The distress call came to me fourth-hand in the form of an email. The colleague of a colleague’s wife’s father wondered if I could help because the father was contemplating stopping the peritoneal dialysis his wife had been helping him do at home for the last several years. He understood that if he stopped dialysis he would die within the next week or so. But death—and the sooner the better—was exactly what he wanted. So the itching would stop. The itching consumed him—and had been, all day, all night for the better part of a year. He scratched his itches until his skin bled and left sores behind. He scratched his itches instead of sleeping. He could see no end in sight. He didn’t want to, he couldn’t, wouldn’t continue to live like this.
But stop dialysis? Oh, you must be depressed, his nephrologist had said and prescribed an antidepressant that the father refused to take.
Hell, I would be depressed too.
There was a time not so many years ago when I had pain in my lower jaw. At first it just felt like a quick stab of a needle when I chewed on that side, and not even every time. But a year later it became like the stab of an icepick every time I chewed and a twisting of that icepick all the times in between. My dentist thought the wisdom tooth was the culprit and recommended I have all of them removed, so I did. But the pain only got worse.
All day, all night it demanded my attention. For weeks. It relegated me to a diet of soup for lunch and soup for dinner. I learned I liked clam chowder. I took an opiate pain medicine that really didn’t help at all until I couldn’t shit for days, so I switched to a medicine specific to nerve pain. It eased my pain from a constant bone-chilling scream to yelling like I was hard of hearing, but I couldn’t imagine living the rest of my life like that. I could see no end in sight. I too wished I could die. So the pain would stop.
The surgeon who pulled my wisdom teeth didn’t know why I hurt so badly. Maybe it wasn’t your wisdom tooth at all, my dentist said eventually. More carefully he examined the tooth in front of the place my wisdom tooth used to be and discovered it was dead, so he sent me to the endodontist for a root canal. The pain vanished soon after the root canal and my death no longer seemed necessary. The sun had started to shine again.
I understood where the father was coming from.
“We can talk about what stopping dialysis would be like, but let’s see if we can make the itching go away first,” I said to the father as I sat with the him along with his wife and daughter in his cozy living room. I hoped I could suggest something helpful as I reviewed his records and listened to what had happened to date.
His nephrologist thought maybe high phosphorus or not enough dialysis was to blame for the itching, but test results showed that both were where they needed to be. Sometimes people on dialysis just itch for reasons we don’t really understand, so the nephrologist threw up his I-have-no-clue hands and sent the father to the dermatologist.
The dermatologist biopsied his skin but found no specific cause either. She prescribed some steroid creams that felt really good as they were being slathered on, but seemed to evaporate minutes later, leaving the itch at its fullest. Maybe you should switch to hemodialysis, she’d said, believing it was better than peritoneal dialysis. (Bless her heart—she didn’t know any better, which makes me wonder why her dermatologist self would even bring it up, so really just bless her heart.)
“I read that maybe Gabapentin could help,” the daughter said.
My eyes stretched and my jaw dropped wide, because I was thinking about the fifth or sixth things I might try, assuming that surely the first four things had already been tried and failed at some point during the better part of the past year that the father suffered so.
“You haven’t tried Gabapentin?” I asked once I collected myself from proving yet again that to assume means to make an ass out of “u” and especially me. The daughter, the mother, and the father all shook their heads at once.
The day before, the father had taken half of a Gabapentin out of his wife’s supply that she took for her chronic pain. Just one dose dropped the itching from a death wishing “10” to an oh-this-ain’t-so-bad “2” for the better part of the day. All that was left for me to do was give some basic recommendations on how to dose the Gabapentin to get the father to an itch?-what-itch? “0” for a patient on dialysis that would last all day long.
But even at an oh-this-ain’t-so-bad "2" his outlook had already changed. No longer did he want to stop dialysis. He didn't feel like he needed to, had to. Something could make the itching stop. The sun was shining again.