14 years (and then some) and counting

It’s been a long time since I’ve posted here. I’ve been struggling to find time to write, even though it’s the only thing I’m really sure I want to do. But writing is hard, so I tend to forget the joy it brings when I get the words so right it brings tears to my eyes and can only remember the times when the words won’t come.

Since my last post about the primary care doctor who sent me a note telling me how to prescribe dialysis someone asked, “So what ever happened with that?”


“Oh, we had a hospital-wide town hall where everyone expressed their feelings about unconscious bias and policies changed,” I said.


And that someone’s face smiled brightly and said, “Really?”


“No,” I said. “Nothing happened.” And their smile faded into a knowing nod.


But maybe that’s not entirely true. Maybe a peer or two uttered something close to a “not cool, man” to the primary care doctor. Maybe my writing and tweeting and talking caused him or someone like him to rethink their actions. Or someone like me to respond differently.


What happened for sure is Rob’s and my transplant anniversary. Since I started this blog in 2014, I had been announcing the anniversary every April 15 (or thereabouts). Nine years and counting. Ten years and counting.


With each passing year, I’ve noticed the congratulations and acknowledgments wane. I get it. For everyone else it’s really only exciting when it’s new. But for us, it remains extremely exciting. We celebrated with gratitude another year of two healthy kidneys between us and hope they take us until we are very, very old. Fourteen years and counting.


reflections of a victim of unconscious bias

A few weeks ago, a primary care physician colleague (white man)—who I’ve known for over a decade—sent me the note below by way of our mutual patient’s caregiver (white man) open, not in a secured envelope.  In the past nearly 4 years the patient has been under my care, the colleague has not once reached out to me by email, phone, text, tweet, telegraph, or carrier pigeon regarding our patient.


He did, however, reach out to my boss (white man) and a hospital executive (white man) a few months ago when the caregiver (reminder, white man) first complained no one in the dialysis unit was listening to him (though the caregiver has never spoken to me directly about his concerns because, I just learned, he found me “intimidating”).

the meaninglessness of an eye flitter

A couple of weeks ago, I was the attending nephrologist for our hospital consultation service when I met Mr. Jones. He had suffered a severe heart attack. His heart was stunned into stillness and couldn’t effectively pump oxygen-filled blood to his kidneys or any of his other parts for the however many minutes it took for the ambulance to get to him and start resuscitation. Once he was transferred to the hospital, the cardiologists successfully reopened the major coronary artery responsible for the attack, but his kidneys weren’t working as well as they had been before. But his kidneys were the least of his troubles. My interaction with his family reminded me of an experience in my own life from about twenty years prior.

irrelevant words matter

It was Friday afternoon and the last patient of the clinic day had arrived. A new patient to me. While the medical assistant asked her screening questions (Do you smoke cigarettes? Do you have pain? Have you fallen recently?) and checked his vitals (blood pressure, heart rate, weight), I started to get to know him through his medical record. I began with the clinic referral to find out why he was in my clinic in the first place. Would I be figuring out why he had an electrolyte problem (like low potassium levels) or thousands of grams of protein in his urine (when normal is less than 30 milligrams)? Or would I find the usual, a case of irreversible kidney damage caused by high blood pressure and/or diabetes? The first line read: 70 year-old formerly incarcerated man with recent hospital admission for…