I had just finished presenting my body of research for the prior six years in hopes of convincing the committee I was worthy of promotion from Assistant to Associate Professor of Medicine when the chairperson said, “It is clear palliative care is your passion, so you should stop wasting your time with the dental research." I. Should. Stop. Wasting. My. Time.
Now, truth be told, I agreed with her. Not because I didn’t think I was doing important work—I published 2 papers showing that people with severe periodontal (gum) disease and normal kidney function were much more likely to have clinically significant kidney disease after just five years than people who didn’t have severe periodontal disease. I was working with a colleague to find evidence of bacteria that caused periodontal disease in kidney biopsy tissue. I was even running the longest randomized controlled trial to find out if treating the gum disease would slow down how fast the kidney disease worsened. And I was one of only a handful of people around the world doing this work.
Rather, I agreed with her because she was right. Palliative care for patients with kidney failure was my passion. And the only reason I was doing the dental work (other than the obvious that it would be cool if taking care of peoples’ mouths could slow down kidney disease) was because I didn’t discover palliative care first.
Palliative care crossed over into every area of my work life. I could see all the research that was needed to help patients, families, nephrologists, and other clinicians realize that dialysis isn’t always the best thing to do and that dialysis isn’t the only thing that should be done for people dealing with end-stage kidney disease. I had a vision for how we could better take care of our patients with advanced kidney disease. Hell, I was even working on figuring out how to incorporate teaching communication skills, symptom management, advance care planning, and all the other things that go along with palliative care into the nephrology fellowship training even though I am content to work on my little projects in my little office—simply because I don’t want our program to keep graduating new nephrologists that can calculate the shit out of how much hypertonic saline to give a patient with very low blood sodium level, but can’t look a person in the eye and talk about the life and death he can expect with kidney failure.
But still—it ain’t every day somebody says some shit that feels like a Mortal Kombat finish ‘em body blow to the chest. Yet at the same time, there is something quite validating about being pushed to do what your heart already wanted to do. So here’s to 2017 and to fulfilling my work heart’s passion in a way that I hope helps others (and gets me promoted ;) )!