As I explained what dialysis actually entailed, he seemed surprised to hear that placement of a vascular access for dialysis required surgery. “Old kidneys” was the final diagnosis, and with it his medical team began a preparatory discussion of whether Dad would pursue dialysis.ĭad was bombarded with a barrage of abstruse medical terms such as “uremia,” “hemodialysis,” “shunt,” and “fistula” and asked for my help in understanding the medical jargon. After days of inpatient workup and a multitude of diagnostic tests, including a kidney biopsy, his doctors could find no reversible cause for his kidney failure. I made an appointment for Dad to follow up with his primary care doctor, but before his appointment, he was hospitalized for shortness of breath and swollen legs as a result of his deteriorating kidney function. Despite my caveats, my parents’ fears were palpable. I told him that it’s often hard to know what to make of a single lab value, that the blood test should be repeated, that even if his kidney function was getting worse, it wasn’t the end of the world, that there were a lot of reversible causes for kidney disease, and so on and on.
Dad listened carefully, and, after a long silence during which my mother refused to break her blank stare at the kitchen floor, he asked: “What does it mean, Son?” I hedged. That evening I stopped by my parents’ house on the way home to share the unwelcome news. After all, more than half of the population older than age seventy-five is reported to have chronic kidney disease, and the number of octogenarians and nonagenarians developing end-stage kidney disease has been rapidly increasing in recent years.
Looking back, I shouldn’t have been so surprised.
As an infectious disease physician who frequently searches for answers to medical enigmas, I did not accept his response and asked him to undergo a few basic blood tests, to which he reluctantly agreed.Ī few days later, when I received the results in my office, I was in for a surprise: His renal function had deteriorated considerably, nearing what is considered end-stage kidney disease. “I just don’t feel like reading the paper much anymore,” he replied. But when Dad began to consistently fall behind in reading his newspapers, many left in their original plastic wrappers, I became concerned and wanted to know why. I wasn’t worried at first after all, he was going on eighty-eight, and a recent visit to his doctor had not turned up any surprises. In retrospect, the first indication that something might have been amiss with Dad’s health was when my mother grumbled that he was taking too many naps during the day despite sleeping soundly at night. As Dad grew older, his definition of quality of life became simpler: maintaining his health living in the comfort of his home with the love of his life, my mother reading his daily newspapers solving Sudoku puzzles watching his favorite sports teams on the television indulging in my mother’s culinary delights listening to Johnny Cash and getting behind the wheel of his favorite toy, an ever-spotless metallic gray Chevy Suburban. Despite these setbacks, he entered the eighth decade of his life relatively healthy compared to many of his contemporaries, who seemed to spend much of their lives in hospitals or nursing homes. Decades of smoking cigarettes-beginning after he joined the military-caught up with him years later, in his sixties, when he was diagnosed with coronary artery and peripheral vascular disease. And like many in this generation, he had declining health. At the age of eighty-seven, Dad was part of the ever-dwindling “greatest generation” of men and women who served their country by fighting in World War II. The choice was either dialysis or die in three months.
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