I was sitting in a clinic today for pre-transplant counselling for patients with kidney failure. As a medical student, my remit is largely to sit in the background and observe what is done and said with a view to learning from it. The first part of the clinic entails a specially trained transplant nurse seeing the patient. Today, the patient came with his wife and they were both recently retired in their late 60s. I deeply admired the respectful way in which the nurse conducted the meeting. She patiently went through the labyrinth of transplantation procedures which can be bewildering to an expert. However, they had both been well briefed at a recent pre-transplant seminar. The gentleman had recently incurred a number of other health complications and although he carried a positive demeanour, he seemed to approach the proceedings with a certain trepidation. To make matters more involved, his devoted wife had volunteered one of her kidneys for donation. It transpired though that she was not a great match for her husband and so they were exploring the possibility of engaging in a swap programme with another couple in a reciprocal position.
After the transplant nurse had dealt with any lingering questions, her place was taken by the renal transplant consultant. The consultant was faced with the "God job". Ultimately, she had to make a clinical decision regarding the viability of the transplant proceeding after taking all the medical problems and his age into account. Her decision took into account the fact that he was nearer to seventy than sixty-five and that on the balance of probabilities, his quality of life would be no greater with a kidney transplant as compared to his current thrice weekly regime of dialysis. The way the consultant delivered the news was a revelation to me and a salutory lesson in how to treat the person in front of you. She told the man and his wife that she didn't think the transplant was the best way forward and explained in great detail and with admirable patience the rationale for her decision. After delivering her decision she paused to allow them to digest it. The gentleman became very upset and his wife was also visibly tearful. Tissues were found and the consultant sought to explore the real reason for their disappointment. Unsurprisingly, the realisation that the rest of his life would now be spent on dialysis was a body blow to both of them.
What added to the complexity of my experience was the fact that I too had dialysed seven years ago. Having been lucky enough to receive a transplant, I appreciated as well as anyone in that room the reality of his predicament. I only dialysed for nine months but it is a time I will never forget. When pressed for the true source of her upset, the gentleman's wife stated that it was simply the loss of freedom on dialysis which was the biggest blow. This I could fully identify with. While dialysis does prolong your life, it is not an existence which suits everybody as you have to plan your entire life around it. It is not optional and transplants apart, is with you for your remaining days. Observing this gentleman in this consultation, I wondered if this would me receiving such a decision twenty years hence. Of course, none of us can determine our future so the trick is to get the most out of the present. As a third year medical student about to enter the fourth, I feel that I am making the most out of my present because if and when kidney failure returns to my life, my capacity to pursue my dream will once more be diminished. If I learned one thing above all else though, it is that medical professionals don't have to be dispassionate just because the subject is not to their liking. We none of us like bad news but at various times we all have to face it. The way in which it is delivered is of great importance as its impact can linger with the recipient for years to come. As unpalatable as the news was to the patient and his wife, the manner of its delivery did nothing to hide the reality. The honesty, empathy and humanity were a real pleasure to witness and I for my part learned a great deal in my quiet corner of the room.
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