defining success

Last week I gave my first truly invited international talk at the American Society of Nephrology Kidney Week in Philadelphia. I say “truly” because I did give a couple of talks about my dental-kidney research in England last year, but I offered myself up on a platter and they kindly accepted. Looks good on the cv because whose to know the background unless I tell them? But I know they ain’t the same, mainly because of the degree of nervousness I felt for each. Having been required to submit the slides for this talk back in August, I had been extremely anxious about it for 3 months. So anxious that I told myself—if I could just get through the talk without crying or soiling myself (with vomit, urine, diarrhea, or some combination thereof), then I would call the talk a success.

But then I began to compare this attitude to a point I made in my talk—that given the tremendous burdens that dialysis can cause in frail people or those with a lot of health problems besides end-stage kidney disease, survival cannot (or at least should not) be our only goal when we are making decisions about whether or not to start patients on dialysis. While containing bodily fluids throughout my talk certainly is a critical start toward a successful talk, things like engaging the audience, clearly presenting data, and imparting knowledge would be required to really define my talk as successful. Similarly, if dialysis keeps my patient alive by removing the potassium, fluids, and toxins that could end her life, but she is enduring severe pain, dizziness, and fatigue in part because of dialysis, can I really say I’m successfully taking care of her?

“I have a patient with like every possible medical problem, but it has been 6 years on dialysis and they are still alive,” I heard a colleague say.

And I didn’t soil my pants.

Good enough.