Authors: Lurlene McDaniel
“I think we’ve got a diagnosis,” Dr. Kowalski said, getting right to the point. “I asked Dr. Harris along because he was able to help figure out the how that went along with the why.”
“What are you talking about?” Jessica’s father asked.
Dr. Kowalski set a thick file folder on the tray table over Jessica’s bed. He looked straight at her. “You’re in kidney failure, Jessica. Your symptoms could fit the profile of many diseases
and medical problems, but the itchiness was the clue that led me to suspect your kidneys weren’t functioning properly.”
“My kidneys?”
“It isn’t cancer?” her mother blurted.
“No,” Dr. Kowalski said.
Her mother was so relieved that she sagged.
The two doctors turned their attention to Jessica. Dr. Harris picked up her hand and held it gently between his palms. “You’re in endstage renal disease,” he told her quietly. “Total kidney failure.”
“But people can’t live without kidneys,” Jeremy said, coming up beside her bed and locking eyes with the doctor.
“You’ll have to begin dialysis immediately,” the doctor continued, turning his attention back to Jessica. “It will take over the function of your kidneys and keep you alive.”
“K
idney failure! But how is that possible?”
Jessica felt as incredulous as her father. With her heart pounding and her mouth as dry as cotton, she waited for the doctors to answer his question.
“That’s what I wanted to know,” Dr. Harris told them. “When Dr. Kowalski called with the results of your lab work, I went back through all your files. You’ve been my patient since you were a newborn, and your family’s given you the best of care.” He paused to nod toward her mother and father.
“Two years ago, I treated you for a strep infection—but not until it was pretty advanced. Whether you know it or not, untreated strep
can cause a host of problems, including rheumatic fever, which affects the heart. In your case, I believe it took a toll on your kidneys. The damage progressed slowly and relentlessly until you were so far along that now there’s nothing we can do about it. Except put you on dialysis.”
Jessica’s head was spinning. This couldn’t be happening to her! How had something gotten so serious with so little warning?
Dr. Kowalski added, “The point is you’re in kidney failure, Jessica, and that’s what we have to deal with.”
“How are ‘we’ going to do that?” Her voice was barely a whisper.
“You’re getting a new doctor. My colleague Ronald Witherspoon is a top-notch nephrologist—that’s a specialist in the treatment of kidney disorders. He’ll be in shortly to explain your course of treatment. He’ll put you on a hemodialysis machine, which will do the work of your kidneys and make you feel a whole lot better. Your edema will clear up, as will the headaches and itching. You’ll feel good again in no time.”
The news was so devastating that she couldn’t imagine ever feeling good again. Certainly not emotionally, anyway. Her body had turned on her, betrayed her, destroyed her kidneys, and her life would never be the same.
“H-How long will Jessie be on this dialysis?” her mother asked. Her face was ashen and pinched, and suddenly she looked much older than her fifty-five years.
“For as long as she lives,” Dr. Kowalski said quietly. “Her kidneys won’t regenerate.”
My whole life! A wave of nausea swept through Jessica.
“Three days a week you’ll come to the dialysis center and be placed on a dialysis machine. The machine takes over the function of your kidneys, cleanses your blood of wastes and toxins, adjusts your body fluids and balances blood chemicals. Unfortunately, it can’t replace the hormone that aids in making red blood cells, so we’ll have to treat your anemia with medication.”
She didn’t care about how the process worked. She only wanted to wake up from this terrible nightmare.
“Is being hooked up to this machine the only way you can help Jessie?” Jeremy asked. She held on to his hand as if it were a lifeline.
“There’s always transplantation,” the doctor said. “But finding a donor isn’t always easy. Many factors have to be weighed, but kidney transplants are our most successful area of transplantation if you become a candidate for one.”
He made it sound like an election. “Do I have a choice?” she asked.
Dr. Harris patted her arm. “Dr. Witherspoon will be better able to discuss the next phase of your treatment with you. Write down all your questions for him.” He peered down at her through steel-rimmed glasses; his eyes seemed clouded and misty. “I’m sorry, Jessica. So very, very sorry.”
When both doctors had gone, she began to cry. Her parents wept with her, holding her, soothing her as if she were once again a tiny child. Only Jeremy remained dry-eyed, but when he took her in his arms she could feel the tension in his muscles, the fierceness in his grip as he crushed her against him. “You’ll lick this thing, Jessie,” he whispered. “You will.”
“How can I? Didn’t you hear them? It’s incurable. I don’t want to be hooked up to a machine for the rest of my life. How can I have a life when I need a machine to help me live?” She sobbed until there were no more tears left in her. Jeremy continued to hold her.
Finally her father spoke. “I know this is horrible, honey, but it’s not the end of the world. You are alive. Mom and I will help you however we can. The first thing to do is read up on it. Find out all we can.”
She knew it was her father’s way. He tackled life’s problems armed with as much knowledge as possible. He’d raised her to believe that fear was the true enemy and that knowledge did much to banish fear.
“I’ll quit my job,” her mother announced. “I want to take care of you.”
In spite of her grief, Jessica felt a twinge of guilt. She didn’t want her parents sacrificing themselves on her account. “Mom, please don’t do anything drastic yet.”
“But you’ll have to go to dialysis three days a week. I can’t let you go alone.”
“I’ll drive her,” Jeremy said quietly.
“She’s our daughter,” Ruth said.
Jessica disliked having them discuss her as if she weren’t even there. “I might be able to drive myself, you know,” she said. “I’m sure if this is something that I’ll have to do the rest of my life, I’ll have to manage on my own eventually.”
The conversation stopped abruptly when Dr. Witherspoon entered the room. He was a short, balding man with expressive brown eyes. After introductions, he explained more about the different kinds of dialysis. Jessica felt a glimmer of hope when he told them that sometimes dialysis could be done at a patient’s home, on a smaller dialysis machine, and could be done at night while the patient slept.
But her hopes were dashed when he said that at first, and “for a while,” she would go to a treatment center near the McMillans’ home in Reston, Virginia, a suburb of Washington. He told her that early the next morning she’d undergo a minor surgical procedure to create a fistula under the skin of the inside of her left arm.
“I’ll join together one of your veins to one of your arteries, and in a short time the vein will
enlarge and strengthen. This makes it easier to insert the two needles of the dialysis machine. In the meantime, we’ll prepare an external shunt, which does the same thing but shows more on the outside of your arm. A nurse will cap off the special tubing after each treatment and bandage your arm.”
Jessica gulped. “Do I have to have the needles stuck in me every time I go for dialysis?”
“Yes. It won’t be so bad,” he said, patting her arm. “The nurse will numb your arm before inserting the needles. Then you’ll be attached to the dialyzer, and your blood will be cleansed and pumped back into your body. The cleaning process doesn’t hurt, and while you’re being dialyzed you can read, watch TV, talk on the phone, do homework.”
“I’ll look like a freak!” Jessica didn’t like the idea one bit.
“The fistula is under the skin; no one can see it. However, it’s very important that you take good care of the site regardless of the type of access device we use. I don’t want it to become infected or have a blood clot form. Don’t worry, you’ll get plenty of information about
proper care. And, of course, you’ll be going in for treatments often, and the staff will keep a watchful eye out for problems.”
“Our daughter will be all right, won’t she?” Jessica heard the edge of hysteria in her father’s voice.
“As long as she remains on dialysis, she’ll be able to lead a fairly normal life.”
Normal! Jessica almost laughed in his face.
Dr. Witherspoon must have caught her expression because he added, “As normal as possible anyway. You’re going to be bombarded with information over the next few days,” he added. “It may seem overwhelming at first. You’ll have to go on a special low-potassium diet. You’ll have to be treated for anemia, maybe high blood pressure. You run the risk of hepatitis, bone deterioration, neuropathy—that’s nerve damage.”
“You’re scaring us,” her father said.
“I want you to understand how serious your daughter’s condition is.”
Jessica felt numb with the understanding.
“You can’t miss dialysis treatments.” Dr. Witherspoon looked directly at her. “I know you’re young, and I know how devastating this
news is for you. But you can’t ignore your disease, or mistreat your body. Renal failure once was an automatic death sentence. But today, with dialysis, kidney patients can have long, productive lives.”
“And a transplant? What about a transplant?” Jessica knew no machine could truly take the place of a living, working organ, so she was interested in that option.
“This hospital has one of the best transplant facilities in the country, so that is a possibility. But that path isn’t an easy one. For starters, thousands of people are waiting for kidneys. There’s a waiting list and a sophisticated system of selection.” He folded her chart, glanced at his watch and prepared to leave.
“I know you have other questions. I’ll send in some of my support staff, who will bring you literature, videotapes, books. A dietician will be in to see you too. And tomorrow morning I’ll insert that shunt. It’ll take a few days for the internal connection to strengthen before it can be used. In the meantime, we’ll begin dialysis while you’re here. You will get through this, Jessica. I promise.”
Alone in the room with her parents and Jeremy,
she glanced helplessly from face to face. “Why is this happening to me?”
No one had an answer. Her parents looked so devastated, she wasn’t sure they could drive themselves home. But the look of sheer determination on Jeremy’s face was the one that gave her strength and courage. “We’ll get through this,” he said.
She nodded. “I suppose I will.”
“And I’ll be here with you every day.”
She wanted to believe him more than anything. But she was the one who was sick, and he had a year and a half of high school ahead of him. How long before he grew tired of having a sick girlfriend? A girlfriend who would be committed to a thrice-weekly rendezvous with a machine that kept her alive?
J
eremy drove to his house much too fast. He was risking getting a speeding ticket, and if he got one his father would have a fit, but Jeremy didn’t care. He couldn’t think of anything except his beloved Jessie and the ordeal she was facing.
“It isn’t fair!” he shouted. The wind rushing through the open car windows snatched his voice away. Icy March air made his face numb, but he didn’t care about that either. He was beyond caring about his own physical comfort. All he knew was that Jessica was sick. That she might be taken away from him. The way Tom had been.
He came to a screeching halt in the driveway
of the Tudor-style brick house in an upscale Reston neighborhood, bolted from the car and ran inside. He was late for dinner. His parents were sitting in the dining room. It was a rare weeknight that his father was home. Startled, they looked up as Jeremy careened into the room, dragged his chair across the polished oak floor and lush oriental carpet and settled in a heap.
“Good heavens!” his father snapped. “Mind your manners. This isn’t a barn, you know.”
“What’s wrong?” his mother asked. As usual, she was the more perceptive of the two.
“Jessica’s in kidney failure.” Jeremy’s voice fairly shook with emotion. “She starts dialysis tomorrow.”
“Oh, no!” His mother rose and came to put her arm around his shoulders. “Jeremy, I’m so sorry. Tell us everything.”
Briefly he told them.
“Poor Jessie,” his mother said, glancing over to her husband, who sat tight-lipped and wordless. “And her poor parents. Is there anything we can do?”
“There’s nothing anybody can do. Nothing. But I know I want to be there for her.”
His father broke his silence. “How do you mean?”
“Once she gets on a schedule, I want to help take her for her treatments so that her mother won’t have to quit her job. I want to be around her, help any way I can.”
His parents exchanged glances. “What about your own life? Your schoolwork?” his father asked.
“How can you even ask such a dumb question?” Jeremy asked, leaping up.
“I resent your attitude—”
Jeremy’s mother interrupted. “Frank, he’s had a terrible shock. I don’t think now’s the time for the two of you to start arguing.”
Frank Travino threw up his hands. “You’re right, Marilyn.” He took a deep breath. “I am sorry about Jessica, son. Go ahead and spend as much time as you need to until she gets situated. Just don’t forget that you have a responsibility to live your own life.”
Jeremy wanted to announce that Jessica was
his life, but thought better of it. “I’m going up to my room,” he said.
“Eat some dinner,” his mother urged.
“I’m not hungry.” She looked distraught, so he added, “Maybe later.”
He went up the spiral staircase to his room, where he leaned heavily against the closed door trying to sort through his emotions. His room was spacious, with a computer, bookcases, a TV and audio equipment taking up one entire wall. A weight-lifting bench stretched along another.
A bulletin board over his desk was crammed with a jumble of photos of Jessica and himself. Slowly he walked over to study the pictures. There were photos of them together out at his family’s lake home the previous summer. Pictures of them at three high-school dances, and more recent ones from Christmas. In every one, Jessica looked radiant, beautifully infused with life and exuberance.