“I’m one of the doctors taking care of your dad.”

As a resident, I made this call countless times.  Even more than breaking bad news to patients, I feared surprising their families at night by telephone.  Nearly always, though, people were calm and certain despite the circumstances, and their response was always the same:  “Do whatever you have to do.”  As a fellow, I looked forward to leaving those calls behind.  No more shocked families, no more code status stalks, no more lines and drains, and intubations.  No more breaking of bad news – at least relatively- right? But when I, now a nephrologist, called in the middle of the night, a funny thing happened.

People paused.

Turns out, “dialysis” is a triggering term for people even in the midst of chaos.  Around half a million people in the United States have end-stage kidney disease.  While a majority of people have no idea of what it means to be ventilator dependent or require a long-term feeding tube, everyone has known someone on dialysis. When I tell them their family member needs it, they are faced with the realization that life will never be the same again.  Realities of the situation aside, my phone call was an awakening for many people.

I wasn’t prepared for this.  One of the reasons I didn’t pursue critical care was the emotional challenge of delivering so much devastating news, even-tempered with miraculous recovery stories. I struggled especially with patients for whom protracted suffering was inevitable, and recovery to a meaningful life seemed improbable.  The wiser and more experienced doctors had a way with those families, making sure they knew what lay ahead.  For me, it was the nightmare of knowing too much but not knowing how to explain.

With time, I’ve found “dialysis dread” to be a relief.  That pause is an opportunity to explain, describe, and caution but also to reassure.  It represents the realization that life is a balance between quantity and quality.  The pause is my cue to offer my opinion, and to listen.  I affirm the hesitation, gratefully, as a reminder that we all understand the gravity of what I’m suggesting.

Each day now, I take a pause.  I marvel at the technology we have in modern medicine, the capability I have to replace the function of an entire organ.  Then I take another pause and make sure that’s the right thing to do.

Anna Gaddy is a nephrologist.

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