four stages

I last saw her 6 weeks ago in my clinic exam room. I told her that her kidney function was getting worse. It was time to start preparing for dialysis. Tears ran down her chubby cheeks.


I had offered her a tissue with my left hand and rubbed her knee with my right. I had tried to console her. This is hard. I'm so sorry.

“But what if I lose weight?”

“I think I’m just under so much stress at work. Maybe I should start working?”


I had tried to explain that there was nothing she could do to reverse her condition. Unfortunately this is what chronic kidney disease does over time. It gets worse. I’m so sorry.

“I should have taken better care of myself.”


I had tried to help her forgive herself. You can take good care of yourself now. It is time to start preparing for dialysis.

Now, staring at my computer screen I learned that instead she decided to run.

“She canceled her next appointment,” read the medical assistant’s email. “She said everything is fine, she just needs a break from the medical center.”


A palliative care expert once told me that denial is a good thing. A way to cope with a difficult situation. Maybe denial is a good thing for a cancer diagnosis. But I don’t see how it is good for people approaching end-stage kidney disease. Denial in people approaching end-stage kidney disease leads to chaos that could have been avoided. Emergency Rooms. Dialysis catheters. Hospital beds.

Taking care of people with worsening chronic kidney disease sometimes feels like a case study in four of the five stages of grief. There’s one I always seem to miss.


Another one trying to run away from her kidney failure, I thought. Unfortunately, her kidney failure would not take a break. She would never outrun it. I’m so sorry.

I shook my head in disappointment, feeling like I’d failed her.