joke's on us

He looked so good, I stopped at the open exam room door and turned back to the fellow and asked, “Is the patient in the bathroom?” “No, that’s him sitting there,” he said.

Mr. Cruz is 79 years old, with black hair so thick and caramel skin so smooth, I thought for sure I was looking at a man in his 60s, or even 50s. Only the thin blue lines of arcus senilis outlining his brown eyes gave him away.

arcus senilis

He claimed to feel as good as he looked, but I suspected he wouldn’t for long. He only had about 5% kidney function left.

His daughter sat in the chair beside him. Though it was their first time in our clinic, I felt pressure to have a conversation about the treatment options for people who only had about 5% kidney function left. No time for an extended getting to know you courtship. Like trying to slide into home base without even bothering to pick up the bat.

I presented the options of dialysis and no dialysis. What both would entail. That people over age 75 with health problems other than the end-stage kidney disease lived as long without dialysis or with it. And maybe had a better quality of life without it.

“Of course he will start dialysis. I want him to live,” she stated firmly through the interpreter.

I did not protest. Despite his chronological age, Mr. Cruz had no known history of dementia or much of anything else, really, to suggest he would be among the ones who have no clear benefit from dialysis. Maybe he would have another decade or so with dialysis. He definitely would not have years without it. A few months perhaps.

Still, I noticed Mr. Cruz stopped talking.

***

“Why is the casket closed at a cancer patient’s funeral?” my oncologist friend started, a coy smile on her face.

“So the oncologist won’t try to do more chemotherapy,” she finished, laughing at her joke.

I laughed too. “I heard that joke differently.”

“How did you hear it?” she asked.

An oncologist walks into a funeral home, looking for his patient. The casket is closed. He opens it and is surprised to find it empty.

“Where is my patient?” he asks an attendant, “I wanted to give him one more round of chemo.”

“Oh, they took him to dialysis.”

As I embark upon this work of trying to change how we think and talk about end-stage kidney disease, I wonder if in the complete version of this joke the attendant goes on to say:

…“Because the family insisted.”