Cardiomyopathy, dilated, with a low ejection fraction and increasing difficullty just getting through an ordinary dialysis without oxygen desaturation, feeling very bad, taking a 911 trip to the ER from the dialysis clinic.... arriving last Monday with a K+ of 7.8!!! No wonder he didn't feel good! No dietary indiscretion. No nopales! (cactus.... pure potassium, nearly and a folk remedy, but not for those with chronic renal failure.) Could he be having a bowel infarction without pain, diarrhea or acidosis?
And, if he is, he's not a surgical candidate. Oh the subtleties.... and in Spanish, and with denial. What a lovely mental adaptive mechanism is denial. Denial is why I almost never write anything for Damned Dialysis, the great patient support network via Live Journal.
Well, we are finished with denial, his and mine. I asked that a Spanish speaking social worker and priest talk with patient and mother, who hovers over him, with love!, but like he was at his first day in school. At 11:30, I will find out: 1) How much progress was made toward coming to grips with the reality of where we are. 2) What his latest LVEF is. It was 27%, and he should be able to live with this a while, but it seems more like it's 17-20% I do not like this part of being a doctor! I do not like trying to figure out what is best in a bad situation. I'm angry at god! Yeah, it's all part of the job. He, the patient, has had 4 or 5 years he wouldn't have had without dialysis. All we ever do is buy time anyway, but mostly, we don't think about it. It leads to existential depression.
I feel better, for the moment. I understand the dynamics of what is played out in my own mind anyway. It's part of the job. Tennis, football, self-pity.... part of the escape!