Walking a mile in a patient’s kidneys (shoes)

Lazare, Kimberly

We are taught, nay, metaphorically beat on the head, with the notion that to truly demonstrate empathy means to walk a mile in our patients’ shoes, so-to-speak. What’s with all the metaphors? I believe that we use metaphors when teaching empathy in medicine because, in the majority of cases, we as physicians have never truly been in our patients’ metaphorical shoes. Like my patient KR, we have never escaped domestic abuse, gathering every last ounce of courage to leave all of our possessions behind, and relocate to a homeless shelter. We have never had to watch our child on life support in the ICU, like my patient DM, who watched for months as his little girl crept inch by inch towards death.

But when I got the call from my twin brother, Jordan, one lazy August afternoon, my definition of empathy would change forever.

“Hey Kim, uhhh, I don’t think my kidneys are working so well”, he said with apprehension. My heart plummeted to the floor.

What words came next from him I cannot remember. My consciousness was shrouded with horrible thoughts zigging and zagging through my brain, neurons firing off at lightning speed. I had thoughts of hemorrhages infiltrating his retina from hypertensive damage, flashes of his new cushingoid physique from years of prednisone use, and a horrifying image of him, limbless and in a wheelchair, due to microvascular complications from diabetes that would be his ultimate fate. The saying knowledge is a curse held true.

The next thing I knew I was running. Running in thirty-degree heat towards St. Joseph’s Hospital, where I would soon find Jordan in the ICU, physically restrained by all of the IV tubing and ECG wiring encapsulating his bed. We were never very affectionate siblings, but in that moment, I hugged him with the intention of never letting go.

The months to come would be rather uneventful and all around disappointing. Soon after he was discharged from hospital, we learned that he had rapidly progressive IgA nephropathy and would require a kidney transplant. The icing on the cake was that neither my parents nor I shared his blood type, making the likelihood of a donor kidney from one of us a remote possibility. Five donors were tested. Some were family members. Others were altruistic donors who must have hearts made of gold. Unfortunately all of them were disqualified from donating for various medical reasons. Optimism turned to pessimism and then to realism for my family. The seasons changed, but for us, we were transported right back to that humid August day when this horrible nightmare began.

In the meantime, Jordan would do his dialysis treatments three times per week. I imagined the blood being shucked out of his body, cleaned of its nitrogenous wastes and then forcefully reintroduced to where it once lay. I could hear the eerie humming of million-dollar machinery tucked away in the basement of the hospital, acting as an understudy to his kidneys, but always falling short of the stellar performance his healthy organs once gave. I pictured him sitting amongst a predominantly geriatric crowd, becoming increasingly knowledgeable about the nuances of playing bridge and learning about what life was like in the ‘good ‘ol days’. As hard as I tried to employ the empathy skills I learned in medical school, I could never quite imagine how I would feel if I were the one whose kidneys had failed me. I prayed that I could share some of his burden.

He and I had undergone blood crossmatching at the beginning of this nightmare on the rare chance that we were a perfect antigen match. His nephrologist explained that this would be the only situation where they would consider an ABO-incompatible direct donation for he and I. The results were in: we were a perfect match! “Well it’s nice to know that you two really are twins”, my mom exalted, with subdued notes of sarcasm, relief, and something else I couldn’t quite put my finger on.

And so it was finally my turn. The veil of guilt I felt while watching distant relatives and strangers being poked and prodded and drained of their blood was finally lifted. They say doctors make the worst patients. I certainly do not allege to be an exception to the rule. Tube after tube of blood was taken from me. A cold ultrasound probe marched over my abdomen as I contorted my body in an effort to visualize the 2-D picture of my internal organs. I begged the nurse doing my ECG to give me a copy of it so I could interpret my P, QRS, and T waves. I think the highlight of my testing experience was trying to conceal a 3L jug of my own urine that I carried around with me for 24 hours. This, however, was only a shred of what Jordan had gone through during the past year. I trudged onwards.

Unlike all those who had gone before me, I passed the testing with an A+. The reality of my impending surgery loomed in the not too distant future. Finally, I could share in Jordan’s experience. From womb to operating table, I guess we were destined to occupy the same physical space. I think there’s no more true definition of empathy than physically having one of my organs cleaved from my body and implanted in his. No more metaphors for me. This here is the real deal.

Theme: Family | Famille
Theme: Physicians | Médecins
Theme: Relationships | Relations

Stories in Family Medicine | Récits en médecine familiale [Internet] Mississauga ON: College of Family Physicians of Canada. 2008 --.




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