"Chance at Life" provides a portal into the lives of dialysis unit regulars, both patients and staff. Together they confront life's limitations and its certain end with unique stories of struggle, hope and resilience.
Rachel is a novice nurse whose well-intentioned choices put her career in jeopardy. Her personal life disintegrates when she discovers she is pregnant and her fiancé abuses her.
Kidney failure derailed Darnell's career path. He waits in vain for a transplant, losing hope as long days on dialysis consume his future.
Elizabeth, a seasoned nurse practitioner, faces her own failing kidneys and plans to refuse dialysis and let nature take its course, though her doctor and daughters won't let her go so easily.
The dialysis unit is a high stakes cauldron of conflicts and ethical dilemmas. A machine malfunction kills a patient, another patient buys a black market kidney, and another patient withdraws from dialysis entirely, throwing herself a going away party.
Chance at Life is a gripping, poignant, exploration of the human spirit and the unforeseen connections that form in the most trying of circumstances, perfect for those who appreciate medical dramas filled with real world challenges and heartfelt storytelling.
"Chance at Life" provides a portal into the lives of dialysis unit regulars, both patients and staff. Together they confront life's limitations and its certain end with unique stories of struggle, hope and resilience.
Rachel is a novice nurse whose well-intentioned choices put her career in jeopardy. Her personal life disintegrates when she discovers she is pregnant and her fiancé abuses her.
Kidney failure derailed Darnell's career path. He waits in vain for a transplant, losing hope as long days on dialysis consume his future.
Elizabeth, a seasoned nurse practitioner, faces her own failing kidneys and plans to refuse dialysis and let nature take its course, though her doctor and daughters won't let her go so easily.
The dialysis unit is a high stakes cauldron of conflicts and ethical dilemmas. A machine malfunction kills a patient, another patient buys a black market kidney, and another patient withdraws from dialysis entirely, throwing herself a going away party.
Chance at Life is a gripping, poignant, exploration of the human spirit and the unforeseen connections that form in the most trying of circumstances, perfect for those who appreciate medical dramas filled with real world challenges and heartfelt storytelling.
This book is dedicated to people requiring dialysis to live, who have taught me how to find love and laughter amid adversity. They have also taught me to appreciate my own life, the free- dom to eat whatever strikes my fancy, and the extraordinary ability to urinate.
Someday in the distant future, stem cell research will enable patients to grow new kidneys to replace their sick and dying ones. In the nearer future, dialysis patients will clean their blood using artificial kidneys the size of cell phones in belts around their waist or with an implanted bioartificial kid- ney. The phenomenon of a chronic dialysis unit is temporary. In those future days, people will wonder what it was like for the people who spent long hours of their lives in achronic dialysis unit, suffering inconvenience, drudgery, and pain for a chance at life. This book is an attempt to tell their stories.
- Chapter 1 -
Rachel panicked when Michael, the other nurse, called in sick to the United Dialysis Associates chronic dialysis unit. Both the unit manager and medical director were away at a con- ference, leaving Rachel with soleresponsibility for thirty-two lives on her shoulders. Luckily, the day had been unevent- ful, with trivial problems; one patient complained that his chair massager didn’t work, another’s TV malfunctioned, and another signed off dialysis early.
The ongoing thermostat skirmishes continued though. Patients shivered with their blood in tubing outside their bodies while the dialysis technicians sweltered in lab coats as they engaged in the physical labor of setting up,cleaning, and tearing down dialysis machines. The techs repeatedly lowered the thermostat settings for their personal comfort, but today, after the third patient complained of freezing, Rachel surrep- titiously raised thethermostat to seventy degrees and…so far, the technicians hadn’t noticed.
The second shift of sixteen patients dialyzed comfortably on recliners next to their dialysis machines lining the four walls of the unit. Some watched TV, while others slept, read books, chatted with their neighbors, or worked on their lap- tops. Rachel studied their faces. In the year she had worked in this unit, she had grown to loveher patients, their quirks, their families, and the special adjustments each patient needed for a comfortable dialysis session.
Rachel drummed her fingers on the counter at the nurse’s station, enjoying a rare quiet moment following the noisy chaos of shift change. It didn’t need to be so hurried and stressful, but chronic dialysis is big business, focused on effi- ciency and the bottom line. Time is money and can’tbe wasted on leisurely and safe shift changes.
The technicians were taking a break in the corner, talking and laughing about her. Well, she didn’t know that for sure, but she knew they didn’t like her. It wasn’t just her youth; the different roles and responsibilities between the nursing staff and dialysis technicians created a chasm, ripe for conflicts.
It was a lonely position some days, but today the techs had included her in the latest gossip bubbling among thestaff. Mr. O’Hara and Mrs. DeLong were having an affair, and two men on the first shift had started leaving the unit arms entwined. Rachel wondered what attracted the couples to each other. Perhaps the attraction was having just one person who knew exactly what they were experiencing. As she prepared her patients’ medications, sheplanned a Shabbat dinner of roasted chicken, potatoes, and asparagus with mushrooms. She hoped her fiancé,Steve, would approve, and planned to stop at the bakery after work to pick up the challah.
The sound of J.R. shouting, “Rachel, Darnell sprung a leak!” jolted her out of her reverie. For a second, sheassumed it was just another of J.R.’s jokes, but when she saw Darnell covered in blood with the dialysis tubingspraying his blood like a gar- den hose, she panicked and ran to his chair shouting, “Oh no! Help! Shit, shit, shit.” She stopped the dialysis machine and applied pressure to Darnell’s arm to stop the bleeding. He had been asleep,but the commotion over his blood loss awakened him. She pushed the head of Darnell’s recliner back to pre- vent him from passing out. Her heart pounded and her hands trembled with the knowledge that with a few more minutes of this he’d be dead.
Darnell was in his mid-twenties, amiable and engaging, a favorite of both staff and patients. He had saunteredinto the unit a few hours earlier, handsome and robust with shoulder- length dreadlocks and smiling eyes, but now he waspale; his skin cold and clammy. Rachel frowned. The technicians helped her re-transfuse the remaining blood fromthe machine. They gave him saline and oxygen, and monitored his blood pressure.
Darnell moaned, “My ears are roaring.”
Tamika, his tech, replied, “Your blood pressure is low from losing all that blood. We’re working to bring it up.”
As Rachel applied pressure to Darnell’s arm, she turned to J.R., the lanky middle-aged jokester in the chair tothe left of Darnell. “Thanks for the alert.” She shook her head. “Close call.”
J.R. grinned. “Do you remember the time I called you over for Ali Baba? He wasn’t bleeding. He just wasn’tbreathing. I kept wondering why he didn’t move.”
Rachel groaned. “His name was Allen Babcock, and don’t remind me of that day.” She returned her attention toDarnell. “What happened?”
He moaned. “I don’t know. I dreamt I caught a walleye off the pier. My needle must have slipped out as I reeled it in.”
Mr. Freeman, the patient to the right of Darnell, said, “That was some dream. No one catches walleye off thatpier.”
Darnell nodded.
Mr. Freeman continued speaking. “That’s the worst blood loss I’ve seen in all my years in a dialysis chair. Areyou okay?”
Darnell nodded again, this time tentatively.
The staff worked as a team to mop Darnell’s blood off the floor, the chair, and the machine. As it was futile toclean the blood off his shirt, Rachel brought him a hospital gown, but he shook his head.
J.R. quick-explained Darnell’s refusal. “A bloody shirt fits his tough guy image better than a hospital gown.”
Rachel anxiously tried to figure out how the accident hap- pened. She took Tamika aside. “Who taped Darnell’sneedles today?”
“I did. Are you insinuating that I don’t know how to tape a needle? I’ve worked in dialysis since before youwere born, Missy.” Tamika stomped away, declaring loud enough for everyone in the unit to hear, “I’m sick and tired of rookie nurses thinking they know something with their fancy degrees, ordering us around, telling us this and that, looking for someone to blame.”
Tamika’s outburst eviscerated Rachel. Her face flushed and her already trembling body shook a bit more. Her voice quivered as she turned to Betty, another tech standing nearby. “Um…this machine should have alarmedbefore Darnell lost all that blood. Um…can you take it to the tech room and check the alarm?” Rachel noted in her head that it was machine number twenty-three. She turned to Darnell. “You need to stay here until your bloodpressure recovers. I don’t want you passing out at the wheel on your drive home.” She asked Betty to give him a cup of chicken broth and saltine crackers.
The afternoon ran its course. Rachel cared for the other patients, administered their medications, and finished her charting while Darnell languished in his chair, unable to stand without his blood pressure dropping. One by one, patients completed their treatments and went home. The techs fin- ished cleaning and calibrating the machines and departed, stranding Rachel and Darnell in the empty unit. Rachel gave him more saline, morechicken broth, and more saltine crack- ers, but the usual strategies weren’t working.
She looked at her watch. “I’m calling an ambulance to take you to the emergency room.”
He shook his head. “I’m not going to the ER. They’ll make me wait for hours for nothing. Been there. Done that.”
“They won’t make you wait today. One glance at your bloody shirt and the triage nurse will rush you right in.”
He shook his head. “Yeah, they’ll rush me in, stick me with needles, and ask questions later.”
“They’ll give you a transfusion to replace some of the blood you lost today,” Rachel offered hopefully.
“They told me in the transplant office to avoid blood trans- fusions because exposure to other peoples’ bloodincreases my chances of rejecting a kidney, if I ever get one…” He looked away.
“You lost a lot of blood.”
“I’m not going to the ER. I just want to go home and sleep.”
Rachel hated when patients didn’t follow her advice, a frequent occurrence in the dialysis unit. She surmised they all had too much experience with the health care system to trust it or anyone in it anymore. “Who can youcall for a ride home?”
“No one.”
Rachel put her hands on her hips. “Well, if you won’t go to the hospital, and you’re in no condition to drive a car,and you can’t spend the night in this chair, what do you propose…?”
“I didn’t drive my car today. I rode my motorcycle,” Darnell replied with a feeble grin.
Rachel rubbed her temples. “That’s great. A motorcycle.” She went to the nurse’s station and paged the on-call doctor repeatedly without response. Finally, she reached Elizabeth, the nurse practitioner who rounded at theunit, and explained her dilemma. Elizabeth advised her to send him to the ER and hung up. Rachel stared at the receiver a few seconds, disap- pointed by Elizabeth’s response. She had hoped Eli would sug- gest a creative solution for her dilemma.
Rachel returned to Darnell’s chair and relayed Elizabeth’s message that he needed to go to the ER.
He refused again. “Can’t you give me a ride home? I only live four miles away.”
Rachel had a fleeting dark thought that this was a bad idea, but she was tired and wanted the day to endalready. She also needed to get home in time to prepare Shabbat dinner.
She sighed. “All right.” She helped Darnell transfer from his dialysis chair to a wheelchair and wheeled him toher car. The parking lot was empty except for one other car and an old red Harley-Davidson Sportster in the corner.
Darnell pointed to his Harley, “That’s Rusty. She planned on giving me a ride home today.”
Rachel narrowed her eyes. “What a junker.”
Darnell put a finger to his lips. “Shh! You might hurt her feelings. Rusty and I go way back.”
In her book, Chance at Life, Susan Ellison Busch, MSN, CNP, explores the lives of patients and medical practitioners. Darnell, J. R., and many others are faced with “life’s winter.” They’re dialyzed patients regularly attending the dialysis clinic while waiting for kidneys that seem to never come. Rachel and Elizabeth (Eli), among others, care for and promote the well-being of their patients. When Darnell is found bleeding, Rachel not only drives him home but also aggressively follows up on why the dialysis machine malfunctioned. Tired of waiting, Marguerite decides to get a kidney from Mexico, and upon hearing this, Eli warns Marguerite of the black market’s dangers. Whereas Darnell’s story symbolizes the importance of following the right channel when it comes to getting a kidney, Marguerite’s serves as a reminder that the dark market is never ideal. In summary, this book is about family, love, religion, racism, science, and politics regarding dialysis, and more importantly, it’s about life and death.
Susan reminds readers of the importance of the kidney. For the people suffering from kidney failures, and now in line waiting for a new kidney, their journeys are revealed here, all painful and hardly a ray of light at the end of the tunnel. Urinating is such an ordinary thing, but for a patient just from a kidney transplant, being able to pass urine once again brings smiles and hope, something to look forward to as this book reveals. Simply put, as Susan writes, "Kidneys are magnificent organs that create the precise internal environment to sustain life. They filter blood; removing waste products and toxins, while retaining important proteins and electrolytes.”
Chance at Life falls in the must-read category, especially for romance readers and those interested in the lives of dedicated health care workers. First, the prologue greatly informs the reader of the book's objective. This heightens the expectation. Second, the characters are people to admire and sympathize with. People to get hooked up with. People as real as our family members, friends, and colleagues. In particular, Rachel loves her patients. Her work is rife with challenges, bureaucracies, and it’s not easy being a friend to everyone. Still, she stands out. Back home, things aren’t that pretty with her fiancé, though she loves her in-laws, and she decides right when love comes her way. Darnell is also a good man. His story tells more of racism, living with kidney failure, and the twist of fate gives him a chance at life in the end. To Susan’s credit, the reader interacts with the characters both in the clinic and outside.
After reading this book, it’s likely that the reader will endeavor to have the healthiest kidneys possible by doing everything they can to ensure their kidneys function accordingly.