Thread by @TheRealDoctorT

The alarm was a reedy chirping sound. In the daytime hustle of the ward it was barely noticeable.

It made my heart sink.

My eyes were glued to the monitor on the water treatment unit.

I knew the dialysis nurse was looking at it too.

“WTR PRES LOW”

A red light flashed. 1/

The devastating winter storm knocked out the power and water supply to most of Texas.

It affected many people, and some paid the ultimate price.

Hemodialysis patients were at particularly high risk because of the nature of their illness, and its treatment. 2/

Patients with end-stage kidney failure usually have several treatment options, including kidney transplantation and various forms of dialysis.

Hemodialysis involves a machine that filters the blood and removes excess fluid.

It is typically a very water-intensive process. 3/

Every year, thousands of dialysis clinics in America use trillions of liters of fresh water.

Trillions of liters.

With loss of water supply, these clinics effectively shut down.

A dialysis patient who makes no urine is in a race against time to get treated. 4/

These patients normally dialyze three times a week. If too much time passes before they can get dialysis, it can easily be fatal.

Fluid overload can lead to respiratory failure, essentially like drowning.

Electrolyte abnormalities can lead to coma, or cardiac arrest. 5/

When the power went out, some dialysis units were still functional with water supply intact, but others weren’t.

Many people worked hard, overtime, to find a way for patients to get their treatments.

The risk was real. Lives were at stake. 6/

With the freeze, hospitals lost water too.

Some places still had water pressure, others had low pressure, or none.

I found myself practicing a sort of medicine I never trained for.

Figuring out how to deliver treatments, juggling logistics, trying to engineer workarounds. 7/

“WTR PRES LOW.”

My heart sank.

Because this was one of the last rooms I had available with adequate water pressure... and we were losing it.

I reached out to my colleagues, and we discussed our options.

I’m grateful to know people smarter than me, willing to help. 8/

What was happening during the COVID pandemic happened again during the storm.

We were pulling together, making sacrifices, holding the line.

Patients sensed it too.

One even told me in between labored breaths, “I’m not that bad Dr. T... you can dialyze someone else.” 9/

Fortunately, we were saved by others working hard too.

Utility teams working around the clock, electrical and water company workers, were able to bring the water back.

We were able to get dialysis services back online, and alarms turned off. 10/

The storm represented the best and the worst of us.

I am glad to have gotten through it safely.

I know many were not so lucky.

Emotionally, with the pandemic still going on, it was another layer of numbness.

Burnout upon burnout.

Ash upon ash.

We wait for phoenixes to rise.