chapter 6

Jane stayed on peritoneal dialysis for three years. In that time, she’d had a couple of episodes of peritonitis, which was an infection of her peritoneum caused by bugs getting into her fluid somehow. The peritonitis was extremely painful, but was treated easily with antibiotics in her peritoneal dialysis fluid.
However, after three years of constant use, her peritoneum was losing it’s permeability, which meant that even though they changed different formulations and the nurse changed different settings on her machine, the treatment itself was becoming less efficient.
The doctors decided when the efficacy of her treatment was no longer viable. She had no choice. She had to go onto hospital haemodialysis.

The switch of treatment modalities hit Jane hard. She lost much of her independence. The first shift she was given started at 06.00. At that time of day, she could not rely on relatives for lifts. Her husband needed the car for work, so she could not drive herself. She couldn’t even use public transport because it was too early. So she opted for hospital transport. Sometimes this was via a non-emergency ambulance, which was little more than a minibus, but most often it was a car-ambulance. A volunteer driver who used his or her own car to take patients for their appointments.
The trouble was that to get there for six, her lift would be at her door at half five or earlier. Sometimes the driver had several patients to pick up. That meant they had to take a roundabout route to the hospital. A journey of fifteen minutes could take three quarters of an hour. At least she did not have to worry about parking!
Once she got to the dialysis unit, she had to sit and wait in the waiting room until her machine was ready and a nurse was available to put her on. This could mean that despite being on the unit on time, she might not start her three and a half hours dialysis until seven or later.
Every time the machine alarmed, it stopped the pump, and added time onto the clock. If the machine was playing up, a three and a half hour dialysis could take four hours to complete.
Once she was finished her session, she had to sit and wait in the waiting room for her driver. The driver would not leave until everyone he had brought to the hospital was finished their treatment, which meant Jane could be waiting around for an hour, then there was the circuitous route back home again to contend with.
If she was being picked up at five for her six o’clock appointment, she had to get up at four or half past. Then she might not get home until one o’clock, or later. She was exhausted, not just because of her treatment, but because she’d had to get up so early. She would have to spend the rest of the day napping.
The next day, she would feel a bit better and managed to do a few jobs, but she had to go to bed so early, so that she could get up in the morning, that she felt she was missing half of her evening.
The problem was the hospital had to run four dialysis shifts a day: morning, afternoon, evening and night. The afternoon or evening shifts would have been better for her, but they were the most popular. Patients who were still working had the priority over evening shifts. Night shift patients had the worst deal because they may not get on their machine until midnight, which meant they would not get home until four or five in the morning.
At least one machine broke down on her shift. This usually meant switching to another one and sending the broken one to the on-site technician. The problem was the machines were running constantly 24 hours a day. Each machine had to be washed down, and the lines changed between patients. They also had to be disinfected inside. A simple heat disinfect could be used after one use. This took an hour to complete and then another half an hour to an hour to set up and prime ready for the next patient. After two uses, the machines needed to be bleached inside. After four uses, the machine would start to clog up inside with bicarbonate which was used to make up part of the dialysate, so it needed to be cleaned inside with acid. Acetic or citric acid was used, but both needed to be used in a well ventilated area, especially if the acetic acid was used. A full chemical disinfect could take two hours.