Rural Dialysis
MARGOLIS, RICHARD J.
States of the Union RURAL DIALYSIS BY RICHARD J. MARGOLIS In 1972 Congress passed an important addition to Medicare known as the End Stage Renal Disease amendment, or ESRD for short....
...Williams "went into shock from congestive heart failure" and was rushed to the emergency room of Candler County Hospital...
...As far as I'm concerned, it's a miracle...
...And then I get called when a patient has been taken to the hospital and she won't let anyone but me draw blood because she's got bad veins...
...Curry estimated "she was perhaps within a few hours of death...
...She had always been a determined cuss," Curry commented, "a young lady of iron will and decision...
...For a time Helen was its only patient...
...I then went on to say that I would try to get a kidney machine for our hospital so that she could get her treatments closer to home, and that I would try to learn how to look after her kind of sickness so she would not have to be treated by 'all of those strange doctors' in the ivory tower...
...Forarural facility, on average, treats only about 35 patients, while its urban counterpart might treat as many as 500...
...Still a third symptom of contentment may be the impressive array of front porches with their obligatory rocking chairs: People in Metter are in no hurry to get up and go...
...Sometimes," she went on, "a patient gets put in jail for one thing or another, and I have to get him out...
...then word began to get around to dialysis patients in surrounding towns that they no longer had to travel to Augusta...
...were it not available, many of them would have to endure the 170-mile round trip to Augusta three times a week...
...In Augusta," Helen told me, "I cleared my kidney every day...
...It wasn't only the money," she said...
...An astonishing aspect of all this is that a majority of dialysis centers, actually around 400, are rural-based...
...I still have it," sheassuredme...
...My intention in going there was to learn how small-town centers differ from those in big cities, particularly from the patient's angle of vision...
...While Helen was being dialyzed, Lillie was learning how to work the machine and how to take care of renal patients...
...Leon Curry opened the Metter hemodialysis center in 1971, 19 months before the Federal government began defraying the costs of such enterprises...
...One night, he wrote, Mrs...
...Her name was Helen Williams...
...Weakly she smiled and shook her fist, threatening me that I'd better make good on my promise...
...Several patients I interviewed used the same words to describe their feelings about him: "I'd follow that man anywhere...
...To this day Lillie Johnson is head nurse of the Metter dialysis center...
...In his opinion, Helen's determination had been stiffened by financial misgivings: "She found out that the cost [of dialysis] was more than she could afford...
...Today more than 700 renal clinics throughout the 50 states, including one in the Virgin Islands, are keeping 116,000 individuals alive by means of dialysis...
...We were there for three months," Lillie recalls...
...I'm not in business," he says...
...Curry founded it for reasons that were typically rural—not because he had discovered a market for dialysis services (there wasn't any), but because he had found one patient in desperate need...
...Because the Metter clinic has three times as many patients as it does hemodialysis machines, it must operate on three shifts, the first one at 6 a.m...
...What I do is for people...
...In the U.S...
...Curry has another way of explaining his special role in Metter...
...Metter lies 200 miles south of Atlanta...
...It is a fanning community of some 3,900 residents, most of them apparentoptimists.Theirslogan, "Everything's Better in Metter," is just one sign of the town's cheerful civic climate...
...Or maybe they got into a fight with their spouse and they want to talk about that...
...He did...
...The patients here are very close," Annie Doyle informed me...
...As he says, "I may not know all of them by name, but I know who their kin are...
...Curry was ableto talk his patient into accepting dialysis treatment: "I marched in and told Helen that she was going to Augusta right now and I would not accept no for an answer...
...What a helluva fix to be in—a young lady with a lot of wit and innate intelligence who had a treatable disease, refusing treatment because she couldn't afford it...
...I go and draw the blood...
...That means those in need of its services who live furthest away must get up at 3:30 in the morning to catch the van at 4:30...
...I still find the whole thing unbelievable...
...Curry would later tell the story in a memorandum prepared for his files, which he titled "Too Young to Die...
...If they have a problem they'll call me," shesaid...
...Medicare each year pumps in about $22,000 per renal patient, and most of those dollars remain in the area in the form of salaries paid to the clinical staff...
...Somehow Dr...
...It was the machine...
...Things weren't always so neighborly...
...she was a 31 -year-old housewife from Cobbtown, Georgia...
...Whatever noise there was came from a computer printer being run in the front office...
...Whereas prior to the passage of ESRD merely a handful of such facilities existed, by 1981 nearly 500 were in operation...
...Only dialysis treatments or a kidney transplant could save her life, yet she had resolutely refused to travel to the nearest dialysis center at the Medical College of Georgia in Augusta...
...Recently I visited a small-town dialysis center in Metter, Georgia, founded by Dr...
...Lord, I didn't know what a kidney machine was...
...For more than two years she had been in kidney failure...
...The overall mood seemed almost churchlike, suggesting an air of hushed intimacy: The machines to which patients were attached emitted nothing but a soft hum as they pumped and purified toxic blood, except for an occasional discreet beep whenever something went wrong...
...I asked her what kind of problems they brought to her...
...Estimates range from $500 million to $1 billion a year...
...Curry, a soft-spoken man with an ample belly and a touch of Southern charisma, came to Metter as a teenager and eventually married his high school sweetheart, Helen Tanner...
...Just about everyone in town came to the new building's dedication ceremony on July 16,1978—everyone, that is, but Helen Williams...
...You really had no time for living...
...The makeshift "dialysis center" in Metter that Helen Williams returned to was housed in a seldom used solarium in the hospital's south wing...
...After a lengthy stint as a pre-med and medical student at Emory University in Atlanta, and two years as a flight surgeon in Vietnam, Curry returned to Metter for good in 1967...
...She was swollen from head to toe...
...By the time he got there she was "panting hard for every breath...
...In those days it took eight hours, not four like now...
...The night before, she had been rushed to a familiar place, the Medical College of Georgia in Augusta...
...She knows all the patients...
...the patients and staff talked in low tones, and the TV set could hardly be heard...
...Curry had got hold of a hemodialysis machine we could use...
...Consider, too, the strong economic boost small-town dialysis clinics give to their communities...
...The origins of Metter's clinic gave me my initial clue...
...You justhaveto keep lovin' and fussin' over them...
...Add to that the many medicines purchased locally, plus the commercial transportation units carrying patients to and from each center, and you are looking at a sizable infusion of funds into rural America...
...It's working just fine...
...The government's guaranteeing payment of these patients' bills gave rise to a remarkable burgeoning of hemodialysis centers from coasttocoast...
...There a team of transplant surgeons gave her a new kidney...
...I was told it came from a24-year-old boyin Hartford, Connecticut, who died in some kind of accident...
...at present approximately 14,000 patients attend rural dialysis centers...
...In time, however, Curry's reputation as a shrewd diagnostician with an irresistible bedside manner carried the day...
...A practical nurse, she grew up in Metter and has worked at the center for many years...
...It doesn't matter how late at night it might be...
...Then we went back to Metter...
...Thought it was an iron lung, something I'd have to get inside of...
...She was so short of breath she could not speak, and the slightest effort caused her to faint...
...The measure instantly made most people afflicted with kidney failure, regardless of age, Medicare beneficiaries...
...It could be they're feeling nausea," shesaid, "orthattheir blood pressure has shot up...
...Others were watching television (a game show), while a few bantered with the nurses...
...In the beginning, Curry now recalls, many were distrustful of the young physician...
...Nearly a quarter-century of doctoring there has enriched his knowledge of the citizenry...
...his practice lagged and he fell deeply into debt...
...If the total seems less than impressive, consider that during the past decade the number of rural dialysis patients has more than tripled...
...The clinic each week treats some 40 rural Georgians...
...That makes it the first rural dialysis facility in Georgia, and possibly in the nation...
...When I interviewed Helen Williams (she's in her 50s now), she offered a somewhat different explanation...
...When I visited the center one morning it was already 9 o'clock, and many of the patients were asleep in their leather recliners...
...Certainly from the perspective of kidney patients in the area, the convenience of a nearby dialysis clinic makes life better in Metter...
...By the time that became a reality, saysCurry, "wehad32patientsandnine machines, plus a social worker, a dietitian and a dozen nurses, technicians and orderlies...
...Nevertheless, "she steadfastly refused to be sent 'up there' to Augusta for dialysis treatments for her failed kidneys...
...It might be two in the morning, but that's OK...
...Leon E. Curry, a family practitioner...
...For openers he enlisted Lillie Johnson, a trusted Metter nurse, to accompany Helen Williams to Augusta...
...Soon the solarium was overflowing with patients and Curry was busy lobbying county officials to come up with funds for a spacious new center next-door to the hospital...
...Another is the unusual tidiness of the streets and sidewalks, all swept clean of litter...
...many, in fact, prefer to sit back and watch the passing parade...
Vol. 74 • March 1991 • No. 4
