Tuesday, June 28, 2011

"Whose Life is it Anyway?" Film Shows - How Far We've Come - in Some Ways

The other day, browsing on Xfinity for something to watch in the "Free Movies" category, I came across the 1981 film, "Whose Life is it Anyway?" starring Richard Dreyfus.

The film told the story of a promising young sculptor who was severely injured in a sportscar vs. semi-truck accident. Dreyfus' character suffered a high cervical spinal cord transsetion, and was left a quadriplegic. Moreover, his internal bleeding resulted in a bilateral nephrectomy - so he had no kidney function at all and was placed on regular hemodialysis.

After the gravity of his situation sunk in, the sculptor asked to have no further treatment - and without dialysis, he would certainly die.

The request spawned an enormous debate among hospital personnel, finally resulting in a private trial - and ultimately, we assume, in the sculptor getting his wish.

It was interesting to see how our medical culture has changed. The scenes depicting doctors smoking in the lounge were obsolete, of course. Though I remember working to change the smoking policy at Swedish/Ballard in the late '80s. Until that time, smoking was common in most hospitals - among patients and personnel. Imagine!

"Whose Life is it Anyway?" was highly "sanitized." Dreyfus' character didn't look like any quadriplegic I've known: no contractures, no muscle atrophy, no visible surgical scars. 

But his deep sigh when a dialysis treatment started was highly recognizable. I so remember this with Steve; he hated "being on the hose," although he clearly valued the fact that dialysis kept him alive.

I remember seeing a booklet at the Northwest Kidney Centers - entitled "When It's Time to Stop Dialysis." I never read it; we simply weren't "there."

But, how wonderful it is that a patient wouldn't have to put up a fight to end treatment - at least not with the court. We now see withdrawal of treatment as a patient's right.

Steve and I had spoken many times about "not letting him suffer." When it's time to die, I believe a person knows this at a very deep level. I suspect that's what Steve was conveying when he said, "Wasn't I supposed to die yesterday?" - the day before he actually died.

End of life issues will always be charged, tough issues - for patients, for families, for society in general. I'm personally glad we've made some progress in this area since the Dreyfus film. It's interesting to watch; you might put it on your list.

Take care,
Linda Gromko, MD

Monday, June 6, 2011

The Feminist Widow in Car World - and The Susan B. Komen 5K Walk

Well, I'm not sure what this post has to do with dialysis, but I'm very sure what it has to do with widowhood. Even in an egalitarian relationship like Steve and I had, there were certain things he just did better than I did - and therefore, fell to him. Like car buying/leasing.

Steve loved cars. Cars with every new doo-dad, every new technology. I had never known that cars could even come with heated seats until I met Steve with his grey VW Toureg. He had the heated seats, the leather interior, the teak trim, and all the rest. It was nice, but it was, well - a car.

For me, a car has to be dependable - and handle reasonably well in the snow. A CD player would be great. But that's about it.

Steve chose my last car, a Suburu Forrester - sort of a small SUV that gave me the illusion of being able to venture into mountains and take a kayak somewhere. Maybe that was his illusion. In truth, I basically went to Costco and that was about it.

Another truth about widowhood is that I need to take a careful look at finances, cutting expenses where I can. A lower lease payment seemed reasonable to me.

Looking at several cars, I could "feel" Steve saying "don't even think about that little toy car, Linda Jo," and I passed up a compact sedan in a tomato bisque color. That would have completely offended Steve's design sensibilities!

But settling into a VW Jetta with a lower payment and enough bells and whistles for anyone's purposes, I felt at peace. At peace, mind you!

Feminist Dr. Linda still seeking Steve's approval about a car purchase? Well, yeah.

But I hear this from other widows, too. Wanting to ask him something; wanting to tell him something. Wanting to poke him in the arm for not being there when I had a car question.

Widowhood? Not my favorite chapter.

But then, there was the earlier part of my day. Yesterday morning, I joined a few thousand others in the Susan B. Komen 5K Walk (or "Walk-not-Run-for-the-love-of-God!") For the Cure.

That's a reality check for you. Our group of sixteen included daughter Brita and her pal Carla. We were walking in support of one of my officemates, Margaret Provenzano, diagnosed with breast cancer a year ago - and doing beautifully. Her pink "surviver shirt" spoke volumes.

Margaret and a group of fans ("Team Provenzano") pose after the Susan B. Komen event on June 5, 2011.

We spotted a man carrying his pre-schooler on his shoulders. His T-shirt read "In memory of my mother; in memory of my wife; with hope for my daughter."

For all the free bagels and pink flipflops, this is serious stuff.

Yet, I remember when I started my practice some twenty-plus years ago, breast cancer was practically a death sentence. Period. Not anymore, though.

I hope the future of kidney disease gets brighter. For now, prevention is the only real answer. As Steve would say, "By the time you're on dialysis, that ship has sailed."

But that's not completely true, either. There's transplant. There's better dialysis. There's home dialysis in its various forms.

Yesterday was a good reminder of the various burdens we bear: widowhood, breast cancer, kidney failure - and the very real hope that's tangled up in all of them.

Take care,
Linda Gromko, MD