Shared Journeys

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I was a second-year fellow when Mr Duffy came to the hospital in 2008 with acute kidney injury. Kidney biopsy showed rapidly progressive glomerulonephritis from antineutrophil cytoplasmic antibody (ANCA) vasculitis. He was treated with immune-modulatory agents, including plasmapheresis, and eventually discharged to see me as an outpatient for his ongoing care.

I was so scared when this young doctor told me I had a rare kidney disease and they were going to give me immunosuppressive medications. I went along with his judgment. I created a bond with this doctor and had faith in him that I would get good care. The thing that really bothered me was that I would not be able to go to Ireland that year. He had told me that things were hazy and I needed some strong medications and to be under a close watch.

I saw him almost every 2 weeks initially and then monthly; his kidney function was improving. I started tapering his steroids and he felt better. He lived far from our office but would make every effort to come to the visits. His wife would always accompany him and made sure we went over all his medications. I was optimistic, but still worried; I wanted things to go well for them.

My wife and I visited this young doctor with hope that there would be some improvement in my kidneys. He was easily reachable and didn't mind it at all when my wife religiously called him weekly just to update him. We learned a lot from him about my disease. I really hated being on the steroids—it would keep me up but I had to take them. My wife thought I was going crazy at one point. Some days I felt that things were going great, other days that things were falling apart.

One day, he got admitted for increased shortness of breath. He was very anemic, developed worsening fluid overload, had methemoglobinemia (from dapsone he was taking for Pnuemocystis jirvoci pneumonia prophylaxis), and developed chest pain on top of it all. Nothing was going right. His creatinine was not improving as quickly as I thought it would, so we started to talk about transplantation.

It was a few days before Christmas, and I was really scared now. I thought things had been fine but it almost felt as if there was no light at the end of the tunnel. I might need a transplant. I might need dialysis. Things were getting very hazy and very confusing to me. He made me get all this cancer workup that turned out normal. He then told me that in case I ever needed a transplant, all things were in motion. I was glad that he was thinking very far ahead but it was still very scary. At this point, I was missing my home, Ireland. My family was here with me—my wife, my kids, my grandkids. I was glad they were all here.

In the next 2 months, we tapered his steroids and he relapsed with worse proteinuria and hematuria and worsening kidney function. He was restarted on steroids but within a few months he had to start dialysis. Meanwhile, his son was a good candidate for transplant and was completing all the workup as a donor.

My kids volunteered to be donors for a kidney. I resisted. I told him to just put me on the regular list. One day, my kids took me out for dinner and decided that my son was going to give me his kidney. My wife and I feel grateful for the wonderful set of children we have who came forth and were very persistent. I finally bowed to their decision and decided to go ahead with my son being the donor for my kidney transplant.

We did a repeat kidney biopsy and he had all chronic changes and no active disease. We scheduled a kidney transplant for him a few months after he had been on dialysis. By that time, I realized, my fellowship would be almost over. I had been talking to him as if I would be there through everything. There was so much left to do. I wanted to leave, to move on—and yet I didn't.

I didn't like the fact that I had to start dialysis. But I did it. I had to do it close to home but it was for a short period of time. He had tried everything and took care of me through all the complications of the pre- and postdialysis course.

I know he was going through a lot in his life as well. He had to find a job. His wife was pregnant. I didn't even know if he was going to be there when I got my transplant. His training was coming to an end soon.

The day had finally come for his transplant. It was my last few days of fellowship, and I saw him before the surgery to wish him good luck. I saw his son and also wished him good luck, congratulating him for doing a great deed. I told his son that he was giving his father an unforgettable gift. He told me that he was giving his father a new life, a gift he deserved. The surgery went smoothly. I saw him twice in clinic before I ended my fellowship. It was time to say goodbye to him and to all the patients I grew to know as a fellow. Meanwhile, I was anxiously awaiting the birth of my first son and the start of a new phase in my career.

I feel like a new man. My wife said that my eyes were never this cheerful and bright. I don't want to look back. The transplant is the best thing that happened to me in the past 2 years. I thank my son and the young doctor who was very persistent in getting me the transplant. Currently, my kidney function is completely normal, I have no blood or protein in my urine, and my so called “ANCA” titers are not detectable. I now have valuable time with my family. I also feel I made a new friend in this doctor—we took this journey together.

I finished my fellowship in June. Four days later, my son was born, and a few weeks after that I started a new job at a new hospital. I kept in touch with Mr Duffy—in the end, I couldn't quite say goodbye. He tells me he is doing very well, now 4 months after his transplant.

Watching him come in with severe disease, seeing him respond to treatment, and then seeing the disappointment in his eyes when the treatment failed was an experience I will never forget. At the same time, getting him ready for transplant, getting his family involved, and accompanying him on the journey of finding a transplant was equally unforgettable. The smiles on their faces were priceless. This one patient taught me glomerular disease, general nephrology, dialysis, and transplantation. But the most important lesson Mr Duffy taught me was that even as what we do for each other changes with time—father caring for son may become son caring for father; doctor helping patient may become patient helping doctor—the essential bonds between us as human beings persist. He will always be part of my life.

I am doing very well now. I hope he is doing well in his new role as a father and a nephrologist. A visit to Ireland is on my list of things to do this year!