Influence

INFLUENCE

I started driving for Lyft — after about 9 months from being discharged.

There were several impetuses: I like driving quite a bit and am a decent navigator in the Bay Area; my vehicle is very comfortable for both the driver and to infirm passengers — I know the later because my sister, wife, and daughters would drive me around in it when I was first discharged; and finally, there were too few ‘paratransit’ drivers for the people that did dialysis with me. I was never an official paratransit driver and vehicle (no wheel chair lift, for example), but I understood the needs of infirm and post-dialysis patients. I also had nothing much to do early in the day, so I drove both early and afternoon (post-dialysis) shifts.

During one of the afternoon shifts, I encountered another ability. While I drove Sandra home, I suggested she try a Mexican restaurant (“La Fonda de Los Carnalitos”) in Redwood City. It was an innocuous suggestion, but two days later I found out she tried the restaurant. That same night. In spite of her saying she was having fried chicken for dinner during that drive.

Nothing incredible, but it seemed very unlikely to be just a coincidence. I tested this out with more (good) restaurant suggestions, and every time ‘my patient’ and rider would eat there that night.

Very strange. Didn’t work in the morning though, so the impact was limited.

“I can influence people” — Dr A. is dressed fashionably [[in …]] as always. “Yes, Mark, you can have a major impact to the world, especially given how long you will be with us. Is that what you are referencing?”

“No. I can my cause my patients to do things… immediately…

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and even sometimes silly or out of character actions. I suggested ice skating at Winter Lodge for exercise, and met the patient on the ice at the very next public session. I recommended visiting the Schulz Museum in Santa Rosa, and found out the patient had made the several hour trip the next day. Suggested Yosemite, they visited over the weekend (this was after Friday’s session).

I am now being very careful what I suggest, and adding lots of caveats (like ‘in the summer’) to prevent messing with their lives. ”

“Interesting…”

Stanford would like you — to go to a different dialysis clinic” Dr A. says at the next session.

“OK. Why?”

“We can discuss that later. Can you go to the San Carlos clinic for a while?”

“Sure. Since I stopped using the catheter, I am not as nervous with new technicians. Before it was pretty scary when a different RN would hook up and clean the catheter. That direct connection to my heart is a little too powerful. Better than the neck catheter though”

“You realize you are dead right? What could they have done to your vestigial heart?”

“I didn’t say it was rational”

A number of members — of my addiction-recovery program are now deceased. These are people who had kidney and liver failure, and were either patiently waiting for a transplant or already had a transplant. A liver transplant is no guarantee of life. A lot of things can go wrong.

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The body can reject the liver, and then you need a second or third one to get one (if any) that are accepted. Kind of like cats: sometimes they just don’t like you and you need to get some more until one is a match.

The body can be too traumatized by the transplant and die from the operation. This is a real problem because you are ranked higher in priority the sicker you are. So generally the most sick get transplants first. It is like playing chicken though, because if you get too sick they won't do the transplant either.

The body can simply get terribly ill due to the drugs you need to take post-transplant. To prevent liver rejection, a patient takes immunosuppressants. That is: the drugs _turn off_ your immune system. That is nice and friendly for the newly invited liver, but is also an open invitation to many uninvited bacteria and viruses. Over time the immunosuppressants are reduced, so the risks get reduced, but they do not go away.

Death is something I already experience much more of since the hospital, and it will only get worse over the upcoming decades. I wonder if Stanford will ‘cancel’ me if I look too young? ❧ ❧ ❧

“We would like you to go to Sacramento — for dialysis”

“That is a bit of a drive doctor. I can do it, but we are talking several hours of overhead”

“It should only be for a few weeks. And it would make the gods ecstatic ”

I meet Nancy a few days later, and sporadically help her get home after the sessions.

“There is a bill ‘2022-114’ — that would be very bad for Stanford” Dr. A says in her office. We always meet in person. It is much less tiring for me than the concentration I need during a zoom

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call. Telephones are even worse: I should be able to vocalize, but I have lost the coordination between my lungs and vocal cords. The slight telepathy (or whatever it is) with visual contact is a crutch that helps me a lot.

“OK. That is unfortunate. And… ?”

“We would like you to help kill it. Nancy is a proponent and major influencer in the state senate. We would like you to convince her to reconsider her support of the bill. It would make the gods ecstatic”

The bill is killed — after a few weeks of interactions with Nancy during our drives. It is slow because I am worried. Worried Nancy realizes what I am doing. Worried someone else will grow suspicious. Worried I will be exposed and likely ‘canceled’.

It is also slow because I don’t always drive her home, and don’t really have any good reason to meet up with her otherwise. But slow and methodical seems to do the trick.

The gods don’t say anything, but I am scheduled back at my normal clinic. So they must be at least happy. ❦

Inserting dialysis needles into your arm — is painful for most patients. The needles commonly used for hemodialysis are '15gauge', which means 15 of them will fit into an inch diameter, or each is about one-fifteenth of an inch in their outer diameter. For metric people that is a bit less than 2mm. I have heard of patients that use 14-gauge needles, which are more than 2mm. This is big enough that it is quite difficult not to flinch, and I regularly fail in spite of the lack of actual injury. I commonly chat or play music to distract myself.

A matured fistula used for hemodialysis is normally about 6mm, so a bit larger than a major vein (the 'great saphenous vein' returning blood to your heart from each leg is 2-4mm) and a bit smaller than

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a major artery (the 'femoral artery' in a 50-year-old is about 10mm). Returning to the needle, that means a 14-15 gauge needle is taking up about a third of the 'tube'. Presumably the other two-thirds are to make sure your arm does not fall off due to gangrene.

In my case, I have a bit-better-than-normal sized fistula (8mm) and given gangrene is not an issue, I can use quite a bit bigger of a needle. But this would be a bit too conspicuous since needles are physical objects and would need to be in inventory ("do you have any 8mm / 2-gauge needles available?") and someone needs to put them into my arm. Not a good way to keep a vampire under cover.

Instead, I use normal needles and the machine lies about its flow rate. The 15-gauge needles in my arm are used by the dialysis machine to pump huge amounts of blood through my body at a much higher pressure (flow rate) than normal. This is equivalent to having larger needles and enables me to support dialysis for a dozen people during the four hour session. ❦

Removing dialysis needles — from your arm is less painful but more problematic. The problems arise from having two 2mm holes in your body, that have been there for as much as four hours. Your body does have a desire/ability to close these holes. But at the same time, your blood stream has a desire to take advantage of them: they are like two holes in a dike and are the "easy way out" for the blood.

For a fistula, the dialysis needles are taken out in "reverse" order: the downstream needle (closer to returning to your heart) is taken out first and covered with _a lot_ of gauze and then pressurebandaged to your arm (or leg) to plug the hole. This combined with either hand-pressure or a mechanical (plastic) pressure system will enable the body to close the hole without the blood streaming through it getting in the way. The second needle is done the same way, but (for me at least, post-dialysis when my blood has been replenished), this one has a lot more pressure on it and is more likely not to be closed if anything is amiss.

An unclosed 2mm hole sprays blood into and then through the

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gauze quite quickly. Then down your arm. Onto the chair, floor, neighboring patient, helpful RNs, and so on. The solution is simple though: be like the little dutch boy and stick your finger into the dike… until a technically savvy nurse with a lot more gauze can come and help. As mentioned above, this has happened to me multiple times, and by just using the 'dutch method', I have managed to live through all of them [cough].

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