Letting Nature Take Its Course

by Dennis Green

Nature. The Natural World. We think of Nature as something exotic, a world apart from and parallel to this one, the world in which we live, a world of concrete and metal and constructed housing. Nature is the great outdoors, the uncivilized parts of the world.

But no…it’s right here. NATURE R US! Inside us, all around us. The workings of Nature — that’s all there is, finally. “What you can depart from is not the Process.” So where do we get our notions of “the unnatural,” our concern that the ways of Nature itself can be thwarted?

If I, and my doctors, were to just “let Nature take its course” right now, I would be dead. As it was, that first week I was hospitalized with renal failure, there was so much resistance on the part of my attending physicians and bedside nurses that I did almost die. I asked for peritoneal dialysis, and they were all reluctant, because very few dialysis patients can tolerate the regimen — only 7% of all patients on dialysis.

The first time I went on dialysis, the process was very gradual, and I worked up to it, taking training classes in the abstract, getting the peritoneal catheter inserted surgically, letting it heal and “rest” for several weeks before using it, then gradually introducing manual dialysis, at first simply overnight. Fill, sleep, drain.

So Dr. O’Neill reconstructed her original surgery about three weeks after the first effort, shaving off some of the little fatty drapery than hangs down into the cavity and was blocking the catheter from draining. She may have repositioned the catheter slightly, its intake valves, or pinned back the fleshy “drapery” that might have been blocking the draining and I know that she trimmed some of the fatty tissue away. I’m sure it ordinarily serves some useful, evolutionary function. After all, the peritoneal cavity wasn’t built as a reservoir for dialysis fluids!

Medical science, in fact, is the unnatural manipulation of natural processes in the service of life extension and health enhancement. I’m just lucky that my nephrologist, Dr. Law, identified me as a candidate for peritoneal dialysis rather than the “warehousing” of hemo. I may even be able to get off hemo after only four or five more sessions.

But I will never forget that huge room, that “warehouse” where dozens of patients lie on couches, on the nod, semi-comatose, while the machines circulate and filter their blood. A disproportionate number of Asian and African-American people, many older than 70, and it occurs to me that this is a very lucrative business. Rent a warehouse, train ten people per shift, stock thousands of gallons of dialysis fluid…get rich.

I hope to be saying my farewells to this strange world, where a state other than life carries on. It can carry on without me.

Somewhere back there in my past, life goes on undisturbed. Nature takes its course. Healthy people run and play and laugh and swim. For now, I am stranded on this little island where nothing is normal, nothing is natural, nothing is the same as it was. “On Dialysis…” I will say, and people will shrug sympathetically, without even a glimmer of awareness what this means.

Late breaking news: letting Nature take its course, yesterday my bladder finally let go of its contents on its own, without the horrible hard plastic catheter being pushed all the way up inside it, and I am feeling very optimistic. I may even get off dialysis again!

©2010 Dennis Green