Clayton and Krystal: Triage

***I am not a doctor. I cannot legally give medical advice in the state of Michigan or any other state. This is a work of fiction. If I took liberties with certain procedures it was to speed the plot along.***

Krystal’s workday was a total shit-storm from the minute she walked through the door.

While she had been recovering from their house being broken into, the Food and Drug Administration had “red-lined” most of the consumable membranes used in dialysis machined due to contamination issues.
 

That created a huge need to shift as many patients as possible to peritoneal dialysis.

Peritoneal dialysis is where a saline solution is injected into the abdominal cavity and left for a period of time. Typically, the solution is injected through a permanent port that is installed in a convenient place. After various chemicals in the blood have had time to move by osmosis from the  OUTSIDES of the intestinal walls and the inner wall of the abdominal wall into the saline solution, the dirty solution is removed via that same port. If necessary, several cycles can be done.

Peritoneal dialysis is not a perfect solution. It is ineffective at removing certain toxins and over the long-term it creates calcium-phosphorous imbalances. But, in the short-run it can keep patients alive while critical parts are sourced and approved for the regular dialysis machines.

Krystal was one of the few nurses with experience tapping an abdomen wall for a virgin, peritoneal dialysis cycle, i.e. without the surgically installed port. There was not time, personnel or enough hardware to install permanent ports into as many patients as quickly as they were needed.

Krystal became part of an assembly line. Patients were wheeled from curtain-enclosed spaces to curtain-enclosed space. Skin was numbed. Local anesthesia was injected. Krystal threaded in a catheter and injected the indicated amount of fluid. And then the patients were wheeled out to a waiting space. After the wait period, the fluid was withdrawn.

While in the waiting space, clerks went from patient-to-patient and started scheduling the installation of permanent ports.

Dale was one of the first patients she had come to know at the Nephro-Center. He was a sweetheart. He was always patient and had a kind word for everybody. He had been on dialysis for over fifteen years.

He approached her while she was grabbing a quick sandwich between patients. “Why didn’t they schedule me for a port?” he asked her.

“Must have been an oversight. I will look into it and let you know the next time you come in.” Krystal said.

Later, when there was a lull in the stream of patients, Krystal found the Director and asked “So, what is the deal with Dale Mendoza? He said that nobody tried to schedule him for a permanent port. Is he moving back to the dialysis machine?”

“No. He is not going back to the dialysis machine. He was skipped over” the Director said.

“What do you mean?” Krystal asked, puzzled.

“Triage” the Director said. “The triage team decided that he will not last sixty days on peritoneal dialysis, so there is no point in installing a port. He is sixty-eight years old, has total kidney failure and has symptoms of moderate-to-severe congestive heart failure. The triage team has been instructed to identify patients over 40 years old who have a second system failure to contend with. We are not scheduling them for ports or the dialysis machine...at least not until we can get assurance of a steady supply of parts.”

“But...you are saying Dale is going to die!” Krystal said.

Not unkindly, the Director said, “We are all going to die, someday. These supply chain issues and all of the companies going out of business with unfilled back-orders are killing us.”

Krystal’s eyes were filling with tears.

“In a way, Dale is lucky. He has time to make peace with his God, and now he has plenty of motivation” the Director said.

Krystal locked herself in the bathroom for a half-hour. It took her that long to collect herself.

Shit, shit, shit, shit.

As she started paying attention, she noticed that more than a quarter of the patients were not being asked to schedule a permanent port installation.

Next Installment