Grief Lives in the Marrow

I feel it in my bones; we're coming to the anniversary of Steve's death on April 13, 2011. I've had grief experiences before. I know how it feels impossibly difficult at the beginning, then it softens, then it comes in waves as innocent stimuli from the world open wounds that were only tenuously knit together.

Anniversary Phenomenon in medicine refers to that under-the-surface sense that something isn't quite right: a visceral understanding of heightened vulnerability born out of a prior loss. 

In my medical practice, when people are feeling sad/lonely/depressed/scattered/hopeless/"off," I'll ask, "Did something of any particular significance happen to you at this time of year?"

The answer is often, "Oh, yes...it was at this time of year when my brother died," or something of similar importance. That's when we talk about the power of grief, and the power of Anniversary Phenomenon.

So, now as we near the end of March, I remember the wound on Steve's big toe: the impossibly large blood blister that appeared the day the elevator door closed on his foot - or maybe, his feet - in the candy-apple red electric wheelchair. It happened on a date: one of our deliciously normal movie dates to a movie and a meal, courtesy of the sometimes uneven courtesy extended by the Access Bus.

I remember the horror as the healing foot suddenly changed: dusky black spreading through the forefoot, lines of dessication along the sole of the devitalized foot.

This photo shows Steve and me preparing for an after-Christmas party in 2009. It was in March 2010 that he had his enormous heart surgery to replace a strangling aortic valve and bypass narrowed coronary vessels. He was terribly sick even in this photo - on dialysis, his heart failing - but he was ambulatory. I love this photo of us working together, to prepare for one of Steve's favorite activities: food with friends on Bainbridge Island.

Brita and I have worked to establish a new normal, and for the most part, I think we've been very successful. But Steve's presence was big in every way. We all miss him.

I know in my heart that he would likely have gotten much sicker, in spite of his valiant struggle and in spite of our cooperative efforts to win him more time. I am comforted by the fact that it is I - not he - who is grieving. At least, we think death exempts us from that piece.

Steve's story: Let Me Go When the Banter Stops: A Doctor's Fight for the Love of Her Life comes out in May. I'm half-joking with friends that I'll promote it with a free box of Kleenex. But then, that would have been a Steve Williams marketing tool!

Take the best of care,
Linda Gromko, MD
Author of Complications: A Doctor's Love Story

"Let Me Go When the Banter Stops" is Coming in May!

We're getting closer to the first anniversary of Steve's death. I do not miss dialysis, but I sure miss him.

I wrote throughout Steve's illness - his fall into acute-on-chronic renal failure, his heart events and heart surgery, his critical illness myopathy, his leg amputation, and finally, his death on April 13, 2011. Through chapters written in real time, through correspondence, through this blog and medical records, Steve's story is carefully chronicled.

"Let Me Go When the Banter Stops: A Doctor's Fight for the Love of her Life" will be released in May 2012.

As I gathered consent signatures from over one-hundred individuals, i.e. consent to be named in the story, it became apparent to me that Let Me Go When the Banter Stops represents a true community effort. And a tribute to Steve and the people who worked so hard to try to get him to the point of having a second kidney transplant.

I worked for hours to prepare the manuscript and photos for submission. I got them all in...and within two hours, my computer simply crashed. It was as though the little laptop limped along just far enough to get this project off the ground! And then, time for a break.

This unusual photo captures Steve all velcro'd into the standing table: a device used
to help him learn to adjust to standing after months of being bed-ridden. He
managed to stand for a total of two minutes, but the dream of walking was out of reach.


There's a lot of medicine in the book. I sincerely wanted to educate people about metabolic syndrome, diabetes, renal failure - and the prevention of these maladies. But at its core, the book is always a true love story.

Let Me Go When the Banter Stops will be available through my website (http://www.lindagromkomd.com/) and through Amazon.com. A Kindle edition will also be available.

Take care,
Linda Gromko, MD

Time to Get Zealous!

I'm attending a Continuing Medical Education conference presented by the University of Washington today and tomorrow. It's a comprehensive CME on Diabetes for the Primary Care Provider.

Having done my late husband's home dialysis care for several years, I am very aware of the human costs of diabetic renal failure. Puncturing your spouse's arms with 15 gauge needles several times a week gives you the right to be a bit of zealot in wanting to prevent diabetes in general, and its renal complications in particular.

We offer a Weight Loss Program in my primary care clinic.Throughout the conference, we're hearing "diet and exercise." That's what we offer - and we take our clients on activities: rowing, kayaking, walking, etc. We're serious!



Queen Anne Medical Weight Loss holds an "Experience Rowing" event at

Lake Washington Rowing Club in May, 2011. This boat had lost a total of 300 pounds: enough

to "build" two whole rowers!



There's just no question about it: we can help reduce the severity and complications of diabetes through lifestyle measures: weight control, physical activity, etc.

We all need to be zealots in the area of prevention: health care providers, educators - all of us. Especially when you know what the consequences of diabetes can be, like I do.

Take care,

Linda Gromko, MD

Day of Remembrance Offers Poignant Support

I've been in health care as a nurse or as a physician for nearly forty years. I've seen people live and die with all sorts of illnesses. But never any disease as relentless or as complex as End Stage Renal Failure. Thankfully, we have transplant and dialysis - but these aren't exactly a walk in the park.

With dialysis, you must affirm your decision to live every day - or at least, you affirm your decision to try not to die.

"Civilians" don't always do that - and maybe we should.

Today, in a Ceremony of Remembrance held at the SeaTac Kidney Center, a harp played as folks gathered. Then, a chaplain lead readings about grief and loss. 

At one point, everyone was given the opportunity to place a colorful stone in a bowl of water at the front of the room. The bowl sat on what looked something like an altar, flanked by a floral arrangement and flickering candles. We then took another stone with us to keep as a remembrance.

Person after person stood, approached the table, and picked up their polished stones.

      "For my husband, Steve Williams," I said, as I deposited the stone with the others in the bowl of water.

      "For my little brother, Steve Williams," said Carole.

And on and on, each person remembering a spouse, a parent, or worse - a child. Some of the losses were very recent. The Kidney Center organizers had been considerate in leaving a small packet of Kleenex on every other chair.

Everybody in that room - at least everybody who had lost someone - knew about kidney disease in a way the rest of the world simply cannot.

As we left, we noticed that wall defining our hallway was shared by an active dialysis center - with treatments going on, even as we remembered our lost loved ones. We saw the overhead television monitors; we couldn't see the patients, of course.

But we knew that somebody there was likely having fistula challenges. Somebody was forgetting to take their phosphate binders. Somebody was having muscle cramps at the end of their treatment. Somebody was waiting for a transplant. Somebody was watching football to pass the time, and somebody was simply bored.

End Stage Renal Failure is a condition you want to prevent at all costs. Remember, the most common causes are high blood pressure and diabetes - often preventable, always modifiable.

On a day of remembrance, we remember the people we've lost. But, we remember what the disease was like also.

Take care,
Linda Gromko, MD

Ceremony of Remembrance Set for Saturday, December 3, 2011

The Northwest Kidney Centers' annual Ceremony of Remembrance is scheduled for Saturday, December 3rd at the SeaTac Pavilion (17900 International Boulevard South; SeaTac, WA 98188). The ceremony will be held from 10-11 a.m. Attendees are invited to bring a memento of their loved one for the Memory Table.

So, what to put on the Memory Table? There's certainly no one thing that captures the essence of my late husband, Steve Williams.

Maybe the grey knit stocking cap and matching gloves I'd put on Steve when we'd go on our dates during the last few months of his life. Dates via Access Bus that allowed us to take in a movie and a meal, dates that gave us a few wonderful hours of fantasy-normalcy each week.

"Linda Jo," Steve would say referencing his marginal appearance, "Let's go out and sell us some pencils!"

Or maybe it will be the "Life is Good" brand T-shirt I bought for Steve when we went to San Diego for the IHRSA Convention (a convention for those in the fitness industry). We went with dialysis machine and all - dialyzing him in the hotel in the evenings. Steve wore that shirt constantly. Maybe it was the salmon on the front; maybe it was the caption: "Good Catch." He was a great catch!

I'm glad there's a ceremony. People we love slip away too fast, and the world moves on - as it should. But the people left behind after a loved one's kidney failure and dialysis have a different perspective of the world, I'd imagine. I know I do.

For further details, and RSVP information, google up Northwest Kidney Centers.

Take care,
Linda Gromko, MD

The Little Kidney Blog Hits 10,000 Pageviews!

Today, my little "Kidney Blog" hit 10,000 page views. I know that may not be an enormous readership as blogs go, but for a little blog of such humble beginnngs - and grandiose intentions - it feels like a milestone to me.

The intentions have been as follows:

• To chronicle issues of Home Dialysis, both hemodialysis and peritoneal dialysis - at least from the experience of Steve and me
• To focus on the support of the all-important CarePartner in Home Dialysis
• To increase awareness of Chronic Kidney Disease - and its prevention.

But the blog has covered other issues also. Issues like rehab, dealing with chronic illness, grieving, preparing the home for ongoing medical care. The most widely read post was not about kidney disease at all!

From the blog's beginning on October 25, 2009, the most popular posts have been:

• A Young Breast Cancer Survivor Talks About Discussing Chronic Conditions with Children - March 10, 2010.
• Stephen Martin Williams (8/16/49-4/13/2011) - April 14,2011
• Welcome to Linda Gromko's Blog - October 25, 2009
• Amputation Puns and Drug Delerium - April 10, 2011
• The Inn at Cherry Hill - Useful Recycling of Old Hospital Space - April 15, 2010

Thank you for following along on this journey. Please keep reading as the journey continues.

Take care,
Linda Gromko, MD

Journaling Reminds us Where We've Been

I don't write an official "journal." Rather, I write chapters - currently, I am working on a book with the working title: "From Complications to Grace: A Family Doctor's Journey." This will be the "rest of the story." My first book, "Complications: A Doctor's Love Story,":chronicled Steve's first year of End Stage Renal Disease, discussed Home Dialysis in some detail, and basically told the story of finding an atypical love in midlife.

Another great tool for journaling is, of course, blogging. This very simple accessible tool allows us to chronicle our own lives - and to be diligent at the discipline of regular writing. (Try your own at http://www.blogger.com/.)

Why should we journal anyway?

In my experience, journaling - by whatever techique you happen to like - is inexpensive therapy. It collects our thoughts, allows us to ventilate, and most importantly, allows us to keep track of what we've gone through. It facilitates enormous catharsis.

My favorite journaling outcome is that I can say, " I may be stressed or struggling right now, but look what I've made it through! This is a relatively easier time. I can certainly make it through this."

Simply put, journaling reminds us that we are stronger than we might believe at any given moment.

Look for "From Complications to Grace: A Family Doctor's Journey" sometime this winter. It won't be boring. And I'm open to any modifications of my working title. I remember that Steve's preferred title for the first book was "Steve Williams is Sexually Gifted."

Journaling keeps our humor accessible, even when we are grieving.

Take care,
Linda Gromko, MD