When Ralph Bruner was told that he would have to begin hemodialysis treatment immediately, his wife, Donna, knew it would be a difficult adjustment for her husband. She knew he would struggle with the schedule. She knew he would have trouble with the dietary restrictions. And she knew the treatment itself would bother her husband. But since he began dialysis just over five years ago, through all the challenges and obstacles, Donna has been his caregiver, confidant and best friend.

Five years ago, Ralph, 54, was a truck driver in Macpherson, Kansas. Donna was working as a hair stylist. Ralph had been experiencing problems with high blood pressure and then diabetes, but had no history of kidney disease in his family.

During a visit to a specialist about problems he was having with high blood pressure, the Bruners learned that Ralph's kidneys were failing and he would need to have a fistula placed as soon as possible. They were told to expect to have the fistula placed in four weeks. Instead, the specialist called the next day, after performing a blood test, to inform them that the fistula would have to be placed immediately.

After the fistula was placed, Ralph began dialysis the next day. The sudden turn of events took the Bruners by surprise and neither of them was really prepared for what to expect from dialysis. "He did not handle it well at all. He was angry and he did not want to go to dialysis," Donna said.

The change in lifestyle was difficult for husband and wife. Ralph's job was very schedule-oriented and Donna was also finding it hard to work on a regular basis.

"I did work for a little while but Ralph started getting sick and couldn't drive himself home from the hospital," Donna explains.

The Bruners wondered if transplantation would be an option. Donna was willing to donate one of her kidneys but due to pre-existing conditions she was deemed an unsuitable donor. Ralph's health was also an issue and transplantation was not considered likely. They understood that dialysis was going to be a part of Ralph's life.

Donna accepted that she would have to help her husband make the necessary adjustments to hemodialysis. Even after five years of treatment, Donna still faces challenges in helping her husband deal with the changes that accompany dialysis.

As her husband's caregiver, she knows first-hand how her husband struggles occasionally with the dietary restrictions and his treatment schedule. He has also found it difficult to adjust to the fact that he is unable to work regularly. But these struggles have taught her to be more understanding and more aware of the need to help others. Donna has become involved in a support group to discuss common problems and help others with resources.

"We have a spouses/caregivers meeting and we just talk about our experiences. We all have similar problems. When you first start, you think you're alone, but now I know we're not alone," Donna said.

Donna also acknowledges how helpful and understanding the staff at her husband's dialysis unit has been. "Everybody has been wonderful. There have been times when I've come in crying and the staff has just been great," Donna said.

According to Donna, dialysis can be scary and upsetting especially if a patient does not know it may be approaching. She recommends that other spouses of dialysis patients talk to a family counselor and join a support group. Her support group has helped Donna stay more involved and informed and taught her what to expect.

Donna knows that her husband has dealt with many emotions since his diagnosis of kidney failure and that he needs plenty of support. She also understands that those who give support are often in need of support themselves.

This article originally appeared in November 2001 aakpRENALIFE, Vol. 17, No. 3.

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