Dialysis from the sharp end of the needle

CBS's Undercover Boss includes TV's best portrayal of dialyzor

By Bill Peckham

After the Super Bowl, CBS premiered a new show - Undercover Boss. It's a new reality show where corporate leaders take entry level jobs at their companies. The premier shows Waste Management President Larry O'Donnell going undercover as Randy and working a range of jobs, from cleaning porta-potties to running residential garbage pick-up routes. One of the jobs was policing blowing garbage at a landfill (UPDATED video - CBS has made a clip with Walter available):

The dialyzor, Walter Settles, is the supervisor who fires Randy - he fires his company's COO.

Watch the full episode, the segment with Walter starts at the 11:44 mark. At 13:47 there's this bit of dialogue:

Walter: I'm on dialysis and that take up three days .. three nights anyway. I lost the functions in my kidneys
Randy: I would have never guessed that you have that kinda health issue. I've been marching up and down those hills picking up trash - you come marching up there. How do you do all that?
Walter: I let my spirit tell my body what's going to happen what I'm going to do what I'm not going to do, because if I let the body tell me what I'm going to do I'm not going to do very much.
Randy: You have such a positive attitude do you work with other people on dialysis?
Walter: I would like to but as long as I can work and I'm able to work I'm going to work ... when I see a perfectly healthy person dragging around, and I can go out there and work circles around them, and he can't do this and can't ... that really pisses me off there, because I wish I was healthy ... you should be able to do more than I do. If I can get out there and fill two bags in 10 minutes, I'm expecting you to do three bags in ten minutes

It's was good television. And it really could have only happened on a reality show. If the show was written we would have never seen someone on dialysis in a physical job.

At the end of the show Larry/Randy's real identity is revealed. When Larry reveals himself to Walter he mentions Walter has been on dialysis 19 or 20 years and promises Walter the opportunity to volunteer on the company clock. 

I think outside of news pieces this marks two television firsts - showing someone who has been on dialysis a long time and showing someone on dialysis working a job that is physically hard. Undercover boss showed a long time dialyzor who has to shower after work. We're out there; it was a pleasant surprise to see this accurate, positive portrayal.

30 Rock musical appeal for kidney donation

By Bill Peckham

The NBC show 30 Rock produced a start studded musical appeal for a kidney last night. The show is a comedy so the lyrics are pretty silly but it still stands as the most star studded appeal for kidney donation I've seen

The stars include Elvis Costello, Mary J. Blige, Clay Aiken, Sheryl Crow, Adam Levine, Adam Horovitz, Mike D., Sara Bareilles, Wyclef Jean, Norah Jones, Talib Kweli, Michael McDonald, Rhett Miller, Steve Earle, Moby, Robert Randolph, Rachael Yamagata, and Cyndi Lauper.

That's quite a line up. Let's hope they all stay engaged with CKD and continue their advocacy on a more serious note.

Dr. Carter, joined by Benton, helped by Ross and Hathaway, work to get Carter peeing again

By Bill Peckham

The full ER episode Old Times (Season 15 : Episode 19) is now available online, I thought is was pretty good. Spoilers Ahead

ER: Is Dr. Carter going to die?

By Anna Bennett

Even though March 12th is World Kidney Day, March really is World Kidney Month.  We are seeing mainstream press write about dialysis, kidney failure and transplant.  CKD5 is in in prime time, watched by millions of people who are emotionally attached to the character played by Noah Wyle, Dr. John Carter.  In tonight's third episode "What we do" of the Carter is sick story line, he is back, has revealed that he is in kidney failure due to prior trauma and amyloidosis secondary to chronic inflammation from Schistosomiasis.  He is back in Chicago, and waiting on the UNOS list for a deceased donor kidney.  We covered all of this is our prior posts. (3/7 episode SPOILERS after the jump)

ER: Dr. John Carter says why he needs dialysis

By Anna Bennett

Bill, Peter, Mel, Harvey & I, the writers at DSEN live with kidney failure every day.  Bill, Peter and Harvey are on dialysis, Mel & I were on dialysis and last Fall, we both had transplants.  We write about dialysis and transplant from a first person perspective.

From a fictional dialysis standpoint, the beloved Dr. John Carter (Noah Wyle) returned to the show ER, looking for some part-time work, road weary (or so we thought) his wife behind in Paris visiting her mother but he was minus working kidneys (we call that CKD5).  Last week, the last scene was of him on dialysis.

Bill & I have been following this story arc quite closely.

This week, during ER's "T- Minus- 6" episode we find out why he is on dialysis (details after the jump Spoiler Alert)

How do you know Dr. Carter is on hemodialysis?

By Bill Peckham

There seems to be a question on some of the ER fan sites about how anyone could know that Dr. Carter is on dialysis. Of course the writers aren't constrained by real world realities but they did go to a lot of effort to accurately portray a hemodialysis machine in use. Click on the annotated screen capture to the right for a larger version of Dr. Carter's dialysis treatment - as shown during the last two minutes of The Beginning of the End, ER Season 15, Episode 16.

Many fans are worried that this means Dr. Carter is going to die. The writers may write what ever they want (if he dies I think it would be a cop out) but the truth is you can live a long time on hemodialysis.

ER's Dr. Carter shown on conventional incenter dialysis

By Bill Peckham

I used to watch ER what seems like a long, long time ago. I remember Dr. John Truman Carter III, portrayed by Noah Wyle, and when Anna wrote that the character is now on dialysis, I was intrigued

That is a nice dialysis unit. Not only is the unit spectacularly clean and quiet, it is also dimly lit. Units are rarely that dark. When I visit a unit I assume I'll be dialyzing under a bank of florescent lights, left on for the duration. So the question is: what's going to happen to Dr. Carter?

When a person's kidneys stop working they need either a kidney transplant or they need to receive regular dialysis. Dr. Carter is shown on hemodialysis in a dialysis unit which puts him in with the majority of people with stage 5 chronic kidney disease (since he is using a fistula or a graft for his access we know he does not have acute kidney disease which could be expected to resolve).  According to the United States Renal Data System (pdf link) as of January 1, 2007, nearly 328,000 patients were receiving hemodialysis therapy, 26,082 were on peritoneal dialysis (another type of dialysis), and 151,502 had a functioning kidney transplant.

Dr. Carter is in that largest group of 328,000 people with CKD5 using hemodialysis. Over 98% of the people in the United States who are using hemodialysis to manage their CKD5, dialyze in a dialysis unit three times a week for three to five hours. This is what it looks like Dr. Carter is shown doing - conventional incenter hemodialysis.

As Anna asked why isn't he doing the healthier form of hemodialysis? - at home, more frequently, using the newest home hemodialysis machine: the NxStage System One (BTW you don't have to be rich or a doctor to do home hemodialysis but I guess it wouldn't hurt). When professionals in the dialysis industry are asked which way they would dialyze they report that daily home hemodialysis would be their first choice. This situation, where the professionals would do one thing and actual practice is something else, could really be helped if a high profile TV show portrayed one of their characters making smart decisions about how to treat their CKD5.

I'll be watching to see how this story line develops. Maybe Dr. Doug Ross will return to donate a kidney to Dr. Carter. Or maybe he'll decide that daily nocturnal home hemodialysis is his best chance to live the life he was meant to live but for his CKD. It would be nice if the show made it clear that Dr. Carter has severe chronic kidney disease which he is managing through the least healthy, yet most common way: conventional incenter hemodialysis. Sigh.

Hopefully this will resolve with Dr. Carter's character sucking it up and making a better choice. But I am not hopeful, after all in the real world there is no reason Dr. Carter couldn't have joined his wife in Europe.

As seen on TV: Fictional Dialysis

By Anna Bennett

I spent a year on home hemo before my deceased donor transplant - which translates into watching a lifetime of TV.  It was while watching medical fiction like House, MD and ER that when the word dialysis was mentioned, my ears would perk up, it is like seeing a friend (or rather frenemy )on TV. 

Fictional dialysis shows millions of viewers the high drama of dialysis.  When all of us know that it is really an energy sapping, boring result of a chronic disease, where the real drama plays out in our heads on sleepless nights when we and those we love quietly cry "why?".

The television show House, MD is particularly guilty of fictional dialysis.  In one show, a person was acutely diagnosed with CKD5, and then she was dialyzed via her fistula (huh?  TV fistulas do not need 6 weeks to mature).

The same with transplants - a fictional patient's kidneys fail and boom, the next day they are getting a family member's kidney.  Who needs a transplant workup when you are on TV? Or even better, when a fictional patient gets a deceased donor kidney the next day.  

World Kidney Day is March 12th, 2009 and there will be a lot of media about kidneys, dialysis and transplant.  Don't get me wrong, any exposure is good if it heightens awareness.  But many times, all people know is what they see on TV, then they, or a family member is diagnosed with kidney failure.  We all want Dr. House to be our "Diagnostician"/Nephrologist it seems that he has a team of Doctors that can all care for one patient at a time.  Those of us who have waited hours to see our Nephrologist for a fleeting moment know the truth about our over stressed health care system.

Which leads to the inspiration for this post, ER.  A show conceived by John Michael Crichton, M.D. (1942-2008).  ER has been one of the "better" medical shows for years. On Thursday's episode, the show closes with Dr. John Carter, a beloved character from years past, returning to Chicago.  He offers to work in the ER (for free!) and alludes that he will be around for a while (as the show is in it's last season, a "while" is a couple of episodes) The final shot of the show is Dr. Carter in the quietest, cleanest dialysis unit I have ever seen.  He is hooked up to a Gambro Pheonix Dialysis Machine. Here is a link to the episode, it plays after a 20 second commercial and the dialysis scene is the very last scene.

Dr Agar would be pleased because it looks like the fake needles taped to his fake fistula seem to be antegrade/antegrade (better for the fistula).  And the actor, Noah Wyle does a superb job of the "I am dead inside" feeling that in-center dialysis can cause. (His character is rich, and a Dr., why isn't he doing extended treatments via NxStage at home???)

Well that is it.  Dialysis as seen on TV. We know better, and we know that it can create misinformation and false expectations when a real person is facing CKD5, and all they know is what they saw on tv.  I am glad that Bill and others have real videos on the web, available for anyone to see dialysis reality.