ARF on CKD

(The title of this post is sometimes seen in a medical chart. It means acute renal failure in someone who already has chronic kidney disease.)

As I was walking to County Hospital one day in November, I heard the sounds of a speeding car and a siren. Then I saw a small black car race past, driving toward oncoming traffic. At the next corner, the driver tried to turn right in front of the car that was about to go through the intersection, and there was a loud crash. Two or three police cars roared up.

Considering that the next thing to happen might be the driver shooting at the police and maybe accidentally hitting a chaplain, I considered changing my route, but saw that at least one person was still walking toward the scene, so I did, too, and came upon a young black man lying spread-eagled in the street, surrounded by several police officers with their guns drawn: rifles (I guess) and handguns. Passersby were collecting on all four corners, many filming the action with their phones. We were instructed to remain on the sidewalk.

I realized I might be about to see the police kill someone in front of my eyes. There was a long breathless moment. The police told the suspect to rise to his knees and move slowly backward toward them. He complied, and they put handcuffs on him, and then put him back on his stomach. The officers did not seem angry or agitated, and their actions did not appear to me unduly rough, though later when I pictured myself walking backward on my knees in the street, I could well imagine that would be extremely painful.

One onlooker, another young black man, saw it differently. He began screaming, “Y’all don’t got to be so rough! This is another black man. You bitches are being rough, and you don’t got to be so rough.” As he stalked off, he added, “Yeah, I said it.”

One police officer stood with a rifle pointed at the trunk of the car until another officer popped the trunk lid and it could be seen that there was nothing of interest in the trunk. After that, we were allowed to cross the street and move along.

At County Hospital, I spoke with a man who had been told he had about two months to live. He said that, on the one hand, this news was shocking, after a lifetime of good health. On the other hand, he said he had had a feeling something like that was going to happen. When I asked what he planned to do with his remaining time, he said a lovely thing: “I’m going to let it turn into an epiphany. I’m going to let it surprise me.”

Another patient that same day said something similar, about kind of knowing he was going to get bad news about his life expectancy. This patient planned to spend his remaining time making amends and trying to be stress free and happy.

Around that time, Carol-Joy came to town. We had a delicious lunch at Udupi Palace (vegetarian Indian food) and spent the afternoon playing cards while workers put up drywall in my apartment (because of the flood last May).

When I arrived at work one day, I shared news that I considered calamitous with two co-workers. One looked grave as I spoke; the other was smiling, which made me feel a bit aggrieved: why is this a time for smiling? I got to apply this lesson just two days later, when I visited a patient I’d seen several times, who had just learned she has only months to live. I realized that I was smiling pleasantly at her, and immediately stopped.

A young volunteer at County Hospital once said of a patient, “He’s a talker talker.” So is this patient. She can easily produce an hour and a half or two hours of seemingly uninterruptible discourse, but in a relaxed manner. It doesn’t make me feel tense to listen to her, but it is by no means a conversation in the conventional sense. This time, I deliberately interrupted her: “I’m sorry, I am interrupting you. This has nothing to do with what you’re saying. We don’t have to talk about this. I just wanted to ask you two questions that you can think about later: Who will you be able to discuss this with? And what do you want to do with your remaining time?”

She said something about a thing she would like to do while she’s still alive, and then she returned to her normal topic, which is the doings of her relatives. (On one occasion, one niece cussed at another. “She didn’t curse. She cussed. Cussing is different from cursing.”) Every 20 minutes or so, she briefly returned to the topic of what she would like to do in her remaining time, so I knew she was thinking about it.

Later, I interrupted with a third question: “Would you like to share what you have learned in life with your relatives, maybe by making a video or an audio recording, or writing it down?” She said she would be most likely to make an audio recording, and then changed the subject again.

This patient does not use humor as a defense mechanism, but she also rarely displays sorrow or any form of fear. I let my own feelings of sorrow arise as I listened to her, partly about what is happening to her, and partly just free-floating sorrow. She did become tearful once or twice, talking about relatives who are no longer living. I don’t know if that was because of the sadness I was consciously letting myself feel, but I have noticed that there does seem to be a correlation between my tuning into emotion when with a patient and the patient doing the same.