Chronic renal failure - a textbook case study

I am going into pedagogue mode now, speaking as a medical professional to all who wish to learn about chronic renal failure (CRF) from the standpoint of the sufferer. So sit still and learn, or change channels now.

Anatomy. We all know they're somewhere towards the lower back part of the body, one on each side, and we know they must have little tubes connecting them to the bladder in some way. But when they're working and pain-free, no one knows where they are, and no-one cares. Only when they have a problem do we care - then the pain in the lower back on one or the other side points to their location in no uncertain terms.

Physiology. They do a lot of things we take for granted: they maintain fluid balance to prevent a build up of excess water; they constantly adjust the pH of the blood to be not too acidic nor too alkaline but "just right"; they maintain salt balance - not just the sodium chloride we shovel on our fish-and-chips, but all the other salts we usually ignore - potassium, calcium, phosphorous, and carbonates. They also bear some responsibility for regulating blood pressure, stimulating haemoglobin levels in the blood, and helping the immune system to cope with life's traumas and the nasties constantly trying to invade our bodies. Oh yes - on top of all this, they get rid of much of the toxic waste our bodies generate each day from burning food for energy ('good' waste), and breaking down all the rubbish we throw into our stomachs ('bad' waste) - especially from the evil meat, that palatable temptation of the devil to ingest poison in the guise of tempting steaks and succulant stews. Be not deceived - the stuff is poison as I have learnt to my cost. [Oops - I am straying from the true disinterest of the good medical text here.]

Clinical manifestations of CRF. These are the manifestations of each of the functions of the kidneys. Having many functions, it follows that there may be many manifestations. At the moment, I seem to have them all.
I have had erratic hypertension and been anaemic for some time. This leaves me tired; I would add irritable, but I think this is just my normal state, not the CRF. The toxic wastes and acidity of the urine makes it burn like crazy, and I need to keep running every hour or two (dysuria and frequency), or I won't make it in time (urgency), and there are horrid sharp pains shooting up my insides like knives. Last night I woke with bad nausea and had to sit downstairs sipping water with a bowl beside me.  The toxic products irritate the skin, and I now have red blotches everywhere, especially the back and legs, that itch like crazy and bleed easily everytime I scratch too vigorously (generalised pruritis). Additionally, a strong immune system helps prevent cancers developing, and the depressed immune system allows them to develop. I therefore blame the CRF for giving me two independent cancers (melanoma and bladder cancer), rather than the other way round.  In short - and in lay parlance - I'm a miserable wreck.

Management. I have to drink plenty and watch my diet. Basically, I must leave off all the things I like (bananas, tomatoes, oranges, olives and avacado) which have too much salt and potassium, and eat plenty of all the things I dislike (broccoli, cabbage, cauliflower and onions!). Also, I repeat, leave off the poison of red meat. If the CRF continues to deteriorate, younger men than me might be offered dialysis to rest the kidneys and remove the toxins, or ultimately renal transplant. Neither option is available for old men over the hill, so I shall have to continue on the downward slope.

The only other management options are to hope for a miracle (trip to Lourdes?), and be thankful for someone like Ann to put up with the grouchiness, and administer creams and drinks and manage my diet like an angel!

Rehabilitation and magic

Rehabilitation

On castle walls Budapest

After the tortured night I suffered following a carnivorous lapse into meat eating (see Confessions), I have resolved to give the poor old kidneys a chance for recuperation. I did not dare stray too far from the hotel with its salvation of a toilet at a time of urgent need, so I remained behind while Ann and Edwin explored the great metropolis of Budapest.

In perfect weather, I strolled the gardens below the hotel, looking back on the castle walls for which it is famous, then ended up in a little street cafe where I had a modest meal of cheese and salad, washed down with home-made lemonade. Delicious, and hopefully it will prove to be restorative. Passing water is still extremely painful and too frequent, but hopefully there will soon be improvement in the poor old pissaroo.

Yesterday, we all explored local attractions, including the Houdini Museum. This contained a potted history of his birth in Hungary and his fame in America in the early 19th Century. The highlight of the visit was a performance by a stage magician, who asked if we all believed in free will. Most of us shouted back "Yes", but Edwin insisted on shouting "No".

The conjurer asked him his name: "Edwin".
"Do you like shopping Edwin?" - "Yes".
"What shop did you go to last?" - "Tesco's."
"What did you buy?" - "Jackfruit."
"Did you have free will to buy it?" - "No. I was influenced by advertisers."
The magician shrugged and nodded as though agreeing. Then, just as the rest of the show was finishing, he said "It's strange, I had a strong urge to write a note to myself just before the show started," and he fished from his pocket his wallet, opened it and took out a tightly folded piece of paper. This he handed to Edwin and asked him to read it.

Edwin took the paper, unfolded it and read, "A man called Edwin will go into a shop called Tesco and purchase some Jackfruit." Naturally, we all applauded wildly and – having seen Edwin's face – I couldn't stop laughing all the way back.

Confessions

Grandad-John in the Flamingo Chair

I must admit a confession to my reading public, one borne with shame and one from whose admittance I must expect ridicule and condemnation in equal measure. We are in Budapest, a most beautiful city where we are taking a short break from the rigours of a peaceful village. Yesterday we indulged in quaint history at the museum of electrical inventions from the turn of the 19th century (old motors, switches, bells, telephones etcetera), followed by a visit to the Museum of Sweets and Selfies - a bizarre collection of colour and toys designed more for young adolescents than grown respectable ladies and grizzled bearded men, but heaps of fun battling through a forest of pink bananas or relaxing in a pink flamingo chair. We followed this by a sudden dive into a gluten-free bakery Edwin had spotted where we indulged in gluten-free beers and a choice of delicious cakes and pastries. But I am glossing over the confession.

Ann in Museum of Sweets and Selfies, Budapest

That evening, being late, we dined in the hotel restaurant where – although nominally vegetarian – I succumbed to a starter of Hungarian goulash. This was filled with large cubes of succulent beef, suspended in a carefully spiced stew of vegetables, and I will not pretend it was not delicious.  But then to crown my sin I selected a dish of wiener schnitzel: a large dish which covered the plate in bread-crumbed Bambi. Retribution was swift. I had forgotten how poisonous red meat is to the kidneys. Mine are already shot to pieces, filled as they are with large cysts and in the throes of advanced renal failure, and they were completely unable to cope with the added load of lethal nitrogenous waste to which I challenged them.  The unaccustomed load of heterocyclic amines and breakdown products of urea and uric acid so irritated my kidneys and bladder that I was awake every hour throughout the night having to run to for a painful wee. 

Today I am confined to my room, unable to stray far from the toilet. Believe me, if anyone suffers from kidney disease, the revenge of the animals can be swift and sure. Today, I am dining on salad leaves and drinking weak tea.

A Philosophy for Life

23 April 2019

I am told by people who generally know these things that my blog posts are mostly vacuous, the kicking of  the empty can down the road of life. My reply is, they are written not to plunge the reader into fits of anguish or self-loathing, but are splashed upon the page simply for my own pleasure; to remind myself that the great world rolls on, delighting in trivia, silly jokes, and minor anecdotes about each other. Occasionally, it gives me platform to rail pitifully against the stupidity or ignorance of our political masters. I know my ineffectual voice is but the clucking of an idle hen, but it helps release the impotent frustration bottled within.

My critics tell me that the world awaits depth and insight into the anguish of dying; that I should grip the reader round the throat and throttle the joy and life out of them; that their greatest desire is to see as it were a mirror held to reflect the inner agony and suffering of inevitable extinction. I shall not oblige them. I attended the dying and dead over many years of general practice, and tried to bring ease to pain, or comfort to the bereaved; I have ministered to suffering in a hospice, some of which could not be relieved and brings me to tears even now; as police surgeon I attended fatalities and unexpected deaths by the score, many at their own hand or that of another. Every news item is filled with grief and suffering in the world. This I used to express in poetry, often writing at three a.m. on my way back from some dire night call, and there it lies for any who care to read such things. These emotions do not need repeating; they remain raw and I have no wish to relive them.

For tears, read the news, satisfy yourself with the slaughter in the world, the mindlessness of impersonal violence wielded without purpose. Better to rejoice that most of us prefer to release our exasperation and despair through the grin, not the gun; through bombast rather than the bomb; in trivia rather than travail. I have no wish to emulate Dostoevsky or Tolstoy; had I such talent I would chose to be a Waugh or Wodehouse every time.

And yet... and yet... to be a purveyor of the soul, it should ring true, it should go deep; but this is not a secret diary, filled with secret longings or shame, it is a public document and must respect the sensitivities of others. And so I will continue to intersperse the trivial and mundane with occasional glimpses of the darkness lurking behind existence. I may tell of inner pain and conflicts; but above all, I seek the momentary release that humour may provide, the incongruities that underpin relationships, and the absurdities of our very existence.

Carrying one's cross alone

Today is Good Friday, and for some reason I spotted a lone figure walking down Clare High Street this morning bearing a huge wooden cross over his shoulders, large enough to mount on Calvary. He was not in a procession, and no-one was attempting to help him carry it. Ann suggested it might be the return of Christ, suffering His Passion again, but this time wondering where the crowds were, or where was Simon of Cyrene when he was needed. It seemed to by a metaphor for the present spiritual indifference in much of the modern world.

Granny Annie and Grandad John entertain Lucy and Theo at Linton Zoo

Following from the funeral, Wednesday also saw the visit of Lucy and her partner Andy, with new arrival Theo in tow. At least, he always seems new – though it is nearly two years since they stood in our kitchen to announce he was on his way. Already he is eighteen months and charging round the world with an energy and determination that seems unquenchable. It is many years since we had to entertain a toddler, but a trip to the local Linton Zoo helped divert him. Linton is the ideal size for this, being compact for slow crawlers like me, well able to be viewed in an afternoon rather than a full day, but full of variety and interest for children. Charging round from enclosures of tortoises or tapirs to cages of lions and tigers certainly managed to bring the magic of entertainment and fatigue in equal measures and, after a rest in the cafe before closing time for ices and drinks, they were well placed to toddle off to Lucy's brother, Matthew, to stay a further day with him and Rosie.

Andy is an honorary member of the Society for Acrimonious Divorce (SAD), having suffered a prolonged and difficult transition from the matrimonial state. However, a recent judicial hearing happily seems to be moving things forward at last, and we wish him all speed on this difficult journey.

Stories and a funeral

Zebra at Linton Zoo

I mentioned to Alan (Ann's cousin who lives in Portugal) that I had now finished my short story, called Liberty Jack, following a second dream that gave me the conclusion, and we started talking about some of the stories I have written. Only one has been published, titled The Fairway, which won a literature prize, and was set on a golf course in South Africa. Alan, who has an unlimited fund of anecdotes, immediately launched into his own tale of a golfing incident in South Africa.

He was playing on one of the Durban links and told to beware of the four zebras. During the round, he knocked his ball into a bunker on the third, but when they went up to it, one of the zebras was lying down in the bunker, covering most of his ball. "Can I declare a lost ball?" asked Alan.

"No - you must address the ball where it lies!" his partner insisted.

Talking afterwards of our wine-and-cheese evening on Monday for Alan and a number of friends and neighbours, Ann and I realised that as we have aged, everyone at that evening, save Edwin, had serious problems in their lives of one sort or another. One neighbour who did not come was David, the husband of Janet Newton who died a few weeks ago, and whom we had not seen for some time since the severe progression of her Alzheimer's. Alan left on Wednesday, taken to the station by Edwin as her funeral was at mid-day.

This was held in Hundon village church and we hoped for an inconspicuous seat near the back. Ann even remembered to leave her phone at home, as her ring tone is Annie's Song, which she did not want blaring out in church. Although a good fifteen minutes early, it was already full and we were forced onto a row near the front. Mary-Ann used to baby sit for one of their grandchildren, now a grown woman, and she and her sister sang a remarkable duet called To Where You Are, in perfect, clear soprano voices. The event was extremely moving. The children also read moving testimonials to their mother, who had been given the devastating news that their father, her first husband, had suddenly died in a car crash when they were young. She married David soon afterwards, and the children evidently loved him. He gave a moving address about how he had had to care for her in the later years of total dependency, and how it reminded him of his mother's death when he had had to dress and clean her too. Then the son, Dean, gave what sounded like a confessional: "Mum, you were always there for me when I needed you. I am so sorry that I was not there for you when you needed me." It left Ann and I wondering how our children might remember us when we die. Finally, as the mourners prepared to leave the aisles, we heard John Denver blaring out Annie's Song. The family had chosen it as the final piece of music for the funeral.

Helpfulness, hysterics and hindrances

Hudgies in Clare

Hudgies is a general store in Clare that bills itself as "Ironmonger, Oil & Colourman." It is set out like a period piece in some historic street museum, but is very much alive and thriving.  I have yet to ask for something Mr Hudgie does not have somewhere in the dark recesses of his inner sanctum (I always think of him thus, though it is not his name). He was once a high-flying fund manager with HBSC, based I think in Tokyo. Many people I know who made their money and retired early used to dream of running a small country pub, but this shop was his dream, and he plays the part to perfection. He wears a faded brown cotton warehouse coat that would be a shoe-in for Open All Hours, and he has a small black dog curled up in a basket beside him, perched on a stool.

This week, I asked if he had any glue capable of fixing the hard plastic of our fridge door handle which had broken off. He produced a tube called "Hard Plastic Glue" - and it seems to work a treat. I also asked about the best way to stop my leaky kitchen tap. "Vaseline on the washer", he advised, and didn't even try to sell me a tub. That too seems to have worked, and thus far the tap stays dry.

Ann's cousin Alan is staying with us again for a few days. He is the founder member of SAD, the Society for Acrimonious Divorce, and was back in the UK for a court appearance to try and finalise his divorce to Iris, the Trinidad women to whom he has remained shackled for two painful years since their separation. In court last week, she broke down in hysterical screams and shouts, lying on the floor, her midriff exposed, kicking her legs wildly. The judge tried in vain for fifteen minutes to calm her, then called the usher who was equally unsuccessful, and the proceedings came to a halt until she had burnt through her fury. At last, Alan got a relatively favourable judgement, and is hopeful that the whole miserable business will soon be concluded. He has vowed never to remarry, and we are sworn to remind him should he look to be straying from this vow.

We also had a few friends over for an informal wine and cheese evening. Most of them we invited verbally, with a telephone call. I invited our neighbours across the road personally when I met the husband in the street. After some debate about whether it would be appropriate, we also invited our next door neighbour, Linda, whose husband is still confined to a nursing home following his stroke. I had not seen her face-to-face for a while, so dropped a card in with the invite. When she came, she told us the other neighbours would not be coming, because they had not had a formal invite. I said no one had a formal invite; it was all quite last minute; she got one because I didn't see her. Ann asked how they knew. "I went over to ask if they were coming," Linda said. "My card was so pretty, I showed it them and asked if they had had one." She paused. "Oh, I hope I didn't stir things."