Essie Reinhart worked full-time as a social worker in the emergency room of Lincoln Hospital in The Bronx. She was married and raising three young boys. She also had lived with high blood pressure as long as she could remember.

Many of the doctors she worked with at the hospital mentioned her blood pressure and asked her why it was so high. She told them she didn't know. She was referred to a specialist to determine the cause of the high blood pressure and was admitted immediately to a hospital. While there, doctors realized her kidneys had failed and that she would have to begin hemodialysis treatment. The year was 1966.

After 36 years, she is still receiving weekly dialysis treatments three times a week.

With the exception of a four-and-a-half year period in which she had a cadaveric kidney transplant, Essie has been a hemodialysis patient on a continual basis. She began dialysis treatment several years before the initiation of the Medicare ESRD Program, which pays for dialysis treatments for most patients with end-stage renal disease.

After the diagnosis of kidney failure, Essie was referred to Dr. Mike Avram in Brooklyn. Dr. Avram removed both of her kidneys and placed a Scribner shunt (an early access device) on her arm so she could receive dialysis.

Over the years, Essie has used a Scribner shunt, a fistula and a graft, which is how she currently receives hemodialysis.

She has seen first-hand the enormous changes that have taken place with regard to dialysis treatment over the past four decades. Essie makes particular note of one development: the flexibility of the treatment schedule. When she began treatment, it was only performed twice a week for 12 hours each session. She now receives three-hour dialysis treatments three times a week.

When discussing dialysis before the Medicare ESRD Program was developed, Essie admits it was very challenging. "You ran for 12 hours (from 6 a.m. to 6 p.m.) on a machine called a Kiil. You only ran twice a week. The most you could lose during each run was four pounds."

To pass the time, Essie talked to fellow patients and staff members. She also received three full meals for breakfast, lunch and dinner. While on dialysis, Essie asked her aunt to care for her children or hired a babysitter.

She also recalls that her cousin appeared before a panel of doctors to describe why she should be eligible for dialysis. This was the method of determining who would be selected for dialysis treatment before the Medicare ESRD Program. Those considered good "candidates" were accepted into the Program while those deemed poor candidates would die from the effects of kidney disease. Because of her background, they decided she would be a good candidate for dialysis treatment.

"You had to have money to pay for it and my union paid for it. I had three young kids and I was productive. And when they cut the time on dialysis, I was able to go back to work," Essie said.

Essie also recalls that dialysis units were not widely available in the 1960s. She had to travel to Brooklyn (over 45 minutes away) to see Dr. Avram. However, the increase in the numbers of dialysis patients after the Medicare Program was implemented led to more units almost immediately. "I noticed that more people were on dialysis. Before, there weren't any machines in the Bronx or in Manhattan."

She also observed that the machines were improved and the hours were drastically shorter.

"At the beginning, it was like trial and error. They (the staff) really didn't know much about kidney disease at that time. Everything just got better - they learned more," Essie said.

Over the past four decades, Essie has seen dialysis treatment evolve before her eyes. However, she realizes that attitude remains a major factor in the quality of life for patients.

"You just have to make up your mind that you have to go on dialysis. You can ask your social worker to make travel arrangements or you can do it yourself. You don't have to be confined at home like you were at first," Essie said.

She should know. She remembers it well.

This article originally appeared in the May 2002 issue of aakpRENALIFE, Vol. 17, No. 6.

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