Long before anyone asked the Make America Great Again crowd to pinpoint exactly when America was great if you were Black, I heard a White stand-up comedian joke about how he could pretty much go back to any time in history and be ok, and acknowledged a Black person would not be ok. Hell, we’re still not ok.
But when I think about medicine, no one could go back in time and expect to be better off. And not just from the discovery of antibiotics or anesthesia perspective—from all the perspectives!
For example, when I donated a kidney 18 years ago, I could have a laparoscopic procedure. I was left with three little scars where the trocars were inserted and one longer one at my bikini line that my kidney was pulled through. And that one doesn’t really count, because I already had a C-section scar there. Someone who had donated earlier was damn near cut in half, because the laparoscopic technique didn’t exist!
Similarly, as I was working on my latest installment of Real Kidney Talk with The People’s Nephrologist in which I explain what a kidney entails, I remembered that time during my nephrology training when I was shown how to do a kidney biopsy without ultrasound guidance. Now I’m old school enough to have been trained how to (and often did) insert IV’s into big central blood vessels like the internal jugular and femoral veins without an ultrasound, where if one fucked around and failed to aim toward the nipple for the IJ (which seems counterintuitive when you’re looking at the neck) or forgot which way the V-A-N was moving out of the groin (vein-artery-nerve or nerve-artery-vein?) and puncture the artery instead of the vein, one would find out just how fast a person could bleed out. But a kidney biopsy?!
My nephrology attending walked me through how the radiologist would put the patient into a CT scanner to locate and mark a spot on the person’s back for them and how, after cleaning the area properly, would give the local anesthesia and insert the biopsy needle based on that mark. And because the kidney moves a little below the protective ribcage with a full inhale, they knew the bottom of the needle was in the right place when the top of it moved back and forth as the patient breathed. And the biopsy needle itself looked kind of like one of those corkscrew wine bottle openers, nothing like the fancy one with a button to deploy the needle and retrieve the sample that I was used to. While I never had a serious complication doing biopsies with ultrasound guidance, I can’t imagine not having a complication doing one the way my attending had been taught.
As many academic centers are or already have shifted to invasive radiologists doing kidney biopsies, I imagine my video will seem irrelevant to patients in a few years. But I hope it helps make the way it’s done now feel a little less scary.