Tuesday, April 4, 2023. A few minutes to 2 p.m., I arrived at my Richmond Hill office for the afternoon session, after a busy morning session in Brooklyn. As I reached for the door handle, a familiar voice called out, “Hey, Doc!” Sitting in a dark SUV in a parking spot across the office was Fred. I was rather surprised to see Fred driving all by himself. I knew that Fred has kidney failure and has been on thrice-weekly hemodialysis for about three years.
“I am here to see you”, Fred hollered out through the car window. “Hi Fred, it’s great to see you. We will talk in a bit.” I answered Fred as I sauntered into the office, clutching my packed lunch in my right hand.
About twenty minutes later, I was sitting across from Fred explaining his results to him. He has kidney failure, already on dialysis three times a week, but the results were not bad at all. I told him to continue his dialysis and return for a comprehensive analysis in three months.
As Fred got up to leave, he threw me a bombshell question. “Doctor”, he began, “there is a question I had always wanted to ask you. Why didn’t you tell me I have less than 10% function left in my kidneys? That means that I lost over 90% of the functions of my kidneys. Why wasn’t I warned when my kidney function was 80%, 50%, or 30% before it fell below 10%?”
I stared at Fred in disbelief. Now it was my turn to explain. I told Fred that his question was so touching that I would remember it for a long time, right up to my death bed. I told Fred that I did warn him. More than 100 times. Fred had high blood pressure. And Diabetes mellitus. Those two conditions are kidney killers. Fred, against medical advice, refused to use medications. These conditions are silent killers. You don’t feel anything until it is too late. I told Fred to ask his wife Elizabeth when he got home and ask her whether I warned him about losing his kidneys or not.
Fred and Elizabeth are very special to me. When I arrived in the United States in 1993 and joined the Jamaica Hospital Medical Center in Queens County, NY as a Resident Doctor, Fred, and Elizabeth were two of the patients allocated to my care. I took care of them for three years. When I left the residency at Jamaica Hospital in 1996 and set up my own practice, they joined my practice. They and all their children have remained my patients since then. These people were very special to me. Their patronage when we had very few patients made a big difference to our bottom line. Fred has always been like a brother to me: ever jovial and cheerful. Carefree. Too carefree.
When Fred was diagnosed with High Blood Pressure, and Diabetes, and refused to take the prescribed medications, I was very concerned. Fred was very nonchalant. He drank quite a bit and I suspected also illicit drug use. When he refused to listen to me, and his Hemoglobin A1C was consistently above 10 and 11, I voiced my concern to Elizabeth that Fred may lose his kidneys if he did not use his medications. I told him to cut down on alcohol use. Instead of cutting down on booze, Fred opened a bar and started selling alcohol! He continued to drink heavily. Four years ago, Fred’s kidney function deteriorated very rapidly. Within one year, he needed kidney dialysis three times a week to keep him alive.
I turned to Fred and explained to him. When kidneys fail, they fail silently. Most of the time, it is difficult to know there is big trouble until your kidney function has dropped below 25%. I took out a piece of paper. I tore it in two equal parts. I told Fred to imagine that the paper is his kidneys. I threw away one half. I showed him the half paper. This kidney has 50% function. But the blood test will remain normal. Then I tore that paper in two again. Now 25% remains. You do not notice deterioration in your kidney function, measured as Blood Urea Nitrogen, and Creatinine levels in your blood, until your kidney function drops below 25%.
By coincidence, Elizabeth came into the office. She came on her own for a totally different purpose; to get a needed injection. She corroborated everything I told Fred. “The doctor warned you repeatedly that you might lose your kidneys”, Elizabeth testified truthfully, “and then you opened a bar”. Fred managed a smile. Alcohol and drug use seemed to have befuddled his memory. All those years when I was warning him, I knew that he was impaired because he was always so nonchalant, cocky and never took anything seriously. He would smile when I told him that his blood pressure and sugar were through the roof. I tried to enlist Elizabeth’s help. All to no avail.
“So the kidneys struggle on until they quit suddenly?” Fred asked finally. “Precisely,” I told Fred. “Sometimes people sleep, wake up, and suddenly see their face and everywhere swollen. The kidneys quit suddenly when they could no longer cope. Like putting a needle into an inflated balloon”.
Fred forced a smile, got up, and exited the office. Elizabeth remained behind to get her shot. “Let him go”, she said, as I looked at her inquiringly. “I knew that he was coming to see you, but we did not come together.” Poor Fred!
