Bob's Blog 12-6-14: Questions Abound, Doctor's Rounds

Bob Here.

My introduction to the wonderful world of dialysis hardly ended with my tumultuous stay in the hospital or my rather unnerving first in-center treatment, most of which was spent in the inverted position.

No, there was a lot more fun to come as I learned the ropes about the dialysis lifestyle's ins and outs.

(Mostly outs, by the way.)

And while at times I didn't react well as I learned how restrictive, monotonous, sickening, and terrifying it can be to be on dialysis, I have to admit it was no bed of roses for the people teaching me either.

One would think that when you're dealing with such a serious illness as kidney failure, your doctor would be providing you with the most critical information that you need to keep on kickin'.

This might be true except I've found that, at the risk of a gross generalization, doctors, as a group, are the most inept, uncommunicative, socially incompetent bunch of knuckleheads that I've ever come across.

Now, don't everyone get their knickers in a wad, I admit there are exceptions. There have been a few docs whom I have thought highly of along the way, but many more whose personalities could be the most effective birth control ever, if only they could find a way to package it.

No, the fact is that most of the important feedback that you get about living with dialysis comes from nurses, dieticians, social workers, and, perhaps most importantly, other patients.

The first time a doctor made his rounds when I was in-center, I really didn't know what to expect. It turns out that he was a visiting physician, not the regular guy, so on top of everything else, he didn't know anything about the center's patients.

Or, much else for that matter.

The doc came wheeling around a cart with a bunch of loose-leaf binders. I had a feeling that he wasn't really looking where he was going as he motored around the room.

My suspicions were confirmed when he finished with one patient a few chairs down from me, swung the cart out into the aisle and hit an attendant passing by right in the kneecaps.

The attendant gave a sharp, "Aaahhcchhh."

It took a few seconds for the accident to register with the doc. He just looked confused as to why something had interrupted his progress.

When he realized what had happened, he said, "Oh, sorry," and continued on his way.

The attendant was cool. He walked off rubbing his right knee, saying, "It's okay. I know a good doctor."

That didn't register with the doc either, but the nurse accompanying him on his rounds looked like she was going to bust a gut.

With every patient the doctor’s approach was exactly the same. He would wheel on up, smile vacantly and say, "And who do we have here?"

Then the nurse would pull out the appropriate binder, give the patient's name and provide a little history and background on the person, none of which the doctor would listen to.

I know this for a fact because when they got to the guy next to me, the nurse told this genius that the patient was having difficulty controlling his phosphorous. He just nodded solemnly and pulled out the man's latest lab sheet.

He was going down the list of about a thousand things that get measured by the monthly labs, making an "uh huh, uh huh" noise along the way.

Then he stopped suddenly.

"Nurse, this patient’s phosphorous is high. Did you notice that?"

The nurse was momentarily stunned, and just stood looking at the guy slack-jawed.

Summoning up about as much patience as possible, she said, "Yes, doctor. The last couple of readings have come in high, so we've worked with the dietician to adjust his binder dosage."

It took a second for that to sink in, then he nodded again, with a couple of more "uh huhs" and said, "Okay, and you've reviewed these changes with the patient?" as if the guy wasn't sitting about a foot away.

The nurse just stared at him before answering. I imagined she was thinking something along the line of, "No, I was going to see how long I could keep it a secret before the guy's organs calcified."

But, give her credit, after a deep breath, she just said, "Yes doctor."

All this time, the patient was just watching the whole exchange with a slightly bemused look.

Then the doctor said, "Well young man, looks like you're doing just fine. Just keep an eye on that phosphorous. Do you have any questions for me?"

I wondered if my neighbor and I were having the same thought. Like, "Yeah, just one question. Where'd you get your medical degree? Out of a Cracker Jacks box?"

But he just shook his head and said, "No. No questions." As if he would have passed up a cure for kidney failure just to get this guy away from him.

Then it was my turn. He managed to wheel the cart over to my chair without injuring anyone and said, "And who do we have here?"

I said, "We have fine. How are you?"

The doc couldn't have been more confused if I was speaking Klingon.

He was looking at me, stuttering, "Uh...I uh...oh, yes...fine, of course...thank you..."

The nurse had that gut splitting look again, but she put the guy out of his misery, breaking in with my name.

"Bob is a new patient," she said. "He just started dialysis recently." Then she handed him my binder.

He looked at the binder. "Hmm. Not much in here. Are we a new patient?"

I couldn't help it. I started laughing. Which, in turn, got the nurse laughing too.

The doc got that look like he was the only one in a room who didn't get a joke.

"Yes," I said finally. "We are...I mean...I am a new patient, I just started dialysis recently." I figured that if I turned the phrases the same as the nurse it might have more of a chance of getting through.

He still looked a little left out by our outburst, but gave up trying to understand and started reviewing my labs. Same oblivious look. Same, "uh huh, uh huh" noises as he went down the list.

I looked at the nurse, but she wouldn't meet my eyes and had a hand over her mouth. I could tell she was trying to avoid further bales of laughter that had probably been building up since this Dr. Kildare had started his rounds.

"Ah," said the doctor, startling us both. "Your kt/v looks good. Nurse, continue the patient's cadence and duration."

I just looked at the nurse. I was hoping that since the guy knew (?) that I was new, he might say a word or two of explanation. But apparently, none was forthcoming.

The nurse said, "Bob, the kt/v measures dialysis adequacy. In helps determine if you're getting enough treatment."

I said, "Oh thank you." Then I turned to the doctor. "I mean, I usually strive for excellence, but in this case, I'll settle for adequacy. Ha ha ha ha..."

The nurse started laughing, but the doc was once again, looking back and forth at us hoping for an explanation.

Then he said, "Oh yes. Heh heh..." And I could tell he still didn't get it.

I said, "Hey doc, long as I have you laughing, this guy goes to a doctor and says, 'Doc, I think I'm a kleptomaniac.' The doctor says, 'Take these pills and if they don't work, pick me up a DVD player.' Ha ha ha..."

The nurse got a good laugh, but the doctor seemed lost and went back to looking at my book.

Then after a pause, he said, "Well young man, looks like you're doing just fine."

I had a crazy image pop up in my head. I had just been dropped off a cliff and my body was smashed beyond recognition. I was in traction, a cast on every limb, with a dozen IV lines, and my head wrapped in bandages. This doctor was standing over my hospital bed saying, "Well young man, looks like you're doing just fine."

I laughed a little bit at my private joke. The doc just smiled and said, "Do you have any questions for me?"

I thought long and hard about my response. The nurse was looking at me biting her lip.

Finally, I couldn't think of anything else that could be conveyed in mixed company, so I said, "How fast do you run the hundred?"

The nurse said, "Excuse me doctor, I'll be right back," and walked away shaking.

The doc was staring at me blankly once again. So, I finally took mercy on him and said, "Just kidding doc. No questions." He quickly moved on to the next patient, with all the nurses and attendants giving him a wide berth.

After he finished his rounds and left the center, my neighbor and I were both shaking our heads in wonder.

My neighbor said, "Wait until you see what we get billed for that."

I said, "We're going to get charged?? For that??"

He said, "Yeah, can you believe it? My bookie could have given us more useful medical advice."

Thankfully, the regular doctor came back for the next set of rounds. Since he would be around more, we had time to get used to him.

And, of course, him to us.

Thanks for reading. Take care.