Personal Journal
When Nephrology fails: A Paradigm Shift
Glen Butuyan, MD
The Nephrologist’s journey is a long and narrow road. At the end of the road dawns a life you chose to live. You start a practice and probably begin a family of your own simultaneously and find yourself in a race with time to compensate for the many years spent preparing for this main event.
You search for opportunities, and you weigh your chances. Surely, apprehension grips you because you thought you were ready for this battle. Yet, the need for you to dive into the practice of your profession and buy an ownership stake in a healthcare facility to ensure a practice that thrives will make you run back to your family for support for your already exhausted finances. Along the way, you realize that the banks are kinder, although more burdensome.
This is a common scenario in urban practice for those not endowed with inherited medical practice. In rural areas, the fight could be equally daunting. Jealousy, possession of patients’ mentality, and a mindset that dialysis cannot save but only prolongs the agony. An enormous reservoir of patience and perseverance is essential to survive and thrive in this profession.
Moreover, even at your peak, the risk of disaster keeps showing up at your doorstep because of the constant specter that you can be a victim of a pseudo martial law that is embedded in our medical insurance system. Nonetheless, life must go on, for we are created to heal the sick with or without PHIC accreditation. Moreover, we earn far greater rewards that can indeed last for ages by doing so.
From the moment I started my medical practice in 1993, my most significant burden has always been how to keep my patients alive at all costs. I always strive to search and try all possible proven regimens and strategies to address and cure the diseases I encounter. Most patients, even the already seriously bedridden and gravely sick ones, beg me to give them an extended stay on earth to enjoy more time with their loved ones. The pressure to extend all the help you can muster for seriously ill patients tremendously drains you physically and mentally. Even patients who have lived full lives into the old age of 70, as mentioned in the Bible, and with ailments wasting away their bodies, desire more time on this earth. As if worldly life can be everlasting and there is no better place after this life.
A few years back, I had my most important life lesson, and it came like a tsunami that struck me big time and momentarily knocked me down. A patient complaining of severe difficulty breathing was admitted due to uremia with a creatinine of 3000+ mmol. I promptly told him that dialytic therapy was the only option and no medication could alleviate his symptoms or save him because the disease was so severe, and he was on the brink of death. I firmly and persistently pleaded that he follows my advice because I wanted him to live. I encouragingly told him that there would be an instant improvement in his first session. I pleaded for him to give my suggested treatment a chance. I got impatient, frustrated, and angry because I felt useless in the face of a patient who refused the treatment I was pleading for him to take. Deep inside, I was telling myself, what is the use of one’s diploma, renown, and the intensive training one has garnered when encountering such a patient. He still has the chance to survive but has resigned and accepted his doom because of unfounded, distorted, and corrupted views about dialysis. What a waste of time and resources, I told myself.
I had been in this kind of predicament several times in my medical practice. The primary reason for the refusal of such patients to undergo dialysis is consistent because of the wrong view that dialysis can kill, weaken, impoverish, shorten life, or make the patient a monster. It is a view that is both funny and tragic because it is a belief ingrained in the minds of so many people not only in the Philippines but even worldwide. Sometimes, you have to bamboozle people to convince them to give dialysis a chance. My best strategy is to tell them to provide three (3) dialysis sessions a try, get discharged, go for a follow-up check-up in a week, and if their creatinine levels go up, then dialysis will resume on an as-needed basis. I need to give them some hope of recovery to make my proposal palatable. I assure them that recovery of patients who undergo dialysis, although recovery speed differs among patients. It may take a month or two, and the longest I have encountered was two years in one of my elderly patients.
Going back to the patient I earlier mentioned, with much frustration, I left him. As I exited the door, I felt a big lump on my throat and a tightening of my chest. But I also felt like someone was trying to pull me back to where the patient was, and in my mind, I was questioning myself: is that the only thing you can do? Is physical healing the greatest need of this dying man who refuses treatment and has accepted his fate’s mortality?
A great conviction and guilt seized me; I turned around and returned to him. I tried to persuade him again, to no avail. So I asked him if I could pray for him before I left him. Why? Because I knew that in a little while, he would be gone. He uttered the word “yes” while gasping for breath. First, I shared the good news to him: that all of us are sinners, the only payment of sin is death, no way we can pay it on our own, and that is why Jesus came to die on the cross, and through his blood, we are healed spiritually and saved. Then, we both prayed, and he repented from his sins, and ultimately he accepted Jesus as his Lord and Savior. Afterward, I left him and felt that the lump on my chest was gone while going through the door.
While on the road to another town, the attending nurse phoned and informed me that the patient I prayed with had died. I had a strange feeling of great relief, and there was rejoicing in my heart because I knew I had done something even when Nephrology failed. From that moment, my eyes and mind were opened, and I searched earnestly into the scriptures to find out if the eternal destiny of this patient changed. It also dawned on me that we, as healthcare workers, could be the last person standing beside these patients as they enter the door to eternity. We certainly experienced this scenario multiple times in the length of our careers. And we could be these patients’ last chance at a glorious destiny.
As Christians, we all know that our salvation is through faith. Salvation is by grace and not a result of good works (Ephesians 2:8-9), and Jesus is the only way (John 14:6 ). He saved us through His blood (1 Peter 1:18-19) 2000 years ago, even before birth. Through repentance and submission of ourselves to the Lordship of Jesus, we are healed from our sins, and we become children of God (Romans 8:16-17) and co-heirs of His kingdom. The best example of such amazing grace is when one of the robbers crucified with Jesus accepted his fate to die on the cross because of his crime. Instead, he gained eternal life in paradise because he took Jesus into his life just before he died.
With much confidence, I can say that I felt assured that my patient is now in paradise because he repented and accepted Jesus as his Lord and Savior. With this paradigm shift that gave me a holistic view of the lives of our patients, I realized that in saving patients’ lives, we also have a more critical role to play in saving souls through spiritual healing. After all, the physical body is destined for the grave, no matter how good the treatment or the doctor is. It is just a question of time. Therefore, my daily mission has become to share the gospel with every patient I meet in my clinics and wards. This has also been my best regimen in extending comfort and healing during the entire course of the pandemic. I hope and pray that it will also be yours.
