First Anniversary: A Special Day.

My apologies, the time line gets crazier as I make the jump from this day last year to the first anniversary of my transplant. Tuesday morning, I received a call from Randy at the office asking if I could help at a Bordeaux Dinner Wednesday night at The Mansion on Turtle Creek. This question came as quite a surprise. I was not even aware of the event. But I wasn't too surprised to decline. The dinner was with a small group of customers honoring the proprietors of two estates that have become cornerstones of Sigel's Bordeaux portfolio, Alfred Tesseron of Chateau Pontet-Canet from Pauillac and Alexandre and Francois Thienpoint of Vieux Chateau Certan and Wings from Pomerol. 

I will omit my notes on the meal and the wines. Needless to say, it was all very special. And quite delicious! If you want to see notes on the dinner and the wines you can read them on my wine blog, Greenville Avenue Wine.

It's difficult to write about the last toasts of the evening. John turned the floor over to Dr. Goran Klintmalm, who started the Baylor Organ Transplant Program 25 years ago. He spoke softly and eloquently of the 'double blessing' made possible by organ transplants. He finished by turning and offering me a toast on the first anniversary of my transplant. I was totally overwhelmed. And he is right. Organ donation and tranplantation is a gift of life and I have been doubly blessed to be a recipient. The knowledge and awareness of this gift grows deeper with every passing day.

I took the opportunity to thank Dr. Klintmalm and his team of miracle workers who do this work. I thanked the donor who died and because of his family's decision to give, I and many others lead fuller, more productive lives. Without the miracles of modern medicine my life would have ended three years ago. It is humbling to be the recipient of such a great gift and it truly gives my life new meaning and purpose.

As Mr. Tesseron and Mr. Thienpoint and others came up to offer congratulations and thank me for what I said, I was once again overcome. 

What a special day!

Transplant! (Almost)

It was an exciting 30 minute drive to Fort Worth. The surgeon had called me while I was on dialysis and said we had made the correct decision to accept the kidney. It was a terrific match and the big news was I was the primary recipient. He would visit more with me later in the day when we were checked in. We travelled light. We were told not to bring personal belongings as I would be changing rooms several times. We checked in through the emergency room, they were ready for us and it went quickly. I noticed another patient checking in for a kidney transplant and it was poignant moment. If the day went as planned, I would be receiving a kidney and she would be going home disappointed.

It was a busy day, as I was taken for X-rays and met with the anesthesiologist, the doctors would be doing followup, doctors who would be designing my cocktail of immuno-suppressants and assorted medications, the chaplain, the social workers and who knows else, all the while talking and texting about the news to family and friends.

Towards the end of the afternoon we met with the surgeon who explained the current situation. Evidently arrangements were still being made as to other recipients of organs from the donor. The donor's body was being kept alive on machines and when everybody was ready, the organs would be removed and transported to the recipients for immediate transplantation. The goal is to minimize the time the organs are not connected to living tissue. At this late point in the day, we were still several hours aways from surgery. He recommended getting started early the next morning so everyone would be fresh and rested. Who was I to disagree with that! So we spent the night in the hospital. The sofa converted into a bed, so Susan was able to sleep in relative comfort and would not have to drive to Dallas and back.

 Early surgery was set for Tuesday, October 28.

Receiving the Call

So, there I stood, October 27, 2008. At 3 am. In the middle of the bedroom with a telephone to my ear, shaking Susan violently to wake her up, trying to hear and understand what Bettina was saying, and now trying to tell Susan what was going on and talk to Bettina. All at the same time. It was quite confusing. And exciting.

So the gist was this. She was making the offer of a kidney, BUT it was considered a high-risk kidney. She would give us a few minutes to make a decision.

WHAT??? Is this a reality show???

The risk involved the life history of the donor. He had gone through a period of IV drug use, but the family said he had been sober for the last four years. During that time he had married and had a young son. The blood was clean and there was no evidence of HIV, hepatitis or any other blood born pathogens. We were not the first to be offered the kidney. Bettina did tell me that I was an excellent match and that she would call back in a few minutes.

Now, Susan and I had a quick, life-or-death conversation, putting quite a strain on our not-yet-awake brains. Our initial instinct was to take the kidney. We were not biased by the history of drug use, but my concern was the reliability of testing for blood born pathogens. So, off to the internet!

Initial Google searches produced a lot of generalized numbers and professional sites where you  pay for access to hard data, but real numbers meaningful to real folk like us were hard to find. So we turned to the ultimate source of reliable data for the masses, Wikipedia. Here were numbers, lots of numbers, all footnoted to various medical journals, and easy to read. Best of all, the numbers showed that medical science seems to have blood testing down, well, to a science. At least as far as HIV, hepatitis and worrisome pathogens were concerned. Performance enhancing cocktails for athletes is another story.

We looked at one another and hugged. Our decision was made. But I cautioned Susan that the deal was not closed. There would be many more blood checks and matching tests before transplantation could occur. Several possible matches are brought in for every organ and the kidney goes to the best match. During the course of dialysis I had seen a number of patients be called in for a transplant only to come back to dialysis after the kidney went to a someone else.

It seemed like hours before Bettina called back. It was difficult to keep emotions in check as I told her we would accept. She seemed to be as excited as we were.

Time for logistics. I was scheduled to be at dialysis at 5 am, which was great timing as my blood would be cleaned prior to surgery which they hoped would happen late that afternoon. But first I had to go to Baylor Dallas for blood draws. Then I would go to dialysis and then we would drive straight to Baylor All Saints in Fort Worth late in the morning.

Time for a little technical transplant talk. UNOS (the national organ-sharing bank, check them out) divides the nation into regions around transplant centers. When organs become available they look first at that region. If a suitable match is not found, the search area expands. Each center and region has a list and patients can be listed on more than one list. The catch is that you have to be able to get to the transplant center quickly and remain in that area for 6-8 weeks after transplant for monitoring. Dallas and Fort Worth are centers of two different regions and Baylor Transplant Services administers programs in both cities. It was easy for me to be on both lists.

Now it was a mad dash to throw on some clothes and head to the hospital, which is about 10 minutes from the house. Once there it took 20 minutes to find the right lab. We finally found life in maternity where a kind nurse took us right down the hall to the lab. They quickly drew many vials of blood and we headed to dialysis. I had called and told them why I was going to be late. After many hugs I was rushed into the center and hooked onto my machine for the last time.

A New Day

It was a long glorious October weekend with cool sunny days and blue skies, but filled with death and sadness.

Sunday night (or Monday morning - I have always maintained that it's night until either you wake up or the sun comes up - whichever happens first!) I woke up to hear the telephone ringing. Damn, it was 3 am! At that time of day it's either bad news or a wrong number. Since I was awake, I got up and stumbled through the house looking  for the cordless phone. Of course the phone stopped ringing right before I found it, so I took it back to the bedroom. Before I got there it rang again. It was 3:18 am. 

"Hello, is this David Waddington?" 

"Yes it is."

"Hi, I'm Bettina Goin with Baylor All-Saints Transplant in Fort Worth. I have a kidney offer for you...."

In Memoriam

As detailed in the last post, October 2008 was turning into a month of deep emotional reactions to my experience with kidney failure and dialysis. It was about to get deeper.

I think it was Monday the thirteenth that I came into work after dialysis. One of the managers was due back after a week of vacation, I was greeted with the news of his unexpected death. Charles was a few years younger than I was, but he had died alone in his apartment from a massive heart attack. While Charles did not live a retiring lifestyle, the news came as a great shock, he was not a man who was used to backing down to much of anything. A few days later we received news of the unexpected death of a former colleague who had long been a fixture on the local wine scene. Mike was 56 when he died, the same age I had been when I started dialysis.

Both men were mourned at gatherings of friends and colleagues. Many bottles of wine were shared with tales and memories. The service for Mike was on Saturday, October 25. The following day, some of us from the store gathered Sunday afternoon with Charles' family and friends for a meal and a time together to celebrate and remember. The month had started with deep reflections and the realization that I was living on borrowed time. The death of two friends drove the point into my heart.




 

Jump to October, 2008

Please forgive this two year jump in the timeline. Obviously dialysis was successful and there are more bumps of learning and adjustment to cover in the story. But by October, 2008, I had totally adjusted to life on dialysis. I was feeling so much better and more alive than I had been in the preceding years of trying to ignore Stage V Renal Failure. The improvement was dramatic.

October has always been a momentous month in my life. Both in Atlanta and in Dallas, it is when the heat finally abates, the weather shifts and summer is really over for another year. Days are either cool, rainy and meditative or sunny and glorious, with blue skies and brisk northern winds. The first of the month sees my birthday and in Dallas we get the great State Fair of Texas.

It was after my birthday last year that I fully realized what had happened when I started dialysis. The time that had been allocated to my life by my incurable Polycystic Kidney Disease had been 56 years.  According to the doctors, it was doubtful I would have seen New Year's Day, 2007. Without the miracle of technology, Susan would have been a widow and my sons without a father.

 I began to have a glimmer of the blessings I had received.

Life Begins With a Needle

Monday, November 6 2006 was a clear fall morning, cool crisp air, pale blue skies with wispy clouds as Susan dropped me off at the hospital on her way to school. It was very casual, she might have been dropping me off at the store. It was my third hospital admission of the year. The first was through the ER, the second she dropped me off for day surgery to create my fistula. Today the fistula was going to be tapped for dialysis.

We have developed a ritual whenever I go into the hospital. She gave me a flat gold chain right before we were married. The only time I am without it is when I am hospitalized. She takes the chain from my neck and puts it around hers for safekeeping. And it keeps me with her.

Check in was smooth and I soon found myself in my room. The TV was terrible, but I had brought several books and occupied my time reading, napping. Doing tai-chi helped as well. Soon the nurse came in and shaved my arm and eventually took me to the dialysis lab. I had done some research and had a general understanding of what was going to happen and had enough knowledge to make me the dread the process.

However I was not prepared for the size of the needles, and they would start with small ones! Apparently my veins run deep in my arms. For years I had been flattered by nurses who were relieved to encounter 'an easy stick' when it came to drawing blood or installing an IV. But the fistula was small and deep. It only took a few sticks to hit the fistula... the first time.

And then, there I was: hooked up to a machine. It's a powerful moment. I was no longer an independent being. I was totally dependent on advanced modern technology to stay alive.

A Bleak Fall

Fall 2006 started dark when I was turned down for transplant because I was too heavy. Reality was beginning to crash into my stubborn will. Losing 15 pounds seemed impossible. I was already eating minimal meals and was trying my best to at least not gain more weight. Exercise was out of the question. Just getting through a day's work took maximum effort. I was always exhausted. Driving home without falling asleep in traffic or at red lights was a struggle. My days off work were just spent resting. I knew that dialysis was inevitable, but I continued to reject the notion and kept living my life with grim determination and a smile on my face.

I should add at this point that I was not in complete denial. In the spring I had seen the vascular surgeon and had surgery to make a fistula in my left arm. The procedure involves selecting a large artery that takes about 50% of the blood that goes into the hand and connecting it directly to a large vein, creating a super-highway to carry the large amount of blood at the high volume required for hemo-dialysis. As blood flows through, the vessel grows larger. It takes about 4-6 months before the fistula is large enough to be used for dialysis. If emergency dialysis is required, a surgeon installs a port in the upper chest with tubes that connect to the dialysis machine. In my typical style, I had the surgery on my day off, was discharged about 10:30 pm, and was at work the following morning!

I was seeing my nephrologist and receiving Procrit injections and  IV Iron infusions every two weeks. The treatments certainly kept me going. I continued to work full-time and sing in the choir at church which meant both weekly rehearsals and several hours every Sunday. Not to mention the occasional work related wine tastings and wine dinners and the occasional bottle of wine (professional obligations, don't ya' know!) I don't remember going to the State Fair that year. I'm sure we did go, but not for long. Just a brief walk-around for a look at the Horned Toads (hand-painted cast replicas, check this guy out!), and a corny dog and a cold beer. It was a struggle through all those years. I can even remember waiting for Susan to get the car and come pick me up. Those who know us will realize the extremity of the situation.

Finally, at the end of October, I went in for an appointment. After waiting for the lab results, Dr. Rinner looked me in the eye and told me that while I had fought a valiant and courageous fight, I was not going to make it through the holidays without a trip to the emergency room with Acute Kidney Failure.

Arrangements were made to enter the hospital the next Monday to begin dialysis. It was the first Monday of November, 2006.

Back to the Story

When we last saw the patient, he had been discharged from the hospital. Cauterization had stabilized bleeding from a duodenal ulcer. Transfusion of 8 pints of blood had restored hemoglobin to a stable and survivable level. The ureter stent had been replaced to allow urine to flow from the remaining kidney to the bladder without impedence from the grotesquely enlarged and deformed polycystic kidney. Feet and ankles were swollen and painful to the point where a walker was required for standing and walking. The kidney was functioning, but barely. The diagnosis had progressed from chronic kidney failure to End Stage Renal Disease. Stage 5 out of 5.

The leg and ankle swelling which was so painful on release from the hospital improved to a livable level. I could walk without pain, but ankle swelling and leg cramps persisted. Fatigue was constant. Every day was a struggle. The next 8 months would see the gradual deterioration of remaining kidney function. While there was no treatment for the PKD which was crushing the kidney, pursuit of several therapeutic avenues could help prolong kidney function.

High blood pressure was most critical as high blood pressure destroys the tiny capillaries where the kidney performs filtration of blood. Capillary damage is the direct cause of kidney failure. The damage is similar to capillary damage done in the brain when high blood pressure causes hemorrhagic strokes. I was taking 4 different drugs plus diuretics to control the blood pressure. Both the drug cocktail and dosages continued to change and increase as the kidney continued to fail.

Fatigue and cramps were symptoms of anemia. I was taking iron supplements, but was not producing red blood cells. The first step of the therapy was to convince my insurance to cover a series of injections of Epoetin (Procrit and Epogen are the brand names) which simulates the protein produced by kidneys that tells bone marrow to produce red blood cells. The drug is expensive, but the injections were eventually approved. However, the anemia continued to persist. Normally the production of blood cells is a gradual process, but now it was occurring in massive spurts. The periodic injections were depleting iron reserves faster than iron supplements could be absorbed. Eventually (again!) my insurance approved IV iron infusion which improved the anemia.

In addition, my regimen of drugs included Calcium, Potassium, and Vitamin D, as well as medication for ulcers and high chlorestorol. There may have been more, I really can't remember. The kidney performs many complex functions other than removing toxins and excess fluid from the blood. It monitors and regulates numerous minerals and vitamins and levels of several different hormones and proteins.


I did feel better after several weeks of Procrit and Iron therapy and proclaimed myself 'Ironman' when I walked into the store after an iron infusion. But maintaining a courageous front through sheer bluster could not mask the medical reality. Even at this point I was determined to avoid dialysis through sheer will and stubbornness.

On advice of my nephrologist we began the application for transplant, although it was too late to realistically hope that I could have a transplant before I would need dialysis. There was hope as allocation of kidneys is a little different than other organs. The difference is the existence of dialysis, which allows someone to live with total kidney failure. This option does not exist with hearts, lungs, or livers. Those organs go to the most critical. Kidneys go to the best matches. Usually kidney failure is a secondary effect of another disease such as diabetes which has other dibilitating effects on the body. Since PKD affects only the kidney, PKD patients have a better longevity with a successful graft.


However I was initially turned down as a candidate for transplant. I was too heavy and needed to loose weight to be considered. It was September, 2006 and the future was dark.

A New Week

Last week was just a rush! Thanks for everyone's support and encouragement. One last interview is scheduled to take place. Michael will be on Countdown with Keith Olbermann on MSNBC at some point. The interview has been postponed twice because Keith is taking care of his father who has been suffering Acute Kidney Failure among other issues. Because of the bond of kidney disease he wants to conduct the interview personally. At this point, scheduling is day-to-day. I will post when the schedule is definite.

Mr. Olbermann did a moving piece on the need for health reform last week where he discussed his father's trouble. Here's a link:

                            Keith Olbermann on Health Care Reform 

Tomorrow I plan to return to the story of my struggle with PKD.

An Exhausting Day

It's been a long day. Up at 4:30 to shower and iron a shirt. Barely got coffee into a cup before the driver was here to take me downtown for the CNN remote. Home again, catch up on emails and Facebook, update the blog, and off to work. 

Then the phone calls start. The first one is a request for an interview from Keith Olbermann (MSNBC) who's doing an hour long special on health care Thursday night. A round of phone calls and emails to family members ensues. Then a call from KABC Talk Radio in Los Angeles. They want a morning drive time interview. Another round of communiques.

Susan watched some talk shows tonight to take a reading. Evidently we paddled at just the right time and have caught a huge wave approaching its peak. It feels awkward to be at the center of attention when so many are so much more devastated. There many families caught in the health care pinch much worse than we are. We (I) have been taken care of to this point. We got into this whole thing when Susan responded to a Kristof column about a couple devastated beyond belief. There are many responses to Kristof's column about us that were written by individuals in far more tragic circumstances. But here we are and it is our time to carry the torch. The most uncomfortable aspect is being the pawn of so much flamboyant rhetoric.

I do want to make one thing clear. When we agreed to talk with Nicholas Kristof, we did not anticipate being a focal point for national debate. The issue is a moral one and one that should be discussed and resolved with a minimum of grandstanding hyperbolic rhetoric. I hear a lot of talk and opinions thrown around without regard for the subtler issues of the nature of diseases and how they affect the lives of individuals, and what medicine can do to enrich our human community, if indeed human community remains. 

While our family faced a crisis when it came to investigating the potential of Michael or Travis as a possible donor for myself, in the end insurance provided two successful years of dialysis and (so far) a very successful transplant. Without dialysis or transplant my life would have ended almost three years ago. 

The substance of the current healthcare debate is how Travis and Michael will be taken care of in the future.

A Bigger Forum

We wondered what, if any, reaction there might be to Nicholas Kristof's NY Times column on Sunday. The response was a little overwhelming. When I walked into the choir room for rehearsal on Sunday, it was being discussed. A friend heard about from a friend who saw it in Copenhagen. Friends of a friend read about it in New York. And of course it spread rapidly and virally on Facebook.

I could not resist reading the comments on Mr. Kristof's blog. Most of his audience approved and thanked him for sharing our story. A few called us "stupid," "ignorant," "negligent" among other things, but that's to be expected. Most were ignorant of the effects of PKD or the realities of dialysis and transplant. The moving fact is that 12% (33 out of 277) of those commenting had issues relating to the relationship of diagnosis (preexisting conditions) to insurability. The 33 broke down as follows:

• 16 were related to PKD
•  5 were related to other kidney disorders
•  2 were related to disclosure of HIV
•  5 were related to other diseases
•  5 were related to other private insurance issues

Of the PKD related issues, most were families just like ours, parents with PKD reluctant to have their children tested; siblings with parents with PKD, frustrated by their inability to help.


All of this feedback was very reassuring. I felt very exposed as we went out on this limb with Mr. Kristof. We were sure of ourselves but we didn't really know how many others there were who shared our concerns. Evidently quite a few and the response was gratifying. The column was certainly noticed and seized upon by individuals active with groups such as the PKD Foundation, fighting to find treatments and a cure.

The big surprise came early Monday when CNN called. Evidently they wanted to interview Kristof on Monday, but he wanted to do it Tuesday with us. So yesterday was a day of massive communications, arranging logistics, and making arrangements. They arranged cars to pick us up and get us to the studios and to take Travis all the way to Stony Brook for his class. We did screening interviews. I prepped by taking Anthony, my drum prodigy nephew to see Jack White and his new band, The Dead Weather. Always best to go on national TV exhausted, slightly hungover and hearing impaired!

The interview went smoothly. The David Letterman story was OUR lead in story! (Dave and Dave, Back to Back.) Travis and I each got in a couple of sentences, but it was Kristof's show. We were just pawns in his game, but we knew that going in. Travis was on a real set in New York with Kristof. I was remote from a small room on the 15th floor of building in downtown Dallas on a stool in front of a Dallas morning backdrop with lights, a camera and sound plug in my ear. An observer would hear nothing, then I would speak, then silence, then I would speak again. End of drama. Out the door, down the elevator, into the waiting limo and back home.

But I think we made a splash! The PKD people seem to be thrilled with the exposure and want to put our story on their website. It was extremely courageous of Travis and Michael to put themselves on the line, especially Michael in light of his diagnosis.

I hope it proves to have been worth the risk and effort and that meaningful health care reform is accomplished.

A Bigger Forum

A few weeks Susan posted a beautifully written comment on a column on health care reform in the New York Times by Nicholas Kristof about the dilemma my need for a new kidney placed on my sons who each have a 50/50 chance of being blessed with a diseased inheritance from their father. He was moved by Susan's words and asked if he could talk with us and possibly use our situation as a column. We agreed and after several weeks discussion among ourselves and with Mr. Kristof, the column was published today.  It captures the poignancy of the boys dilemma and relates it to the current national debate.

Here's the link:

Nicholas Kristof: Dad's Life or Yours?

Hitting the Bottom

So 2006 was off with a BANG!

From the selling floor to Champagne on New Year's Eve, to Chili and Black-eyed Peas on New Year's day, to passing out and nearly bleeding to death, through the ER to ICU and now confined to a hospital bed with a multitude of tubes going every which way. I guess it beat the alternative.

As I lay there in the dark of night unable to sleep with the night noises of the hospital echoing down the halls I had plenty of time to grapple with the reality of the future. The days of Stubborn Stupidity had run their course, thankfully just short of their logical end. I was alive thanks to the generosity of the many who had donated blood. My kidney was still working, barely. My future would at some point be dependent on either machines or a living organ from another person. The psychological adjustment was not easy. The path led through dark nights of depression and despair.

Depression and despair was aggravated by my intense desire to go home. Some doctors would soft pedal and say it was possible, but the final decision was my neprologist who for some strange reason, didn't trust me to follow up. It was a long weekend in the hospital capped off by the decision to administer another round of transfusions. 

The next question became the ureter stent that was now almost 6 months past the time it should be been replaced. (Damn, stents are just temporary?) The surgery was scheduled for the middle of the week, which meant a couple of days in a hospital bed. At this point I had been on IV's for over a week. My feet and ankles were so swollen and sore that standing was extremely painful. Just hobbling to the bathroom was difficult. The old stent came out smoothly (evidently salt and mineral deposits from continued exposure to urine can make removal of an old stent a little difficult and damaging to the internal tubing.) 

After almost two weeks in the hospital, I was finally discharged. I was taken to my parents' house so I could have continuous care. I had to use a walker.

I had finally hit the bottom.

ICU and Beyond

And so, early the next morning, we called the doctor. Surprise, surprise! Off to the ER.

Predictably, I wasn't in favor. I felt weak, but not dizzy. I don't remember, but I would be surprised if I didn't dress for work! But on we went. At the initial triage, my blood pressure was 84 over 64! Wa-a-ayyy low. I was checked into a room in the ER, dressed for hospital success, hooked up to IV's and the tests began. My nephrologist came in and I had to address the fact that I hadn't seen him in sixteen months. For some reason he treated me like a misbehavin' teenager and didn't show much sympathy. Evidently the reason I was dizzy and passing out was that I was very low on blood and especially red blood cells. I was about to receive a complicated lesson on the redness of blood.

The diagnosis was complicated, but let's back up a bit to lay some groundwork. Despite my resolve not to wear the walking boot, the year had not been without chronic pain in my left ankle and foot. Continuous swelling had kept the tendinitis from fully healing and pain had been more or less constant. I knew that some painkillers were deterimental to kidney function and that aspirin thinned blood, so I consumed aspirin. A lot of aspirin.

What I didn't know was that aspirin was acid and the acid can cause bleeding ulcers. Bleeding was confirmed by the black sticky stools I had been having for several days. The blood loss was aggravated by severe anemia caused by kidney failure. Kidneys have many functions. Everyone knows about the filtering of toxins, but few are aware that the kidney monitors hemoglobin levels in the blood. When more red blood cells are needed, the kidneys produce a protein called erythropoietin which causes bone marrow to produce more red blood cells. Biotech companies now produce these proteins for use in treating anemia. Athletes requiring extreme stamina (cyclists, long distance runners) like to use 'EPO' to produce abnormally high numbers of red blood cells to supply extra oxygen to their muscles, aka 'blood doping.'

So, kidney failure means no 'epo' which means no red blood cells which means anemia! Internal bleeding plus severe anemia means no red blood. I was bleeding to death. I had passed out in our living room from lack of red blood cells.

And so the transfusions began. In the afternoon I was taken to the endoscopy lab for more fun and games. Here they ran a tube down the esophagus, took pictures of the ulcer and cauterized it. Hopefully that would stop the bleeding. Eventually that night I was moved into the ICU where they could closely monitor my condition during the transfusions. Initially I received 6 units of blood. The good news was that it stabilized. The bleeding had stopped and I was moved to a regular room. By now I had IV's for ulcer medication, pain medication, blood thinner, blood transfusions and who knows what else. I had three or four IV's in my right arm and one or two in my left. It's not good when a nurse is surprised by the number of IV's.

The next couple of days were just observation and I began to make plans for going home. But I was continually denied by the doctors. More transfusions were being discussed, which came as a surprise as my hemoglobin level was running stable at around 8 units. I asked a nurse what was normal and she said 12 to 14. I knew I had received 6 units, so I did the math and reviewed it with the nurse. "I was THAT low?" I asked. "Yes, you're a lucky man," she replied. I was beginning to see how close a call I had had with death.

As the days were on, my thoughts ran on two paths. The first was coming to grips with reality, not easy after years of stubborn stupidity. The kidney was failing. The rest of my life was going to depend on either dialysis or transplant. I could not conceive of how we could handle what would no doubt be staggering costs. I couldn't conceieve of how we could pay for this hospital stay! The other thoughts were the units of blood. They would have all come from different individuals who had given blood for whatever reasons. At this point I had received blood from 6 different individuals. I was beginning to understand what is meant by "the kindness of strangers." The notion of receiving these gifts was humbling.