Two Fathoms Deep

Dialysis is dialysis, whether in a large Brazilian city or a small town in Arkansas.

Parents are still selfish and think about how much easier their life would be with a "normal" child (or at least without a sick one).

It's difficult to rationalize with people in denial.  To tell someone their calcium level is 3.8 has the same meaning here that it does in the United States.  Some people still don't react accordingly when you tell them the patient will likely die if they don't follow medical advice.

Your level of wealth and education does not always directly correlate to your level of compliance.

The person with a hemoglobin level of 2 who chooses not to come to the hospital until tomorrow will probably die before he makes the journey.  Even if that patient was feeling healthier than their wife, who didn't want to make the drive.

In the hospital, a slight break in the sterile field will cause a staph infection from hell.  At home, you can swim in a river filled with feces and never infect your dialysis catheter.  

You can't give your child his medication if you have left it at the hospital for two weeks.  Giving a child crack cocaine instead is probably a bad idea in any country.

AV fistulas fail.  So do kidney transplants.

Sometimes (rarely) children are born with no kidneys.

Sometimes children on dialysis grow to become adults on dialysis.  Sometimes lining up at the clinic every Thursday to sign up for cadaveric donation pays off.  Sometimes the transplant doesn't fail because your body became septic from infection and the immunosuppressants had to be withheld.  Sometimes the sick smiles and can make you smile as much as the healthy one.  Hope springs eternal no matter where you live.

  

Easily my most interesting experience yesterday, if only the second most valuable.