here we go!


Twenty-six million adults in this country have chronic kidney disease and over half a million have end-stage kidney disease, yet most Americans don’t know what dialysis is. And what the hell is a nephrologist? Until I went to medical school, I was no different. I’m just a country girl from Spring Lake, North Carolina-- outside city limits, where distances are measured in fields because there’s no such thing as a block.  I didn’t come from doctors, didn’t know any doctors, and rarely saw a doctor. No need to see one when Robitussin, Calamine lotion, and Vick’s Vapor Rub cured all that ailed. So that I ended up becoming a doctor—and a kidney specialist at that, was unlikely, unanticipated, and damn near accidental.

Long story short on how I got to this point: I was a primary care doctor who started dating a man who was on dialysis. (No, he was not my patient. That’s nasty.) I went with him to a kidney transplant evaluation appointment and did not like what I heard. That and love led me to giving him my left kidney and becoming a nephrologist. (Too short? I’ll say more in another blog entry or 2. Maybe even 3. Promise.)

Entering nephrology exposed me to a side of Medicine that I could not see as a kidney donor or even as a primary care doctor. It was like stepping into the Land of Oz. But instead of Munchkins and lions and tigers and bears (oh my!), this new world was rife with dialysis machines, magical thinking, and fear.

No doubt my background as a primary care doc, a patient, and lover of a patient have created a unique lens through which I see this world. That and my sensitive soul leave me deeply affected by experiences with patients, nephrologists in training, and colleagues from my own training to where I sit now, about 5 years into a faculty position at San Francisco General Hospital. Some of these experiences have been disturbing. Some heartwarming. Some just plain sad. But all of them, I believe, have taught me something, made me wish for something different, or made me pause for a moment and think about why they’ve stayed with me. In this blog, I hope to share many of these experiences with you.

Why blog? Here are 3 reasons in no particular order: Because the last patient story I wrote took 14 months from first draft to making it into the world in the form of a health policy journal article. Because I hope this type of writing will lead to something positive for as many somebodies as possible. Because I need the writing practice.

For those of you in the medical field, be it within the Land of Oz or not, I hope my blog stories will resonate with you, lead you to think about something in a different way, or even affect how you engage patients and families.  For those of you who have or love/care for somebody with chronic kidney disease, I hope this blog will give you some information and some understanding of this sometimes irrational and usually too aggressive world of Medicine in a way that will affect how you interact with health care providers or even how you think about yours or your loved one's health care.

Not that I think my way of thinking is the way you ought to be thinking. Truthfully, I’m still trying to figure a lot of this out. There are many contradictions in Oz and it is most definitely in full color—no black and white here.

Like my background, I think this blog is unique. There are several nephrologists blogging about the science of nephrology and quite a few patients blogging about real life on dialysis. This blog is somewhere in the middle. As promised, I will give you more of the hows and whys that led me here. And I may venture into a little science for background information from time to time. But mostly, I will stick to the stories, the Art of Medicine.

A few more promises: This blog will be non-fiction. I might change a detail here or there to protect identities, but the meat will remain, often raw. There will be lots of stories about my experiences with patients—the living will have given me their blessing to write about them or I will keep the description too vague to identify. I will make my best effort to get blessings from the loved ones of the dead. All others are fair game as I see it, but I will not include names and know my intention is not to bad-mouth any individual on a personal level. I will be honest about my stuff too. Finally, I will make my best effort to blog once a week. I hope you enjoy it.