Thoughts from Mark "Hat" Rackley

“If you lend money to one of my people among you who is needy, do not treat it like a business deal; charge no interest.

• Exodus 22:25

There was a man all alone; he had neither son nor brother. There was no end to his toil, yet his eyes were not content with his wealth. “For whom am I toiling,” he asked, “and why am I depriving myself of enjoyment?” This too is meaningless— a miserable business!

• Ecclesiastes 4:8

“‘Tarshish did business with you because of your great wealth of goods; they exchanged silver, iron, tin and lead for your merchandise.
“‘Greece, Tubal and Meshek did business with you; they traded human beings and articles of bronze for your wares.
“‘Men of Beth Togarmah exchanged chariot horses, cavalry horses and mules for your merchandise.
“‘The men of Rhodes traded with you, and many coastlands were your customers; they paid you with ivory tusks and ebony.
“‘Aram did business with you because of your many products; they exchanged turquoise, purple fabric, embroidered work, fine linen, coral and rubies for your merchandise.
“‘Judah and Israel traded with you; they exchanged wheat from Minnith and confections, honey, olive oil and balm for your wares.

• Ezekiel 27:12-17

On the day of writing this, I had just finished a very hard week, only writing one post.  I was taking my wife hither and yon to get her graft cleaned out.  About two weeks ago, she had her graft infiltrated which led to a series of other problems.  The other problems had been brewing, but now they came to an emergency status – as the surgeon said, an unnecessary emergency status.

I have written before about how at the kidney dialysis center my wife’s fistula was slashed by an IV needle because the technician was told that the needle had to be inserted before he could go on a smoke break, allegedly.  The temporary fix to cover up for that mistake lasted until my wife got home.  By the time the ambulance got her to the emergency room, she had become unconscious with practically no blood pressure.  The IV at the ER was delayed in that the expert phlebotomist of the hospital could not find a vein that was not collapsed due to the lack of blood.  It is a miracle that she did not die.

Then there was another trip to the ER this past April Fool’s Day, actually the night before, but a little after midnight, she was admitted and given a couple of pints of blood.  The blood count (hemoglobin) was so low that they could not explain why she was still alive.

But they take blood samples at the kidney dialysis center at least once each month.  It had been checked.  The reading was well below the danger limit, but the doctors said nothing, never noticing that my wife was bleeding out internally.  She had bleeding ulcers and diverticulitis combined.  She had so much diarrhea that she could not tell whether the dark stool was from blood or the medicines that she was taking.  It took nearly a week in the hospital to get back on track.  She would have died instead of going to the hospital, except that I knew something was wrong and nobody was taking action.  I forced the ER visit.

Now, what is an infiltration?  When you get an IV needle that goes into the vein on one side and comes out on the other side.  My wife’s infiltration was in her graft, used for dialysis.  The graft is not human tissue.  To plug a hole, the flow of blood has to be slowed down or stopped long enough for clotting to plug the hole.  Eventually, there will be so many plugged holes (since artificial grafts cannot heal) that the graft has to be replaced.  So, when the graft is infiltrated, there are two holes, one on the back side, making pressure to stop the bleeding that much harder.

But now, let us look at the dialysis process.  They pump a solution into the vein that is designed to trap the poisons in the body that the kidneys can no longer remove.  Then the blood is drawn from the body and filtered in a machine to rid the body of this solution which now carries the poisons.  For the four hours on dialysis, both pumping in and drawing out is done at the same time.

But if the graft is infiltrated and a second attempt is made to start the process, you have two holes in the graft with no chance to “heal” or really clot.  Thus, for four hours, a small drip of blood went from the graft into her soft tissue of the arm.  Her arm became like a balloon, a purple balloon.  Then with the fierce pressure applied afterwards to stop the bleeding, the fluid retention in my wife’s arm made the pain horribly worse.

By that evening, her swollen arm was extremely hot, about 110F.  There was no sign of infection.  I iced down the arm and she was able to sleep.

What made everything worse was that the vein was occluded.  What is an occlusion?  It is when a vein starts to narrow or clog up.  My wife has tiny veins and while this one was acceptable for dialysis in the arm, it narrows at the arm pit.  This means that the solution that they pump into her stays in the arm, just stretching the graft and vein.  This leads to high blood pressure in that one spot, increasing the leaks in the infiltration holes.

We had to endure a week more of dialysis because the surgeon refused to do the surgery with my wife so bloated.  One nurse at the dialysis center forced others away from my wife, doing everything my wife needed, protecting her from the uncaring nurses and technicians.  My wife had three straight dialysis sessions with this nurse protecting her, without further incident.

The surgeon did a masterful job, but as my wife was about to go to sleep before the procedure, she asked the surgeon why the dialysis people wanted to do the surgery at their clinic without an anesthesiologist.  The doctor said that was how they made their money.  When he saw the worried look on my wife’s face, he leaned in and whispered, “But you are safe in my hands.  I will protect you.”

So there, my wife had a protector at the dialysis center (but the nurse could not be there all the time) and a protector when an angioplasty was needed.  An angioplasty, an invasive procedure.  They do a catheterization in the arm.  They take a lot of pictures.  And then they balloon the vein to stretch it out in the area of the occlusion.  They would put a stent in place, but the vein is trying to create a new vein to bypass the blockage and being in the armpit, the vein is prone to a lot of movement.  The stent could shift and cause damage on its own.

I think of angioplasty, and I think of all the people on the church’s prayer list that have had it done.  The prayer team would pray like crazy for the person to be healed.  Now, my wife has had more than a half dozen of these procedures in the past year and a half.  As I whispered to my wife as she was rolled into surgery, “Don’t worry.  You know the drill.  You have had this done before.”  Strange how a little perspective shift changes our attitude.

But when my wife told me what the doctor had said about how the kidney dialysis people made their money, she was trying to figure it out.

I told her about the insurance explanations of benefits that we get in the mail every month.  When she has a procedure like this in addition to her normal schedule of dialysis, instead of a short letter, we get a booklet.  Instead of one-hundred-dollar charges for a doctor visit, everything is in the thousands.

I then reminded her that one of the doctors who has his initial on the door was supposed to retire last month.  He would not wish to pay to have the lights fixed over my wife’s assigned corner dialysis station – placed there by the nurse who hates her.  To get the needles properly inserted, someone brings their cellphone over to her dark corner and uses the flashlight feature to provide the light necessary.

Why has my “baby been put in the corner”?  She talks to the other patients to pass the four hour time away.  The bad nurse wants all the patients to stay quiet, not have any fun, just get four hours closer to death with their mouths shut.  And my wife disrupts that plan by providing joy to people who desperately need it.

But then my wife asked why technicians were inserting needles.  When we have gone to dialysis in Tennessee or Georgia, the nurses did that exclusively and the technicians monitored the computer to direct the nurses to a patient that was not doing well – according to the computer, and it would be a book to explain the reasons for that.  But at our home clinic the roles are reversed.  She was infiltrated by a technician that had only done two or three needles in her lifetime, poorly trained and unqualified.

I had to repeat what I had said to my wife before.  It was cheaper to not fix a light fixture or a television or put batteries in the television remote.  It was cheaper to have technicians do the needle insertion rather than hire more nurses.  It was cheaper to continuously be understaffed.  It was cheaper to not upgrade the dialysis machines to a newer, better machine.

And again, I reminded her that the doctor with his initial in the name on the door, the company name, was retiring and he had the last call on all expenditures.

This was not a place of healing.  Kidney dialysis does not heal anyone.  It prolongs breathing.  I would say that it prolongs life, but when you are in dialysis 12 hours each week and it nearly takes the remaining 156 hours of the week to recover from the procedure, 99 out of one hundred would say that this is not really LIFE.

And I said that being a nurse in such a facility was hard.  Easy work, but you got to watch people slowly die for a living.  So, the occasional bad nurse has figured out a way to hate and torment the patients.  That way, she can celebrate a death instead of dying a little bit inside when someone you have cared for has passed on.  In a way, her soul died years ago.

But my wife needs dialysis to survive and as one person retires, other doctors take that person’s place, and some of them are very loving and caring. Hopefully, the business will someday soon be more than just a business.

Lord, give strength to all who are having dialysis.  Give strength and patience to all nurses, technicians, and doctors who deal with these patients.  May they all know from whom life began.  You alone control such things.  You alone can truly heal each of us.  We can only fully trust when we are cradled in Your arms.  In Thy name I pray, Amen.

Soli Deo Gloria.  Only to God be the Glory.