Had a 78-year-old female patient with a BUN of 81 and a creatinine of 6.2. She has a history of HTN, CHF, anemia, CKD, and DMII. She was only in the hospital a week ago and she was back again this time for pneumonia and increased swelling in her legs. She looked miserable and was getting worse with nausea, vomitting, and inability to keep any of her food down. She needed dialysis, but she had refused previously. When I spoke to her, she refused dialysis because she was scared that it would be painful. When I asked the family why they refused dialysis, they also thought it was painful and somehow involved inserting something straight into the kidneys from the back. I explained to them how dialysis works and even showed them the machine and where the tubing and catheter would be going. After that they understood much more and consented to the dialysis. Simple education. Educating the patients is the key so they can make informed decisions. I don't think anyone really took the time to explain it to the patient or the patient's family. I was able to make a difference. The little things that make this job rewarding despite the stress.
Addendum: Saw the patient today (10/30/12). She was smiling, talkative, doing well. Transferred her from the ICU. Felt good.
