragged her into a mind-numbing exchange that went something like this:

Me: "Do you think my time would go faster if I played some music on my guitar?"

Her: [Vacant stare] "You have to keep your right arm immobile so how are you going to do that?"

Me: "Yeah, you're probably right. Maybe my harmonica would be better."

Her: [Slight pause] "Do you play your guitar often at home?"

Me: "No. I don't have a guitar."

Her: [Rolls eyes, turns to walk away. Stops, turns around] "Do you have a harmonica?"

Me: "Well...no."

Anyway, she apparently decided that she didn't have time for any of my nonsense and just came over to accede to my request. She undid the wheel locks and asked which way I wanted it turned.

"Just a little bit to the right," I said.

So, she started moving my chair.

"Little more, little more, ah, little too much, go back a little, yeah. There we are. Perfect. Thanks."

She rolled her eyes, re-did my locks, and made a beeline to get away from me. But, when she reached the nurse's station about ten feet away, she stopped cold, and looked back. Of course, I had gone back to reading my book and was acting like nothing had happened.

She came storming back over.

"Okay, I'm probably going to regret this, but I have to ask. Why did you need the angle of your chair changed??"

Now I adopted the confused look. "Huh?" I said.

She stomped her feet a little. "You never watch TV, the light isn't any better now. And I know you don't want to socialize with anyone. So, why? Why the chair shift?"

"Oh," I said. "Well, my chair was angling a little too far to the left. I usually get it exactly right before I sit down. But, I must have messed up today." Then I casually went back to reading.

"That's it?" she asked. Then she did a passable imitation of me. "'My chair was angling a little too far to the left.' Nothing else?"

"Nope. That's it."

She turned to walk away again. I said, "Seriously. I need my chair to be at just the correct angle. The light, the air, my view of the other patients. And staff. And the entrance. It has to be just so, or I can't function. If my chair was off, I'd probably have to step outside."

She snorted a little. "So you're saying you're a hopeless creature of habit?"

I considered that for a moment. Then I said, "Yeah. I guess that's what I'm saying."

Now, it didn't occur to me at the time, but I was really speaking for the great majority of dialysis patients. We are creatures of habit. We almost have to be.

Dialysis is so incredibly routinized and repetitive that even if it wasn't our nature in our pre-kidney failure lives, being on dialysis transforms us into such creatures of habit that anything disrupting our normal procedure is enough to make us take a nose dive off the deep end of the sanity spectrum.

And, in-center patients really get their routines drilled home. You have to be there at a very specific time three times per week. No ifs, ands, or buts, your butt has to be there. Now, of course, you can try the mostly futile attempt to change your schedule, but centers these days are generally booked solid, so changing isn't always possible.

Bad weather? Tough, be there on time.

Good weather that you might want to...you know...enjoy? Hah. Be there on time.

Got family coming in that you want to greet on arrival? Nertz to you. Be there on time.

You probably get the picture.

And, trust me, this habitualism can get so psycho that your chair being at the wrong angle can indeed send you into a complete tailspin.

Now, a psychiatrist would probably say that following set schedules is healthy, that we learn from our routines. If you walk into a closed door and bang your head, next time, you'll know to open it first. And, of course, in the case of dialysis, messing up and missing treatments can have dire consequences.

But, since the chair-angle incident, I've had the opportunity to observe this trait in other patients.

One time, a long-time patient came in on the third shift, and there was someone else in his normal chair.

(Honest, this was years before Sheldon on The Big Bang Theory.)

This guy actually went up to the patient and said, "You're in my chair."

The guy, who I think was visiting from out of town, just looked totally confused, and the best he could utter was a "What? Whattayamean??"

Then the nurse came running over to steer the established patient to another station before a brawl broke out, ensuring him that he would have his normal chair back the next time.

He reluctantly sat down, muttering the whole time and flashing the intruder with the occasional dirty look.

At some point in our dialysis regimen, we get to where we patients want our setups, needle sticks, taping, checking of vitals, treatment environment, personnel, and other seemingly minute details all done a very specific way.

I was sitting in-center peacefully one day. Everything was going fine, all the other patients had been put on and the center was quiet.

All of a sudden, the guy across from me started yelling.

"Oh crap...OH CRAP..."

Of course, when you hear this in a dialysis center, you always fear the worst. The nurses, attendants, social worker, dietician, and everybody shy of the dentist whose office was next door went running over.

"What's wrong??" asked the nurse in a bit of a panic.

"She forgot to tape the arterial line to my arm!!"

At that point, it was like looking at a staff photograph of everyone working in the center. They were all standing completely still, staring at the guy in disbelief.

Now, you have to understand, his needles were in no danger of coming out, they had been taped thoroughly. But he was used to having his arterial line taped to his arm and for whatever reason, it hadn't been done.

"That's what you were yelling about?" asked the nurse.

"Heck yes," he said. "Whatever happened to the standards here? This place is like an insane asylum run by the Mickey Mouse Company."

Most of the staff slowly went back to whatever they were doing a little shell-shocked. Meanwhile, the nurse quickly slapped another piece of tape on the guy and walked away shaking her head.

Another guy only wanted the Charge Nurse dealing with his needles and treatment.

Now, everybody on the Big D knows how busy these charge nurses are. In addition to being responsible for every patient in the center, they have to deal with an ever-increasing mountain of paperwork as part of their jobs.

But when an attendant came over to put this guy on, he said something like, "I'd rather set my underwear on fire while I'm still in it than let you put those needles in my arm."

He insisted on having the charge nurse, a woman named Teri (who was, by the way, a gift from God), start, maintain, and finish his entire session.

So, Teri came out, calmly explained why it wasn't possible for her to give him the kind of one-on-one attention he desired. Then she put his needles in and started his treatment. She asked if he understood her position and, seemingly placated, the guy said, "Yes. I understand. Thank you very much."

Of course, a few minutes later his machine alarm went off, startling him.

He yelled at the top of his lungs, "TERI!!!"

Some habits, it seems, truly can't be broken.

Thanks for reading. Take care.