Hundreds of Interlaced Fingers

by Vanessa Grubbs, M. D.

  Melanie answered her phone on the second ring. Minutes later I sat with her at her kitchen table. I wanted her to tell me what to do. But as free-flowing as Melanie was with her advice for work, she was tight-lipped when it came to personal matters. Instead she offered her house keys and a futon to me and my three-year-old baby for as long as it took me to figure it out.

  Nearly a year later, I found an unfamiliar male voice on the other end of my phone. It was Robert.

  Melanie was his friend too and had encouraged him to call me to get the skinny on a few of the doctors at Highland. He was still on dialysis, for more than four years by then, and was trying to elicit the support of physician advocates in his effort to get a kidney transplant.

  I spoke frankly about my colleagues at Highland as Melanie told him I would, and he chuckled as I spoke. The conversation ended with his smooth baritone voice inviting me to a dinner at Melanie’s home to discuss his health with a larger group.

  “Of course. A friend of Melanie’s is a friend of mine,” I said.

  I thought the dinner would be for a group of seven or eight, but it turned out to be just Robert, Melanie, and me. It was an early June evening in Oakland, which meant we were still wearing light jackets. Melanie’s home was a quaint Craftsman she had raised her children in. After her divorce many years before, she had painted every room a different vibrant color.

  I arrived first. Having come straight from work, I was wearing black slacks and a long-sleeved polyester-blend blouse. I was standing in Melanie’s throwback 1950s kitchen when Robert walked in cradling a loaf of French bread and some fancy cheeses in his arms. As he looked at me, head to toe and back up again, his left brow lifted and the edges of his mouth pressed downward in a silent Aww shit, like he was seeing me—and my curves—for the first time. I instinctively crossed my arms over my chest and smiled a stilted hello. It was too late for one of my wide, innocent smiles. A very sexual energy was already in the air. Shit, I thought.

  The three of us sat down to dinner. Conversation flowed easily and bubbled with laughter as we ate the meal Melanie prepared. I reminded him of how he blew me off at that first encounter. He denied it. That was not his intention, he said. He was just used to people coming up asking him for things.

  “Whatever. You were rude.” I rolled my eyes but smiled in spite of myself, betraying my forgiveness. He smiled back.

  I was so distracted by Robert, I didn’t notice what Melanie was doing with her face, which was why I was so surprised when after we had barely put our forks down, she stood up, grabbed her purse, and announced, “I’m going to run to the store and get us some ice cream for dessert. I’ll be back shortly.” And with a twirl into her coat she was out the door. I watched the door close with eyes wide and jaw dropped in what the hell just happened wonder. Melanie had left Robert and me there sitting across from each other at her little kitchen table, our knees almost touching.

  We looked at each other. A moment of awkwardness gave way to close-lipped smiles. He leaned forward, his arms folded on the table.

  “So what’s your story?” I asked. Still licking the bitter wounds that the lies the last man told had left behind, I expected little more than bullshit to come from the lips of this man in front of me.

  Instead he spoke candidly about where he was in his life. Perhaps too candidly, like there was no time to waste, but I followed suit. I told him about my three-year-old son and divorce under way. He told me that he lived with his parents. What kind of grown man tells a woman he just met that he lives with his mama? I tried not to change my facial expression, but he read it anyway. One who passed out from very low blood pressure, and no longer felt safe living alone, he offered. He was putting his cards on the table as if to say This is who I am. Your move. There was an honesty in his eyes that was foreign to me. I liked it. It didn’t even matter anymore that they were green.

  Later when we walked to our cars, we caught each other looking back over our shoulders, like some clichéd scene from damn near every boy-meets-girl movie. We smiled.

  “Melanie!” I hissed into the phone as I drove home. “Did you set that up?”

  “I did if it works out,” she said.

  3

  Bid Whist

  The next day I received flowers at work. A beautiful bouquet of orange baby calla lilies in a shallow, dark green ceramic dish. The card read: My apologies if I greeted you with anything less than a smile when we first met. In earnest, Robert Phillips.

  Who says “in earnest”? I thought, but smiled. Scenes from the night before flashed through my mind—lingering gazes, involuntary smiles, looks over shoulders—and sent a flood of warm tingles through me. I smiled some more. Even twirled one of my locks around my finger. I took the bait and dialed his number. I planned to thank him for the flowers and ask him out to lunch.

  He answered on the second ring. His voice sounded thick like he was just waking up . . . or didn’t feel well. He cleared his throat.

  “Oh . . . hi, it’s Vanessa. I’m sorry, did I wake you?” Though it was early afternoon.

  “No, I’m at dialysis,” he said plainly and cleared his throat again.

  “Oh! I’m sorry!” As if I had just walked in on him naked. “I can call you back another time.”

  I was pulling the phone away from my ear when I heard him say, “No, it’s fine. Really. I can talk.”

  “OK,” I said, though I still felt uneasy. I had been snapped out of girly girl into a vision of his reality as a person on dialysis. But soon conversation was easy again.

  “I’d love to,” he said to my lunch invitation. “I’m free tomorrow.”

  It was a Thursday. We met at Kincaid’s in Jack London Square, a surf-and-turf restaurant overlooking the Oakland Bay. I wore a scarf wrapped around my head so that my locks spilled out of the top. It was my in your face rejection of a European standard of beauty and projection of the Nubian princess that I am or at least feel like on the inside hairdo. Robert wore slacks and a button-down shirt and a slight approving smile on his face. Neither of us planned to go back to the office that day, so lunch was leisurely—and heavily laden with alcohol, which no doubt contributed at least in part to the easy conversation. It felt like we were the only patrons there. I was aware only of him, the view of the bay, and the waiter appearing occasionally to ask if we wanted another round.

  By my third Grey Goose Appletini and his third double Jack on the rocks, I had probably shared too much about life with my ex and he had shared things I hadn’t even thought to ask about yet. While I knew that only a functioning liver was needed to process alcohol, I didn’t know how much he’d be paying for taking in all that extra liquid—the nausea, vomiting, and maybe even shortness of breath—until it could be dialyzed off because his kidneys couldn’t pee it out. So for the time being, it was all smiles and lingering gazes. And lots of laughter.

  Afterward, we walked together to the parking garage.

  “I had a really good time,” he said. “We should go out again soon.”

  I smiled, nodding in agreement. “I’m free this weekend,” I said, and immediately wished I could suck back in the words that had just fallen out of my face as I saw Robert’s brows lift in surprise and his mouth spread into a closed-lip smile.

  I flushed and then tried to explain myself. “I mean . . . It’s just that I alternate weekends with my son’s father . . . Avery’s with him this weekend . . .” I stammered. Still a bit too eager, but at least I was letting him know that my eagerness was laced with some logic and that my time with my son would not be interrupted. But truth be told, waiting more than a couple of days to see Robert again felt unacceptably far away.

  He smiled at my awkwardness. “OK. I’ll call you later and we can make plans for this weekend.”

  He opened his arms tentatively, his face questioning if I would welcome a hug. I took a step toward him and reached my arms around his neck. As his arms wrapped around me, I instinctively laid my head on his chest, but at least I didn’t
hang on too long. At least I don’t think I did.

  I stepped back and bashfully brought my eyes to his. I found them twinkling. We said our good-byes and I smiled all the way home.

  He called the next day.

  One might think that, as a doctor, I might be particularly hesitant to get involved with a man I knew had end-stage kidney disease because any illness with “end-stage” in its name is by definition life-threatening. But it was more of myself as a woman going through a divorce that questioned my ability to pick a good man. So naturally, I presented the male specimen to a small panel of trusted girlfriends and asked what they thought I should do.

  First there was Phyllis.

  “Mira. Look it,” she said to me, revving up to make her point. “Who do you think you are?”

  This was not the reaction I expected. I just looked at her, my eyes wide in surprise.

  Phyllis was a statuesque Latina and the oldest girl in a family of eight kids where there was never enough money but usually too much alcohol. She managed to escape her upbringing and become an ICU nurse, then after a decade went to medical school because she was tired of following doctors’ orders. She wanted to be the one giving the orders. She was a year behind me in training, my intern when I was a resident at Highland. And she was my sister. Secretly, we even referred to ourselves as SISS—Sistas in Stirring up Shit, for it was the two of us who started giving voice to the issues that led to the formation of ODA. It was Phyllis who drove down to Anaheim with me for an Internal Medicine Board Review course and was content to live off peanut butter sandwiches for lunch and dinner because we were that broke. And it was Phyllis who I called at 2 a.m. when my ex’s incessant phone calls and antics in those early weeks of our separation had me second-guessing my decision to leave. Then it was, “Mira. Look it, you have to be strong, Vanessa!” as if she had me by the shoulders, shaking me through the phone line. “Mira. Look it” always preceded some you may not want to hear this but goddamnit you’re gonna tough love, Phyllis-style.

  “Who do you think you are to disregard somebody just because he is sick?” she continued without blinking. “Who died and made you so perfect?”

  I was speechless as I mentally noted one for Robert.

  Melva was next.

  “Girl, please,” she said with a wave of her hand.

  Melva was a petite psychiatrist with a Diana Ross and the Supremes bob and was on her way to becoming the Dr. Phil of Baltimore. We met through the Kellogg Scholars in Health Disparities program, which I entered that year to get a taste of what a research career in medicine might be like. I figured she would be able to give me advice and diagnose the crazy at play.

  “He just needs a kidney and he’s good, right?” As if I were perseverating unnecessarily.

  I smiled as I noted two for Robert.

  It was everyday dolphin earring–wearing Jane—because her last name was Dolphin—the older nurse I worked with at Highland and trusted to babysit my son, who said, “Don’t get involved with a sick man. You’ll be taking care of him later.” Her words sent a defensive jolt through my heart that told me what it knew all along. I wanted to take the chance with Robert. No need to ask anyone else.

  It was on the second date that I decided for sure that I wanted to move forward with Robert. We were sitting at a restaurant bar waiting for our table when Robert confided that he didn’t have too many second dates. He laid down his cards, faceup, on first dates. Most decided the game he presented was too complicated. Like Bid Whist when all they were up for was a game of Go Fish.

  He seemed nervous, unable to sit still. Like That first date was just the first hand, girl. I was nervous too. The entirety of my renal training at Highland was a monthlong rotation in my second and third years of residency, so my knowledge of the nuances of the kidney was minimal. Sure, I knew that normally we are born with two kidneys and that they are located in the back, one on either side of the spine behind the membrane sheet that wraps around other organs in the abdominal cavity, and are only partially protected by the last two ribs. I knew a few things that could make the kidneys stop working—like high blood pressure and diabetes and certain poisons and rare blood vessel diseases—but most of the details and inner workings of the kidneys were a mystery to me. And since the bulk of my training was in the hospital, I mostly saw dialysis patients in trouble—usually because of problems with their hemodialysis access.

  I understood hemodialysis on only the most basic level. I knew the dialysis machine is like a big kidney, siphoning away extra fluid, waste, and electrolytes like potassium from the blood because the patient’s kidneys can no longer pee these things out. I knew the “access” is literally how we gain access to the patient’s blood. Through the hemodialysis access, the patient is connected to the dialysis machine so that their blood can be routed through it at a rate of about a cup and a half a minute. Hemodialysis access is a lifeline because without it—a failed access—there is no way to connect to the machine. Not being able to connect to the machine means no dialysis. No dialysis means all the extra fluid, waste, and electrolytes like potassium are left behind and accumulating to the point that soon there would be no life. If I was going to risk my heart on Robert, it was important to me that Robert didn’t have problems with his access.

  “Do you have a fistula?” I asked.

  “Yeah,” he said excitedly, as if he was happy that he didn’t have to be the one to bring it up. “Wanna see it?”

  “Yes,” I said without hesitation. I needed to see it.

  In other areas of medicine, a fistula is not a good thing. In other areas, a fistula is an abnormal connection between body parts, like the obstetric kind that forms when in a very young mother’s narrow pelvis the baby’s skull presses the vagina against her intestine or bladder for days during labor. Eventually the pressure leaves a hole behind, and the woman is left constantly leaking stool or urine. But when it comes to dialysis, an arteriovenous fistula is created intentionally when the surgeon sews two blood vessels in the arm together—an artery to a vein.

  I imagined the body’s system of blood vessels as an intricate map of roadways. Normally arteries branch off the heart like a main thoroughfare that splits off into four-lane boulevards, then two-lane avenues, then one-way streets carrying oxygen-rich blood to all the body parts. At the end of one-way streets are alleys—capillaries. But instead of dead-ending, the alleys connect to an almost identical set of streets heading back to the heart—the veins. The streets meet the highways meet the main vein thoroughfare carrying oxygen-drained blood to begin again the heart’s cycle of pumping it back to the lungs for more oxygen. The surgeon’s connection of an artery and vein to create an ateriovenous fistula bypasses the narrowest streets and alleys altogether so that traffic no longer has to slow down for red lights or stop signs—blood flow increases from about half a cup a minute to two cups a minute as soon as the stitches are in place and to somewhere between another cup and two faster just weeks later. This fast-paced blood flow forces the vein to become longer and thicker. Within a couple of months it will be “mature”—long enough and thick enough to withstand two dialysis needles too large for a regular vein puncturing it at least three centimeters (a bit more than an inch) apart three times a week and with a blood flow potentially faster than other types of access yet slow enough that a person won’t bleed to death in seconds—as an artery would—when the needles are removed. The fistula is the best type of dialysis access even though there can be complications: blood sometimes clots in them; part of the blood vessel wall can become dangerously thin and at risk of rupturing; or part of it could narrow, restricting blood flow. But it is still best because there is nothing foreign left behind to potentially create additional problems, as with the arteriovenous graft or the hemodialysis catheter, the two other types of access.

  The arteriovenous graft is next best. It lays in a loop beneath the skin in the arm after the surgeon sews one end of the man-made version of a blood vessel to an artery and the othe
r end to a vein. Surgeons do this when the patient’s vein is too narrow to ever mature. The graft is more prone to infection and clotting than the fistula, but it is ready to withstand dialysis needles within a couple of weeks.

  The catheter is the worst of the choices. Yes, it is convenient, ready to use immediately after being inserted into one of the body’s large veins in the chest or groin, and patients like that its tails hang outside the body connected to the dialysis machine. No needles necessary. However, the pencil-thick plastic tube is often the source of dangerous blood infections and clotting, much more frequently than the graft. Infection and clotting are often followed by replacement. Each replacement catheter damages the blood vessel a bit more, each insult sending the body into repair mode, laying down a bit more scab until, soon, no catheter can traverse—which is a problem because there are only four places to put a catheter without having to go through the spine or liver first. And having to go through the spine or liver first is never a good sign.

  Robert hurriedly rolled up his left sleeve to reveal the curved, thickened blood vessel coursing up his forearm like a snake. I could feel him studying my face for its reaction. Many of his past dates’ faces had contorted to match the deformity they perceived on his arm. But worse were the ones that dissolved into pity. All of them had snatched their fingers away as if the snake would turn on them. This was his test.

  I ran my hand up the length of it, feeling the strong skin and buzz, buzz, buzz pulsating beneath my fingertips. No thinned areas that were at risk of bursting open, taking his life in minutes. No faint stirring of blood signaling that all flow would soon cease to exist. His lifeline. Oh, yes, I thought, we can do this, boy. I sensed him exhale as he watched my face spread into a smile.