I remember it was almost
Christmas because carols softly played on the radio in the nurses�?station. I walked into Jimmy’s room. A small seven-year-old, he seemed dwarfed by the big, indifferent, mechanical hospital bed with its starchy white sheets.
He looked up at me through suspicious eyes, hidden in a face puffed up from the use of steroids to control his kidney condition. “What are you gonna do to me now?�?they seemed to ask. “What blood tests are you gonna order? Don’t you know they hurt, Doc?�?BR>
Jimmy had a disease called nephrotic syndrome, and it was not responding to any therapy we had tried. This was his sixth month with the illness, his second week in the hospital. I was feeling guilty -- I had failed him. As I smiled at him, my heart felt even heavier.
The shadow of defeat had dulled his eyes.
“Oh no,�?I thought, “he’s given up.�?When a patient gives up, your chances of helping that patient lower dramatically.
“Jimmy, I want to try something.�?BR>
He burrowed into the sheets. “It gonna hurt?�?BR>
“No, we’ll use the intravenous line that’s already in your arm. No new needles.�?What I planned I had tried a few weeks earlier without success. I gave him intravenous Lasix, a drug that is supposed to “open up�?the kidneys.
This time I planned a new twist, which the nephrologist said probably would not work but was worth a try. A half hour before I injected the Lasix I would inject albumin, a simple protein that would draw water from the bloated cells into the bloodstream. Then, when I gave the Lasix, the water flooding the bloodstream might flow into and open up the kidneys. The problem was, if it didn’t, the “flooded�?blood vessels could give Jimmy lung congestion until his body readjusted. I had discussed this with his
parents. Desperate, they agreed to try.
So I gave albumin into his intravenous line. A half hour later I came back to give the Lasix. He was breathing harder and looked scared. I had an idea. I never believed in divine intervention, but Jimmy came from a very religious
family.
“You pray a lot?�?I asked.
“Yes, “he answered. “I pray every night. But I guess God don’t hear me.�?BR>
“He hears you,�?I replied, not knowing in all honesty if God did or didn’t, but Jimmy needed reassurance. And belief. “Try praying as I give this medicine to you. Oh, and I want you to pretend you see your kidneys -- remember all those pictures of them I showed you awhile back?�?BR>
“Yes.�?BR>
“Well, I want you to picture them spilling all the extra water in your body into your bladder. You remember the picture of your bladder I showed you?�?I figured I might as well try visualization. This was in the early 1970s. Some articles had been written about visualization and some evidence existed that it worked -- in some cases, anyway.
“Yeah.�?BR>
“Good. Start now. Concentrate on your kidneys.�?I placed my hands there and shut my eyes, concentrating -- just to show him how, you understand. Then injected the Lasix.
Jimmy closed his eyes and concentrated, and mouthed a prayer.
What the heck. I also prayed, even though I knew it wouldn’t work. I did not believe in divine intervention. When I died I would have a few choice questions for God about why he allowed certain terrible things to happen to certain
children. One of my friends suggested that when I did die, God would probably send me the other way just to avoid me. But in for a penny, in for a pound.
“How long will it take to work?�?the nurse asked as she adjusted the dripping intravenous line. I motioned for her to step from the room.
“In a person with normal kidneys, maybe twenty minutes -- fifteen minutes tops,�?I replied. “With Jimmy, I’m hoping a half hour. But I have to tell you, it’s a real long shot. Stay with him. If he has trouble and needs oxygen, call me. I’ll be at the nurses�?station writing all this down.�?BR>
I sat down and opened Jimmy’s cold, metal-jacketed chart, almost cursing the irony of the Christmas carol on the radio: “Oh Holy Night.�?Before I had scribbled one sentence, the nurse stuck out her head from Jimmy’s room. “A half hour to work?�?she asked.
“For normal kidneys.�?BR>
“Otherwise fifteen minutes ‘tops,�?right, Doc?�?BR>
“That’s what I said.�?BR>
“Well, the floodgates have opened: He’s urinating like crazy. Within just two minutes he asked for the urinal. I’ve got to go get another.�?BR>
Two minutes? Impossible. I went to the room as fast as my cane would allow me to walk. Jimmy had already filled the plastic yellow urinal. The nurse rushed in with another two. He grabbed one and started filling that one, too. He grinned at me, the light back in his blue eyes.
I left the room, a numbness coursing through my mind and body. It couldn’t be. If he diuresed -- if his kidneys opened up -- he was on the way to a cure. No, it just could not happen that fast. Impossible. Medically impossible. And yet...
Was it sheer pharmacology and physiology breaking the rules? Was it the visualization?
I could clearly hear a fragment of a carol on the radio. I felt goosebumps: “Fall on your knees, oh hear the angel voices...�?BR>
A paraphrase of the last line from
Miracle on 34th Street came to me: “And then again, maybe I didn’t do such a wonderful thing, after all.�?/DIV>
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