Dialysis Diaries Part 4: Emergency Repair Revised by Ron Steinman

Dialysis Diaries, Emergency Repair: Part 4 Revised by Ron Steinman
An important reminder: This is National Kidney Month. One in seven persons have kidney disease. My Dialysis Diaries published on Linkedin and my blogs, describe how I, who has kidney disease, live with it daily.
Note: Normally I would end this entry with the update that follows, but to understand what happened to me, I am placing it here at the start. In the original post, I described my first radiation intervention, a procedure that took place in a special unit at a major hospital –a procedure that is quite common, according to my doctor — to clear the blood clots in my graft that were not allowing me to have the necessary flow of blood for dialysis. Despite the procedure, at my next session I still had blood clots that were in the way of the blood exchange necessary for my treatment. To my dismay and the medical staff, the first radiation intervention failed. After cancelling the third day of dialysis on the following Monday morning, I had a second radiation intervention: same place, almost the same time, same doctor, and the same turkey sandwich on white bread when finished. Though called a minor procedure, the after effect was as debilitating as the first time the doctors worked on me. Recovery was slow but it was enough for my treatments to continue. Dialysis has now been working but with difficulty. I say all this to make sure that readers understand that dialysis is not that easy. After several months I realize dialysis is not as benign as I thought. It is a difficult path that I am on, one that I will explore further in the series.
Just when I thought all was going well with dialysis, it collapsed. Friday afternoon, on the day my session came apart, I did everything I was supposed to do. I had watched my water intake, I ate a hearty lunch after having a good breakfast, and I did some writing. I worked out on my new stationary bike. I showered, dressed and arrived at the center on my scheduled time. But after I weighed myself, went to my assigned chair, placed my phone, my tablet, my glasses and book on my side platform, sat in my chair and waited for the technician to do her job, nothing went right. When the technician went to work on my arm everything she did failed. But it was not her fault.
She found the proper openings in my graft, inserted the needles, but, to her surprise, she found it did not work. The needles she inserted did not do their job. For some reason the flow they were supposed to generate clogged with blood, meaning that blood clots took over. I am not usually what they call “a bleeder” but I was bleeding. It was slow, inexorable, and not good. The flow was not good. My blood was clotting. Clear and simple. The flow was not consistent, and not quietly, effortlessly streaming, as it should have been doing.
I have every faith in the technicians during my treatment. The tech working on me knew what she was doing but she could not get the procedure going. She tried several times to insert the needles into my arm. The pain was minor. It was a skin-prick into my upper arm, fleeting and not long lasting. I did not know something serious was going on until the technician decided she could not make the connection she required and decided to call a more experienced technician to help and a nurse to observe the procedure.
The most experienced technician in the unit arrived at my chair. She put on purple plastic gloves, pulled a chair closer to my left side, and immediately stared to work on my arm. She had no luck either. The problem prevailed. The blood did not flow. Instead, it clotted. She showed me the clot and it was not pleasant to look at: a thick, dark mess on a sea of thinner blood resting on white gauze. I could see the clotted blood and it was upsetting. Is that my blood, I wondered? Even when shaken vigorously it remained clotted, meaning it was not uniform, rather it was cloudy looking like red and white melted butter.
She tried several times to insert the needles but she kept shaking her head. She told me that maybe she should stop because it was not working. The clotting was more serious than she originally thought. To alleviate the minor pain and the time it was taking to get me started in dialysis that day, I agreed that we should stop. After a consultation with other technicians and nurses, the decision was made that I would need to go to another facility to get the graft looked at and fixed. People at the center told me that it was typical. It happens frequently, they told me. It is nothing new. They had ways to fix the problem and they were aiming to get me to another facility as quickly as possible, a place where they had the equipment to take care of the setback I had experienced. They were setting that up for the following, morning. Sent home, I would receive a phone call telling me where to go and what time to be there,
I arrived home in a state of mild shock and great disappointment. I worried that without the now frequent and accepted (by me) dialysis treatment I might suffer what I was trying to avoid when I started it. A technician assured me that I would be dialyzed when everything was back to normal. At home, I received two phone calls that clarified the next step that I hoped would fix my graft and make it accessible for the treatment. The procedure to unclog the graft would take place at a hospital Monday morning, not Saturday as I expected. A nurse gave me instructions where to go at the hospital and to arrive at 9 a.m. for check in. Bring your insurance cards and a list of current meds, she said, and eat nothing from midnight Sunday. All easy enough, except that the two-day wait would not be easy.
Early Monday morning, without four days of dialysis, we (Eileen and I) made our way to the hospital for radiation intervention therapy, a procedure designed to clean the clots from my blood. Once the clots were gone, dialysis could proceed as usual. I will not regale you with all the details of the surgery because they are many, varied and complicated — beyond my ability to describe clearly what happened in the operating room where the procedure took place. I will say this, though the methods are surprisingly technical, and complex, performed by exceptionally well-trained doctors. Initially I thought the process would be simple, would take little time and easily clean up the mess happening with my blood. But that was not the case.
On the table in a well-equipped operating theater, I realized nothing is easy in modern medicine. Using sophisticated instruments and radiation imagery, the doctors performed an operation on my tiniest veins and arteries to rid me of the blood clots. The surgeons inserted a miniscule stent and fixed my problem. After almost two hours on the table, I spent a short time in recovery. In a warm touch, a nurse provided Eileen and me with cranberry juice and a turkey sandwiches, though without dressing. My doctor then sent me on my way to continue dialysis without interruption, I hoped. I say hoped, because my doctor told me that I might experience the same problem in the future.
Unfortunately, returning to dialysis has not been easy. There is a new difficulty. My arm is still healing. The entry points for the needles are still recovering and might be for some time. There is a bit of pain when the technicans inserts the two needles. No doubt it will be weeks before my arm and the graft with its new stent will return to normal for easy dialysis. I am dependent on careful, talented technicians and nurses to do the best they can until my arm heals. Though it sounds mildly pessimistic, I am sure I will be fine, yet I know there are no guarantees of permanent success. I have to live with that idea. From where I am now, that is good enough.