Professional joys...

"Hey, doctor, how are you?"; I turned around, and there he was, a young man, smiling at me, Simon. And I was so happy to see him, a young man looking good. I remember the first time I saw him, a 17-year-old boy, so lost and desperate, not understanding what was happening to him, asking from some kind of reassurance. He landed in the hospital Nephrology clinic, sent from another hospital, where they had nonchalantly told him he had to start dialysis and hinted he should be a drug addict, since he was HCV positive. He was angry, he had never used drugs and he didn't understand what was happening to him. It turned out he had a congenital disease, that had caused him to have hearing impairment and severe low platelet counts since childhood, reason why he had received multiple blood transfusions as a child (and caught the hepatitis C virus), and progressive renal failure, that had been overlooked then and had just been detected in the near end-stage phase. And that's where I met him, this dirty-blond kid dressed in black, in a grungy urban-depressive look. He went by himself to the hospital, and it was extremely delicate to explain him about his condition, the imminence of dialysis, etc. He didn't seem to understand, didn't want to understand, and, even if it's relatively common to have to explain this kind of situation to people who never knew they had any kidney problem (it's very frequently undiagnosed until the end-stage), it was particularly hard to tell it to this fragile, upset and lonely kid. I asked him in the end to bring his parents to the next appointment.

But he came back alone; his condition was getting worse, we had to make some treatment decisions, and he was not even of legal age. I pressed him, asking about his parents, finally he told me his mother was severely bi-polar and his father was deaf and aloof and he couldn't count on them. There was an older twenty-something brother though, and I urged him to bring him with him as soon as possible.

Then, what I feared happened: he turned up an afternoon severely uremic in need of immediate dialysis. His brother was with him then, totally bewildered, he hadn't told him anything until then. I was glad it was me the nephrologist on duty, at least I was familiar with the situation and the boy seemed to trust me. I tried to comfort him and the brother as best I could, and silently thanked I was experienced enough - one doesn't put a dialysis catheter in a patient with 9000 platelets with a relaxed mood... Fortunately, everything went smoothly, and in a few days he was feeling much better. His father showed up, and things became calmer. He then opted for peritoneal dialysis, and didn't see much of him for a couple of years, since I was not in that department.

By chance, it was again when I was on duty that a kidney turned up; I was glad to call Simon and to assist him after the procedure. It was successful and, as I was working then at the transplantation unit, I saw him very often for a few years. By then I knew him pretty well, and it was a pleasure to watch him grow. He played the drums in a rock and roll band - he gave me the link to their musics, which were an extremely noisy kind of punk rock, and I joked they were like that because he was half-deaf - then he studied computers and started to work. From a depressed and mixed-up kid he turned into a self-assured young man and, being so used to care for old people, he's one of the patients for whom I always had this kind of paternal feelings.

A few years ago I left the transplantation team, so now I only see him if by chance we meet when he goes to the hospital for blood tests or appointments. I'm glad his transplanted kidney is working well 11 years later, he's now about 30 and leading a full productive life. I really feel professionally and personally fulfilled when I meet him, and just hope he keeps being well and I won't have to put him on dialysis again.