I Was Once a Hemo-dialysis Rookie

    

Dialysis session at Capitol Dialysis Center in Quezon City with my wife and DOH Assec. Dr. Enrique Tayag 

    

We all had our milestones in life. Sometimes we have experienced them with happiness,  sometimes with challenge and pain. What matters most is how we dealt on them. Was it with fear and uncertainty or was it with courage and hope?

    

     One of my fears before is entering a hospital; I just could not stand looking at sick and bloody patients in the emergency room. I do not like a place that exudes pain, suffering and death. When my Nephrologist advised me to be admitted to a hospital, we chose the regional hospital in the city that is managed by the government. Upon entering the ER, my nervousness was heightened as I looked on  the many patients that are either laid on stretchers or sitting patiently as they wait for their turn to be checked up by the doctor. The room was crowded with nurses (student and registered) and resident doctors busy with their daily routine especially if a new patient is wheeled in from an incoming ambulance. 

     My wife took care of the requirements for admission including my PHILHEATH (government health insurance) requirements so most of the time I was alone and I could not stop thinking of my condition, what will happen to me and my family and the expenses that will be incurred. My brain was overloaded with different images, thoughts and I am confused, nervous and tired. As I am seated and waiting for the doctor, a female nurse approached me and asked me where my companion is and I said that my wife is still outside. The nurse who I learned afterwards is a student nurse informed me that she will insert a Hep Lock (tube where a Catheter (long tube) for IV fluids will be connected) on me. I did not bother to ask her any question and I am quite weak so she tried to insert the Hep Lock on me. She attempted twice until my veins were swollen and the pain has increased so she finally gave up and called a "real" and experienced nurse who effortlessly inserted the Hep Lock at the back of my hand. I realized then that the first nurse was a student who is not supervised by her Clinical Instructor. After a two hour wait, I was checked up by the admitting physician and finally wheeled to a private room. This was my first admission in a government hospital and I am not aware that these things could happen.

       I was relieved when I entered my room with air-conditioning, TV, toilet, chairs and a soft cushioned bed. But it was not long enough as I lay down in the comfort of my hospital bed that a surgeon walked into the room and told me that I will be operated upon. I felt nervous again when he asked me where would I like my emergency dialysis access would be placed: in my thigh or wrist or neck. He explained the advantages of an IJ (Intra-Jugular) Catheter in the neck so I decided to choose it. 

     The next day in hospital was blood transfusion day and this was the first time in my life that another person's blood will run in the veins of my body. At first, I was hesitant and I felt that my body will be violated by a foreign blood but I have no choice. I was transfused with two bags of blood in my room and another two at the Hemo-Dialysis Unit (HDU). The purpose of these transfusions is to increase my Hemoglobin from 6 to 11 because I will not have dialysis if my Hemoglobin is low since I will strain my heart. The day of the operation came and a rubbery three inch pointed tube was inserted in my neck near my heart. I heard the surgeon said to the assistant nurses in Visayan: " Maayo man ni pero dali ra malata" (this is good but will easily get infected). Oh my Lord! An infection in my neck and near my heart! I was terrified by that thought. There was no complication during the operation. When my access in the neck was done, I was immediately rushed to the HDU at around 7:00 PM where I had my first dialysis. In the HDU, my stretcher was placed beside a dialysis machine. I saw two uniformed nurses and one dialysis technician. These people will become my regular partners in my weekly dialysis. It was my first time to see two tubes from the dialysis machine were connected to my neck and I saw my blood running in those tubes. Not a pleasant sight I tell you. My first dialysis took only two hours; the regular dialysis is four hours.  This first dialysis is to "acquaint" my body to Hemo-Dialysis since after my session, I still felt weak and dizzy; how much more if it is a four hours dialysis. I ate a hearty meal that night and it was the first time that I was able to sleep well. My Nephrologist told me that the next dialysis session will already be four hours, "there will be no pain just relax" she said. 

     My four hour dialysis came two days after my first dialysis. That time I sat in a wheelchair from my room to the HDU and then I walked to the dialysis chair. I was not used to sitting for long period of time so I sang tunes in a low voice to kill the time. The dialysis went well  and as usual I felt weak and dizzy. At that time I had a little knowledge of what dialysis is. I had to undergo a second surgery and this is about my Fistula (artery and vein joined together, usually in the wrist but some have their Fistula on the upper arm). This is done to make the vein larger so that the nurse can insert the Cannula (dialysis) Needles later after 1 or 1.5 months with regular wrist exercise. My Fistula was done and I was eventually discharged from the hospital after nine days of stay.

       Taking a bath with my IJ Catheter in the neck then was a little bit challenging since I have to take good care not to wet it to prevent infection. I have to be aware of the IJ Catheter when I sleep  so it will not be pulled and I will not bleed to death.  The HDU of the hospital where I was admitted was full of dialysis patients and many patients are still waiting for their regular dialysis slot so I have to do my dialysis in a different dialysis center. The advice of my Nephrologist is to have regular dialysis of twice a week so that I would not have Edema (too much fluid in the body) and Uremia (too much nitrogenous waste in the body). Luckily I only had dialysis once in the other dialysis center and I got my regular dialysis slot at the HDU of the regional hospital in the city. This is the start of my "class" (dialysis session) and met new "classmates"(fellow dialysis patients) during Monday and Thursday. Before my dialysis, I have to weigh myself for the nurse to estimate my "Dry" Weight (it is the patient's lowest weight that can be possibly achieved after four hours of dialysis where the patient is "Normotensive" or having normal blood pressure). 

     Actually, the "Dry Weight" is only an estimate done by the doctor during the first dialysis and the nurse after the first dialysis based on the patient's chart). After I have taken my weight, the nurse will deduct the previous weight after dialysis to my new weight before dialysis. The difference is the excess body fluid that will be taken by the dialysis machine from my body. Being an estimate, the nurse  could go below the "true" Dry Weight and could result to hypo-tension (due to less blood plasma volume). 

     This is what I experienced before. I am already hooked in the dialysis machine and undergoing dialysis  when after 45 minutes I felt queasy, had cold sweat and almost passed out. My blood pressure went down from 100/80 to just 80/60. The nurse and technician reclined my chair so I could lie flat then they flushed my blood with normal saline solution to increase the volume. They took my blood Glucose level to see if I am not Hypo-Glycemic (low blood sugar). During that life threatening situation I could not do anything so instead of worrying, I just prayed to God and offered everything to Him. Fortunately, my BP went back to a normal value and later that day, I was through with my dialysis.

       On previous occasions, I have seen some feverish patients having an infection on their dialysis access and saw them shiver to the bone during dialysis. Their eyes wide open and their body stiff from feeling very cold so the nurse gave them medicine to lessen their shivering and the technician put lighted lamps near their body to provide extra heat. Whenever I see suffering patients, I pray for their comfort and healing. For me, I have maintained my IJ Catheter in my neck without complication or infection for 1.5 months and the day came when my Fistula was ready for dialysis. This was the first time the HDU nurse had inserted the dialysis needles on my vein and I was not comfortable with these big needles inside my vein. I could not describe the pain and I felt heat in my body and to think these needles would be in my vein for four hours! After four dialysis sessions, the nurse advised me to get my IJ Catheter pulled off. Luckily, I did not experience any infection on my access and I did not shiver during dialysis. Again, praise the Lord almighty!