Page 24 - WCMS4Q21

Share Your Story
Sometimes it Takes a House Call
By Richard Swartz, MD and Erica Perry, MSW
Preface
Rick Swartz, who died suddenly and unexpectedly October 11, 2021, was a dedicated and renowned nephrologist and friend. Two years ago, he told me the following story, which I asked him to write up for publication in the Bulletin. It reflects the finest qualities of being a physician. I have reprinted the story in his memory, to reread and to remember him.
Cumulated experience and outcome data clearly show that chronic dialysis patients have a shortened life expectancy and a mortality rate that averages at least 15% per year, ongoing and continuous so that attrition among this population is linear. On average, life expectancy going forward from the time a patient starts on chronic dialysis starts is reduced by one half to two thirds, depending on age and comorbidity. Life on dialysis is challenging; underlying comorbidities do not improve. A significant number of folks doing chronic dialysis will decide that enough is enough and choose to get off the 3-day-a-week treadmill, stop dialysis, and ask for support and comfort in their remaining time. Decades of out- come data and clinical experience tell us that once dialysis stops, death ensues in 8 + 2 days and in that brief interval patients can be managed comfortably with attentive Hospice and palliative treatment.
The office forwarded me a message from Charlie, saying that he was “a bit miffed” and wanted me to call him promptly. Charlie was a man in his mid-seventies,
with chronic renal failure. He was a clockmaker by trade and meticulous by nature. He was stoic and very practi- cal, following his treatment regimen precisely and adhering to his renal diet. Perhaps related to the precision in his occupation, he was also realistic about the progres- sive nature of his illness and the need to plan for his eventual death. His plan included purchasing a house in a small town, so that his wife, who did not drive, would have access to stores and necessities.
His list of serious medical problems started with hypertension and coronary artery disease. He had developed kidney disease that progressed to the point that he needed dialysis. Peripheral vascular complica- tions had ensued, causing progressive pain and lower extremity ischemia such that distal amputation was unlikely to succeed and more proximal amputation might well be needed. Unfortunately, his vascular disease was not confined to one leg. He very likely faced ongoing pain, long rehab, disability, and confinement.
24 Washtenaw County Medical Society BULLETIN WINTER 2021