Out-Patient Hemodialysis

Image courtesy of Peter Quaife - The Lighter Side of Dialysis

Hospital discharge was painful, literally. My joints were still swollen and the pain killers they prescribed were not really doing their job. So I got a list of medications and an order for out-patient dialysis. We secured a two-day a week schedule with the dialysis center but were told to be present an hour before the scheduled session. Later I found out that this time is needed to process payment, purchase the required 5000 IU Epoetin Beta antianemic injection, retrieving your dialyzer from stowage and getting the machine ready for it’s next use. Even with that lead time, you don’t really get to start on time. So the four hours is actually more than that. My average, six to six and a half hours spent in the center each time.

You are issued a patient card. It’s like an ATM card with a magnetic tape and a microchip where information about the patient is stored. When the seat is ready, the nurse calls you in. It’s a large hall with twenty or so machines spread out and a nurses’ station in the center. There are private rooms with individual machines in one end of the hall. The other end of the hall is a big room which contains six dialysis machines. This is where I was led to. The package I have included rent for this semi-private room. It is less busy than the main hall and more quiet. Well, not really quiet since the overhead cable television sets were on and, as I would later note, were only capable of reaching GMA’s Kapuso and ABSCBN”s Kapamilya. You get a fresh linen seat cover and a blanket. Yes, it could get cold in that room. 

Card in hand, you proceed to the weighing scale, insert the patient card into the slot and weigh in. The card reader beeps to let you know that it has recorded your starting weight for that session. I was at 77.5 kilograms that day. This information is needed so that the nurse will know how much fluid to pull out during that dialysis session to get you back to your dry weight. I was told that my doctor-assigned dry body weight was 76.5 kilograms. The dry weight, loosely, is the lowest, most tolerated post-dialysis weight. It is your target weight after dialysis treatment. Therefore, you do the same weighing routine after the session. Maybe I’ll have more about this dry weight thing at a later post.

After you weigh in, you proceed to your designated machine and insert your card into the slot provided. This sends your information to the machine; patient name, treatment parameters, registered pre-dialysis weight, etc. You check to confirm that it is the dialyzer with your name on it that is installed on that machine. You wait for the nurse to get to you. Sometimes it’s a bit of a wait, the nurse may still be working on other patients who came before you. And when you are finally attended to, they dress your wound(IJ catheter area, see previous post), check your access if it is working properly, meaning, blood can freely flow in and out, and then connect the tubes. A blood pressure monitor cuff is also wrapped around an arm. And your blood pressure is initially checked. During the course of the four-hour session, your blood pressure and pulse rate are automatically checked by the machine every thirty minutes. The nurse then enters the session’s treatment variables into touch screen monitor of the dialysis machine. With that done, this is the real start of the four-hour session.

Four hours is a long time. Especially when you spend it seated on a chair and your movements are impeded. So what does one do during all that time? You can choose to sleep as the chair is quite comfortable and can be made to recline all the way, or you can watch TV, but as I said, it’s either on GMA or ABSCBN as the other patients and their companions who came before you are already watching either of the two channels. You can eat. As I have said, the center encourages eating during the session as this prevents sudden drops in blood sugar levels. I do eat when settled in the chair already. You can read. I always take some reading material along. A ‘classmate’ of mine solves Sudoku puzzles. Another plays games on her iPad. One can watch movies on a laptop or tablet. Or you can start to write about all these things happening and maybe share it online. You can chat with with your 'classmates' or their companions or with the nurse when he/she is close by and learn more about the disease and the experiences of others. You only need to shift your weight and redistribute it on the chair now and then so as not to get a sore behind. 

It is a long time, four hours. I learned to use some of it for reflection. For examen. For prayer. And it has helped. It’s me time. It forces you to slow down. It calms. Because of this, I do not mind the long sessions at all. On the contrary, I look forward to them. But who knows, I’m only on my third week of out-patient dialysis. Maybe these will take their toll. I hope not. I am fighting this. I will not be defeated by this. I will work up to get a successful transplant.