Waiting: Life on the list
By Lex Alexander
Sunday, Jan. 6, 2008 3:00 am
"I'm a little down today," Waymond Blackmon says about 3:30 on a recent Wednesday. "I guess it's time for dialysis."
Three days a week, Blackmon has a three- to four-hour date with a machine. That standing appointment, those long hours, will continue until the day when he receives a kidney transplant. It's a day that may never come.
The Greensboro man is among about 350,000 people nationwide and roughly 800 in Guilford County whose kidneys have permanently failed. African Americans, who make up about 12 percent of Americans, are more than a third of dialysis patients.
The number of patients has increased along with increased incidence of diabetes and high blood pressure, the two main causes of kidney failure.
Dialysis patients require machines to filter their blood because their kidneys no longer can. Without dialysis, most people with end-stage kidney failure will die within 14 days. With it, some patients have survived for decades.
Dialysis affects every aspect of patients' lives: finances, psychology, energy level, libido.
On this day, Blackmon, 56, a small-projects manager for N.C. A&T's physical plant, has arrived for his treatment at the Greensboro Kidney Center in his work clothes: a gray plaid suit and an A&T ball cap.
He gestures toward a woman who is leaving the center assisted by her husband: "See how people leave out of here? You don't leave out of here with a whole lot of energy."
* * *
Blackmon's family had no history of kidney failure, although it does have a history of high blood pressure.
He was hospitalized in March 2001 with a headache and what he thought was high blood pressure and walking pneumonia. He expected to be out of the hospital quickly. Instead, he spent three days in a coma and nearly died before his doctor told him his kidneys had failed and he would have to begin dialysis.
"I didn't take it negative or positive," he recalls. "But when you walk into dialysis, that's when it hits you: This is something you're going to have to do for the rest of your life."
* * *
After a short wait, a technician calls Blackmon back for his treatment. Treatment takes place in a long, open room in which up to 56 patients can undergo dialysis during a shift.
The technician weighs Blackmon about 141 pounds on this day and checks his pulse and blood pressure. Tracking weight is essential to keeping his fluids in balance. A treatment typically takes five to 10 pounds of fluid off.
He walks the length of the room and sits in the chair where he will spend the next several hours. Next to the chair, he puts his backpack, which contains a battery-powered DVD player, a towel, blankets and reading material.
He waits as samples of his blood are drawn and a patient-care technician, Ashley Reising, inserts dialysis needles into his arm. He does not flinch.
The needles are inserted into a fistula, a surgically created connection between an artery and vein that is used to make a blood vessel large enough for the dialysis needles.
Once the needles are inserted, the tubes attached to them are hooked up to the dialysis machine, and the treatment begins. Reising reclines his chair, and Blackmon drapes himself in a thin blue blanket.
* * *
The best time for dialysis, Blackmon says, is in the morning: "Go ahead and get it over with." But he comes in late afternoon to minimize disruption of his work schedule.
"I like to come in here and relax," he says. "But after a couple of hours, your body says, 'I'm ready to get out of here.'"
After dialysis, he says, he feels exhausted: "It'll take until 9 or 10 the next day to feel perky." Typically, he goes home, tends to the dogs he raises, eats a simple meal he is partial to egg rolls showers and goes to bed.
"That's what you should do," he says. "You don't have no energy at all."
* * *
Nurse practitioner Tracey Sherrod records Blackmon's blood pressure, and it is high 203 over 117. "We've got to get that blood pressure down," Sherrod says, telling him she will get him blood-pressure medication.
Soon afterward, Blackmon's physician, Dr. James Deterding, stops by. Like Sherrod, he stresses the need to lower Blackmon's blood pressure. Soon Sherrod returns with a dose of Micardis for that purpose.
Deterding tells Blackmon that a recent X-ray of his fistula showed no blockages. "Thank God," Blackmon mutters. If a blockage can't be cleared, he has to undergo surgery to create a new fistula.
If Blackmon experiences problems with the fistula in his left arm, doctors can try other sites on that arm. But once all the sites on that arm are used up, doctors must use his right arm. After that? Both legs.
And after that? "I don't want to think about it," Blackmon says.
* * *
Blackmon doesn't complain much about his situation. Compared to many dialysis patients, he is in good health. He frequently walks to work from his home near Bennett College and occasionally takes bicycle trips as far away as Charlotte. He drives himself to dialysis.
"Most times, when you walk in that door, everyone is in a wheelchair or on a cane," he says. "It'll make you humble."
But dialysis can mean life changes nonetheless. Travel is out unless he can confirm that he can receive dialysis on schedule wherever he is traveling.
He must take vitamins to replace nutrients filtered out of his blood along with impurities. As have many dialysis patients, he has experienced depression. He tried antidepressants, but he stopped because "they made me paranoid."
Dialysis also can cause severe cramping.
"Imagine you get one in your stomach as you're lying back, and they're trying to tell you, 'Relax! Relax!'" he says, laughing.
But the cramps are no laughing matter. "It's like someone sticking a knife in your arm or your leg," he says.
He routinely experiences them within hours of dialysis. But they can come at any time, even in the middle of the night, when they aggravate the insomnia that dialysis can cause.
He and the technicians are experimenting with removing less fluid from his body during dialysis in hopes of minimizing the cramping.
"Everyone tries their little techniques to get by the cramps, but no one gets past them," he says.
What helps get him past the pain, he says, is family support, primarily from his brother, Michael Williams, who runs a barber shop on Martin Luther King Jr. Drive.
Blackmon speaks with him daily.
"If I needed something, anything I need, any conversation, I can talk to him about," Blackmon says. "I very seldom request or need anything."
What does Blackmon ask of his brother?
"Cut my hair for free," Blackmon says, "and don't talk junk."
* * *
About 40 minutes into Blackmon's treatment, he rolls up a second blanket and puts it behind his head.
"The chairs are not comfortable," says Blackmon, who is 5 feet 6 inches tall. "I think they're more for tall people. Short people have problems."
At 5 p.m., an hour after treatment started, Blackmon's blood pressure has retreated a bit, to 175 over 113.
He begins reading "A Topical Guide to the Authority of Jesus Christ." "The more faith in God, the less headaches," he says. By 5:30, his blood pressure has dropped a bit more, to 165 over 105. It's time, he announces, to try to take a nap. But after 20 minutes, he gives up and turns on his DVD player, which plays "Tales from the Neverending Story."
"I'm into the kiddie movies," he says.
About 6 p.m., he begins receiving an intravenous iron supplement. Dialysis patients frequently have anemia. His blood pressure is 161 over 109. On the other side of a screen, a patient is talking loudly.
"Sometimes he's next to me, and it'll (make me mad) because I'm trying to sleep," Blackmon says. "But you can't complain. He's been on dialysis for 10 years."
* * *
Some patients have survived on dialysis for decades, but Blackmon hopes not to be one of them. He is a candidate for a kidney transplant, one among more than 66,000 nationwide.
He spent several years on Duke University Medical Center's waiting list before switching to the list at Wake Forest University Baptist Medical Center. Baptist is closer, and he thinks its program is more aggressive about finding donor kidneys for patients.
Twice, Duke called to alert him to prepare for a possible transplant near Christmas in both 2004 and 2005.
"Then they called two or three days later and said someone else was a better recipient," he says, "so you know my Christmas was (crummy)."
As of Dec. 28, Baptist's waiting list had 463 people, according to the Organ Procurement and Transplantation Network, which coordinates transplants nationwide.
The center performs about 125 transplants a year, and 15 to 20 people on the waiting list die of kidney-related issues each year, says Dr. Patty Adams, a professor of medicine and chief of professional services at Baptist.
The median wait for a kidney for African Americans in 2001-02, the most recent figures available, was about 44 percent longer than for Caucasians, according to the Organ Procurement and Transplantation Network.
Many factors can affect how quickly a patient receives a transplant. They include the availability of a living donor, blood type, other health conditions and how reactive a patient's immune system is likely to be to a transplanted organ.
Some dialysis patients prefer the security of the known to the risk of transplant surgery, Adams says, even though transplant success rates average 90 percent.
"There's some risk to any surgery, but if you survive the early days of it, then your risk becomes considerably less than dialysis," Adams says. "But a lot of people are frightened of having the risk up front."
Reising, the patient-care technician, is all for transplants.
"It wouldn't bother me at all if I came in and didn't have a job because everybody had gotten a kidney," she says.
* * *
Shortly after 6, Blackmon calls a friend, Tonya Clinkscale, to invite her to lunch on Friday. Then, about 6:10 p.m., he says, "I'm starting to get dizzy."
He can cut his dialysis treatment short if he begins to feel bad. And he sometimes does, although he must sign a release for the center when he does so.
About 10 minutes later he tells Reising: "I'm ready to go. I'm feeling dizzy."
He adds, slowly and thickly: "Hear how my voice has started changing? I'm dizzy. It's time to get off."
Cramps and sudden drops in blood pressure also can lead him to end treatment, he says.
"When you go through cramps, heart spells and your blood pressure drops, the next day you ain't got nothing," he says. "You may as well spend the day in bed."
For Blackmon, who must be at work at 7 a.m. the next day, that isn't an option.
As Reising begins preparing to take him off the machine, he already sounds better.
"In about half an hour, I will feel better," he says. And he'll drive himself home.
Contact Lex Alexander at 373-7088 or firstname.lastname@example.org