Sunday Surkhi-iDoc- A walking miracle

I was reminded of a patient of mine today and I shall be very brief. He was admitted with peripheral neuropathy under my care (1973-4) while I was new out of my Residency and still talked with my chief (who was an old expert on neuropathy). He responded to correcting his BUN level and supportive therapy for neuropathy and quickly responded, discharged for F/up. His BUN was around 30 and he managed OK with that Past-- He had nephrectomy 1931(dont remember which side) and his Urologist(was still alive) I talked with on phone guided me to help maintain him. His only remaining Kidney was full of pockets of infected material and there was a stag-horn calculus in the pelvis. From time to time (he would not stop playing Golf, but being a nurse in his younger days he had learnt to control his electrolyte and fluid balance with that kind of BUN) he would come to ER with hematuria. His wife also had calculi in her both kidneys (may be that was there reason for love?). Whenever he would come to ER with hematuria and mild fever he would insist he wanted to be seen by me and the ER physician would tell him, "No no he is neurologist, you need a Urologist" but the patient would win. I looked after that patient despite my specialty because he had confidence in me. He saw two urologists and both declared him "terminal" and would start drastic measures against his wishes, so he had no choice but to stick with me. The regimen his original Urologist had given me was keeping him functioning and enjoying life. Then his wife had a stoke and died (I am cutting the story short). He met his old school sweetheart and got married and told me he is moving to Florida. Next thing I remember he came back after a year in my office with a dialysis schedule, and told me in no uncertain terms he wants to get rid of these procedures. I was always amazed at the fact that he really lived on a tiny hypertrophied piece of kidny left over, and told him he was a walking miracle. Anyway, I helped him and slowly took him off dialysis and to my further amazement he was back to his previous self, without dialysis. As time passed however he started getting worse and died with a stroke. All in all I looked after him of roughly for about ten years. This is nothing against the urologists but they failed to see his compensated renal function, not good but enough to enable him a bit enjoyment of life. There was nothing special about my treatment which was guided by his original urologist anyway but that is what I was saying about "doctoring", the important thing whether you are a physician or surgeon.