My Dialysis Calendar

When nephritis hit me some years ago I knew nothing about dialysis and had barely heard the term. But in the intervening years -- now four or five -- I learned a lot, thanks to the help of the doctors and nurses with whom I worked in Austin. They were superb teachers and were patient in teaching me the rules.

Once I began treatment, I quickly adapted to an obligatory Dialysis Calendar. Monday, Wednesday and Friday became days sacred to the dialysis system. I never was late in reporting; I never missed a day. Even to think of shortchanging the requirements of dialysis sends a shudder through me.

When I finish each three-and-a-half hour assignment on the dialysis machine, I come home exhausted and must take a recuperative nap. This means that I must conduct my normal life, including such social occasions as develop, on Tuesday, Thursday and the weekend. It is amazing how many people want to see me to talk about various aspects of my life, but it is obligatory that their visits occur on my days away from dialysis. In a dozen or so very important meetings, such as those with my longtime agent Owen Laster, or my editor at Random House, or dear friends like Stan Musial, the great All-American baseball player or Ed Piszek, a Philadelphia business man who has joined me on many projects, I am able to see them briefly right after my dialysis session, especially on Friday with a carry-over to Saturday or Sunday. I treasure these meetings and end them exhausted. But since I recuperate quickly, the next day I am in pretty good shape.

So Tuesday and Thursday are precious days. I reserve them for the people who work with me or for special visitors like Lady Bird Johnson or Hall of Fame pitcher Robin Roberts. I tend to end my Tuesday and Thursday sessions at about 3 p.m., after which I take a nap. This Calendar, rigidly but willingly adhered to, is the basis of a fairly satisfactory overall life.

I do not go to my dialysis on Monday, Wednesday and Friday with any reluctance. I have enormous respect for the doctors, nurses and assistants who care for me and for the some 60 other patients coming to dialysis these days. They make up a splendid group. I have an affectionate regard for the wonderful way in which they treat me. But fundamental to everything is my gratitude that I lived into the period when dialysis chairs were numerous and well-attended. I have heard many tales of the period here in Austin some years ago, when there were only one or two chairs and when the Death Squad met to allocate them among the many claimants who needed them. In those evil days when the Squad, composed of caring doctors and wonderful nurses, finished their work, it meant that patients A, B and C would get use of the chairs, while the unfortunate patients D, E and F were sentenced to death.

I have felt convinced since my first days of dialysis that sometime around the year A.D. 2010, some radical new system of dialysis would be invented. Recent miracles with cloning, as performed in Scotland, could mean an unlimited supply of healthy kidneys. Or the brilliance of our medical explorers could very well come up with some new system that I cannot visualize. The bottom line of my personal reaction is that even under the rigid dictates of the present system, a reasonably happy life can be achieved if one is willing to meet the system halfway.

But I am always mindful of the mournful young man I met during my first weeks in dialysis. He was 32 years old and a handsome young fellow. But he had not yet learned to live by the Dialysis Calendar and his spirits flagged. When I saw that he was reporting late for his sessions and leaving early I remonstrated with him, reminding that the system -- unpleasant though it might be to him -- did keep him alive and that he could, if he wished, work out a satisfactory life.

He looked at me almost in contempt and asked: 'How old are you Sir?'

And I said: 'Eighty-seven.'

He burst into a derisive laugh: 'Sir, I'm 32. You've had your life and can adjust your remaining days to a new regime. More power to you. I'm just starting my life and the thought that it's going to be lived like this terrifies me.'

Shortly, he appeared later and later and left earlier. And then, he stopped coming altogether, which every dialysis patient is free to do. Three weeks later, I heard that he was dead.

James A. Michener