chapter 2

Up until the age of 32, Jane had been fit and healthy. As a child, she had swam twice a day, every day and participated in club swimming galas. As a teenager and young adult, she had competed up to national level.
Her preferred event was the 200m freestyle, but her coach pushed her to swim individual medley events, which meant she had to be able to swim every stroke fast and efficiently.
As she grew older, the training to maintain the same level of fitness was becoming increasingly more difficult to maintain. She suffered a series of minor injuries when she was 23, which led to her giving up the sport competitively.
Her dedication to the sport had made an impact on her schooling. Her exam results were not as good as they could have been if she had not been in such an intense training programme. She had never had a proper job. There was only one thing she knew anything about and that was swimming! So, she took a course or two and became a swimming teacher for children and adults.
Now she was not competing, she swam only for pleasure. She still swam faster and covered more lengths than most people, she just didn’t drive herself so hard and she didn’t swim every single day.
When she was swimming competitively, she’d had to make sure she consumed enough calories to fuel her strenuous exercise regime. She followed a diet outlined by her sports nutritionist. She often had to consume over 5,000 calories a day, most of that was from lean proteins.
When she retired, she’d carried on eating as she had been when she was competing. She was no longer burning off as many calories. It was inevitable that she was going to gain a few pounds. She’d already gained two stones before she realised anything was wrong.
She tried to curb her appetite somewhat, but her stomach was used to large volumes of food.
She tried several diets on and off until her early thirties. They would all work, for a month or so, but then she would put all the weight back on, plus more!

When she was 32, she had a flu-like illness. Afterwards, she felt tired and lethargic. She had a funny taste in her mouth and she wasn’t peeing as much as she ought to. She thought she must be dehydrated, but drinking more did not increase her urine output. All it did was make her legs fill with fluid.
She thought it was most peculiar and decided to go to the GP’s for his advice.
The doctor was concerned enough to take her blood there and then rather than wait for an appointment for the phlebotomist. He assured her that there was probably nothing to worry about, but made sure that her contact details were up to date anyway.

Jane went about her own business as usual. She did a bit of shopping, called in at the pool for a quick swim and then went home.
Her husband was waiting for her anxiously. He’d had a call from the surgery two hours ago. They’d had the results from the blood tests back. The GP said she had to go to the hospital immediately!

She did not have to wait long in A&E to be seen as she was expected. She had her blood tests repeated and had to drink a chalky vanilla drink called calcium resonium. A venflon was put into a vein in her arm and she started an infusion of glucose and insulin. She was a bit bewildered by it all, but the junior nephrology doctor said her potassium was dangerously high and they had to get it down. The measures they had used so far were all temporary, but they allowed time to investigate why her potassium was high.
The junior doctor was joined by a nephrology registrar and they both quizzed her about her medical history, especially recently. Had she been eating an excessive number of bananas or drinking too much coffee? She ought to avoid consuming both at present because they both contained high amounts of potassium.
They did an ECG, she had her blood pressure temperature and oxygen saturation levels checked. When the glucose and insulin was finished, she had an injection of calcium gluconate to stabilise her heart rhythm.
Once they received the blood results, they repeated the tests, but in the meantime, she was to be admitted to the ward.
She was on the ward in about an hour. She had all the tests repeated again and was hooked up to a cardiac monitor.
The second set of tests showed some improvement, but it was not as good as they would have liked. She needed more intervention to improve her blood tests. She was put into a gown and taken into a clinical looking treatment room on her bed. A nurse and the registrar were both there waiting for her. She agreed to whatever it was they were going to do, but she didn’t fully understand what they were doing and why they were doing it. She just had to trust that they knew what they were doing. She understood they were putting some line inside her, but she did not understand why it was necessary.
She was covered in green towels and given a local anaesthetic in her neck. She could feel the doctor pushing and prodding as he inserted a double wide bore line into her internal jugular vein and secured it in place with a stitch and a dressing. As soon as the line was in, she was wheeled into another room where another nurse waited for her. There was a big machine covered in tubes next to her bed. The machine had a pump on it and was pumping some kind of fluid around it.
The nurse wasted no time. She repeated her blood pressure, pulse and temperature, then put on a pair of gloves. She placed a white paper towel over Jane’s neck, so she could not see what was happening, but she could feel the nurse was using the line in her neck for something. When the towel was removed, Jane could see that the line in her neck was attached to long tubes that were attached to the machine beside her. Her blood was being drained from her body, sent around the machine and then it was being pumped back into her.
She felt even more bewildered than before. A few hours earlier she’d just come in and was looking forward to a nice night in with her feet up in front of the telly. It was barely nine o’clock and she was in hospital and on haemodialysis.
The nurse sent more blood off for analysis, but she took it directly from the extracoporeal circuit on the machine. She sat with Jane the whole time, checking her vital statistics every fifteen minutes and checking the pressures, flows and safety devices on the machine were all working correctly.
Meanwhile, she had time to explain how her kidneys were not working as efficiently as they should be for some reason. The doctors would investigate why that was in the next few days. If her kidneys were not working efficiently, they were unable to eliminate the poisons that built up in the body as a product of normal metabolism. Usually those poisons would be got rid of when she peed. She had not been passing urine properly recently. The urine she had passed was likely to have been poor quality. The poisons had built up inside of her and reached dangerous levels. The haemodialysis would clean her blood efficiently and get rid of the poisons that had built up. It would take a few hours to get her bloods back down to somewhere near normal. If her potassium level had not been artificially brought down, she would have been at risk of immediate cardiac arrest.
What!!!! Jane had wondered why the doctors and nurses were running around her do much with concerned looks on their faces. She had not realised her condition was life threatening! She now understood why they’d not explained things in more detail and given her time to digest the information.
Now she was out of danger, they could spend more time with her, allaying her fears.