Learning by Listening

Joann Spinale, MD

As a first-year fellow, life can be hectic. You come into the Hospital as early as you can tolerate and try to do as much as you can before your attending comes in. Then your day is full of pages, consults, meeting patients, learning, teaching, and hopefully making a difference. The days are long but you (usually) get to go home and recuperate before the next day. During this busy year, one thing that helped me survive was my experience in dialysis.

At The Children’s Hospital of Philadelphia, we have a hemodialysis unit on the first floor of the Main Building. It has around 7 chairs that are usually pretty full. Typically, we have around 10 to 12 children receiving chronic dialysis at any given time. They come in 3 times a week either in the mornings or afternoons. When I started my fellowship, I knew very little about dialysis but thought it was such an amazing concept. The fact that there is a machine that can replicate many of the functions of the kidney is incredible. Even though the physiology of dialysis was so interesting to me, the part of the process that I truly fell in love with was meeting the patients.

Dialysis is one place where you have a captive audience since patients are on dialysis for 3 to 4 hours in a session. It is a great opportunity to sit with and really get to know these children, who have already seen so much of the medical system. One patient that I remember vividly was an adolescent graduating from high school. For one of her classes, she was reading The Immortal Life of Henrietta Lacks. She actually asked to interview me on camera for her report. Despite being slightly camera-shy myself, it was such a great opportunity to talk to her about informed consent and get her perspective as a patient. Spending the time hearing more about where her father worked and what her plans for the future were not only was interesting but also—I believe—helped her feel more open with me. When she was subsequently admitted to the Hospital, it was much easier to talk to her and find out what she really thought was going on.

Another highlight in dialysis was a boy who had already failed one kidney transplant despite his young age. Medically and socially the situation was complicated. However, when I met him, he was so full of energy. Sitting with him, we bonded over drawing pictures (that I proudly hung in my office) and taking funny pictures together. He would make my day just by running over to me and giving me a big hug.

First year of fellowship was certainly challenging but it was the patients who truly made it a rewarding year. The dialysis unit is an amazing place full of interesting patients who each have their own story and unique personality. Spending time there was educational, but also enjoyable and helped me leave work with a smile.