Who Stole My Kidneys?

Miracle Mary

 “I want a second opinion,” Mary said, when I asked her if she knew why she was here today for this visit. 

As she spoke, Mary studied my face, looking for clues, trying to determine if I would listen to her and agree to care for her.

“I was recently treated at the medical center, but now I wish to be treated by a physician close to my home,” she added.

 I had agreed to care for Mary before I finished reviewing her chart. Sitting at my desk in the nephrology clinic, where I work, I had reviewed Mary’s file prior to her appointment. A nephrologist is a physician who specializes in taking care of patients with kidney disease and high blood pressure. Our training involves four years of college, four years of medical school, and seven years of post-medical school training in the specialties of internal medicine and nephrology. 

In despair, I reviewed Mary’s medical records for some detail that might have been overlooked or incompletely investigated, hoping it might guide me to a rational and possibly effective treatment.

Mary has severe, uncontrolled blood pressure, and she is only fifty years of age—although she looks twenty years older. Tall in stature, she has long brown hair and a very petite body.  The previous physician’s diagnosis was uncontrolled hypertension with kidney failure.

I imagined how Mary had translated her diagnosis in private to her family in order to help them understand why her kidneys were failing and how she would need artificial kidney treatment.  By the time Mary saw me, she had been started on dialysis.  In the 1960s, a diagnosis of renal failure was similar to a diagnosis of cancer.  Without a kidney transplant or dialysis, a patient with kidney failure would only live a few weeks.  Death was eminent because the toxins and fluid normally removed by the healthy kidney accumulate in the body.  Patients become comatose and die shortly thereafter from respiratory distress and cessation of a normal heartbeat.

“Before we go on,” I told Mary, “let’s start from the beginning.  I want to hear the story directly from you and in detail, from the time you first developed problems with your blood pressure until the time you saw the nephrologist at the medical center.  Then I will examine your vital organs, review your laboratory data, and we will think through this disease process together.”

In medical school, and through mentors in residency, I learned that there was a journey taken when a physician listened empathetically to a patient recount a history and when vital organ systems were evaluated in a systematic fashion.  It was a journey of investigation that allowed me an opportunity to understand the origins and previous management of her disease. I planned to walk deliberately along the milestones of my new patient’s life, the family history of medical diseases, the nature of her occupation, the status of her personal relationships, and the history of her prior and current illnesses and treatments. Hopefully, for a brief but illuminating moment, I would become truly empathetic and integrated into her experience.