old habits are hard to break, part 1

Her inhaled surprise and brows knitted in worry as I spoke the words made me regret them immediately. “Your mother has about 4 percent kidney function left.” I prided myself on my habit of explaining disease processes and lab results in that just right Goldilocks place of not too hard and not too dumbed down. An explanation of what proteinuria is began with likening the glomerulus, the filtering unit of the kidney, to a colander with holes large enough to let water and dirt—urine and toxins—pass, but too small, unless damaged by certain diseases, to allow your lettuce—protein—to get through.

But here was a situation that called for vagueness. Just a reassuring declaration of “stable” to make the inevitable not seem so imminent. After all, without dialysis, one cannot live with zero percent kidney function. Many would have been started on dialysis with 10 percent kidney function.

As the nephrologist in this half-day a week clinic about once a month, I hadn’t met them before, but I could sense the gears of Daugther’s mind churning. She already knew the percent was 5 a month prior from the last provider who saw them in this clinic. To hear “4” now couldn’t be good. Four was lower than five. Lower was less. Lower was worse.  Four was closer to zero. Maybe Mother’s decision to forego dialysis was not a good one, even though she was 90 years old. Daughter wasn’t ready to lose her mother.

old hands It doesn’t matter if the percent is 5 or 4, I explained trying to clean up my mess. What is important now is how your mother feels. But it was too late. There would be no undoing this damage. At least not today.

Mother sat next to Daughter, not seeming to care at all that she was not quite understanding all of the English words being spoken. Her eyes, tea-stained and encased in wrinkles, twinkled when she smiled her tooth-lite smile. She twinkled often.

But Mother was having some nausea. It seemed the blue and white pill that she takes three times a day, yes the Phoslo phosphorus binder, was causing it. Well, why don’t we stop that medicine and see if it helps, I suggested. Your mother being able to enjoy her food is more important than the phosphorus blood test. The phosphorus level doesn’t need to be as low as it is. Daughter’s eyes widened as if to ask what kind of doctor was I, suggesting fewer pills? Could I be trusted? Was I trying to let Mother die sooner?

And Mother was having some constipation. Well, why don’t we stop the iron pills, I suggested. Her anemia tests are fine.  Daughter’s eyes widened wider.

It’s OK, Doctor. I give her the Colace.

Well, maybe she wouldn’t need the stool softener if she wasn’t taking the constipating iron, I offered.  The fewer the pills, the better now. Better to focus on how she is feeling. Better to focus on things she enjoys.

Nodding. She doesn’t like the pills, Daughter confessed. Maybe I am getting through, I think. Maybe I am helping Daughter see a different way of caring for her mother now was still caring for her mother. She agreed to stop giving the Phoslo.

***

I called a few days later to see if the nausea was better. The severe kidney failure alone could have been the culprit all along.

Oh, yes, Doctor, thank you, said Daughter. It’s OK. The nausea got better…so I started back giving her the Phoslo.

I sat with my ear to the receiver, believing that I had not helped at all.