Wisdom of the Young

As my medical-surgical rotation in my second year of nursing school was nearly ending, I remember receiving my patient assignment for the week the night before and wondering if I would even be able to take care of R.B. As I skimmed through R.B.'s several diagnoses and medications, pure confusion and anxiety ran through me. Despite my teacher's note stating "Do not stay up all night worrying and reading but you should get to know the meds", reverse psychology kicked in. Cristine did stay up all night trying to sort out who R.B. was. In the file that my instructor had sent, multiple abbreviations unbeknownst to me appeared: PKD, CKD, ESRD, CAPD, HD ... They left me saying WTF out loud. However, the complexity of this man's profile on paper became incomparable to the real complexities I would later encounter upon meeting him face-to-face.

R.B. was a 19-year-old male who had gone through a series of hardships since birth. Born with polycystic kidney disease (PKD) and congenital hepatic fibrosis, R.B. underwent bilateral kidney removal and transplantation at the age of 3. To prevent his body from rejecting his donated kidneys, he had been taking medications to suppress his immune system. However, at the age of 15, a new diagnosis of intestinal lymphoma changed the course of his life as nearly fatal complications ensued.

When I met R.B. for the first time, it caught me by surprise. He was a 5' lad with thin arms, swollen legs and a protuberant abdomen that appeared to carry half of his total weight. He had glasses like Harry Potter and juvenile facial features that made him appear no older than 14 years of age. It was hard to believe that an individual with such physical traits was two years older than me at the time. As I introduced myself, I am met by a soft-spoken and calm voice. R.B. was a man who had gone through unimaginable obstacles that rendered him a recurrent visitor of hospitals. In just two days, in addition to what I had read in his chart, I unfolded his side of his story.

"Since I was fifteen, my life has become a nightmare", he told me in a controlled manner. After his cancer diagnosis, R.B. had undergone several sessions of chemotherapy. However, the cost of this life-saving treatment was the cessation of his anti-rejection meds for his kidney transplant. Once an individual undergoes a transplant, it is an absolute must for him/her to continue taking immunosuppressants to prevent their own body from attacking the transplanted organ. Unfortunately, it was suspected that his anti-rejection meds may have contributed to the development of his lymphoma and thus, led to the difficult decision of discontinuing their use. Inevitably, R.B.'s body began rejecting his kidneys. With no renal function, R.B. had hemodialysis three times a week whilst completing his chemo. Once in remission, R.B. had opted for CAPD - continuous ambulatory peritoneal dialysis, to filter out waste products from his blood. Given the remote location of his home, heading to the city for his dialysis sessions would be too time consuming. Hence, his mother had undertaken the responsibility to dialyze him at home. This was the temporary solution until new kidneys would be available. During that wait, R.B. unluckily developed peritonitis-turned-sepsis twice within the last year. This admission was the third time it would occur.

When I did my initial assessments of R.B., his easygoing nature and his patience made interactions with him seemless. Since I still was a nursing student, one of our weekly assignments included filling out our patients' database sheets to confirm full comprehension of who they were. R.B.'s case was the most intriguing and complex one I ever worked on. As I did my physical evaluation on him, I was surprised at how open he was when it came to pointing out unique findings. He guided me as where to palpate to feel his enlarged spleen of 23 centimeters (splenomegaly) and rigid liver. He also would tap on his belly to show me the "waves" induced by the physical maneuver. He had what we call "ascites" (fluid accumulation in the abdomen secondary to impaired liver function). As a result, he developed cirrhosis which rendered his abdomen severely protruded and his abdominal veins noticeable from a mile away.

After one of his dialysis sessions, I remember walking around the unit with him. On our promenade, R.B. told me about his family and his dreams. He was one of five children. His parents were divorced but remain very involved in his life and his care. His father would occasionally bring him outside of the hospital to have supper. His mom would stay at his bedside until visiting hours were up. He told me about doing online school and how he hoped one day to work for Ubisoft as a software designer. He told me about an older brother that he never met due to his premature death secondary to PKD.

As we returned to his room, he expressed his inner thoughts about his whole situation. Despite a calm demeanor, he stated feeling lost and fearful. "I don't know what to think", he admitted to me after being told by the doctors that a fourth sepsis could kill him, and that continuing peritoneal dialysis was strongly not advised. I listened attentively to his concerns and was taken aback from his level of self-awareness, self-reflection and emotional maturity. The way he expressed himself was similar to a grandfather telling his tale to his grandchildren; a story filled with wisdom beyond words. Even through all of his challenges, R.B. accepted his reality as it was. He was aware of his mortality and his uncertain future, yet he did not let such emotions overthrow the present. He lived as he could, with the means he had. Rather than bottling up his sentiments, he was an open book. He permitted himself to be vulnerable and verbalized his train of thought in a graceful fashion. When hearing about his life first-hand, I couldn't help but acknowledge his strength and courage. In response, R.B. replied "Yeah, sometimes I am a bit too resilient".

At some point in our lives, death may pay us a brief visit. It may look at us in the eye, gently caress our cheek, not utter a single word and disappear for an indefinite period of time. Such encounter may have a significant impact that prompts the person to alter their way of thinking and living. It may be the wake-up call to change for the better, or it may the source of one's hopelessness and defeat. But, what happens when death becomes too comfortable with your presence? When it ignores all boundaries, comes to see you more frequently and hugs you tighter after every meeting?

How would that make you feel?