Early Days of Dialysis in New York

Donald A. Feinfeld, MD, FACP, FASN

 

 

In 1967 the faculty of Department of Surgery at Columbia University College of Physicians  & Surgeons (P&S) realized that they weren't getting many residency applications from academically oriented graduating medical students.  Since they felt that their mission was to train academic surgeons, they asked around and learned that one of the most exciting areas of academic surgery was organ transplantation, which in that era meant kidney transplantation.  However, the Chairman of Medicine at P & S, Dr. Stanley Bradley, did not accept the use of dialysis, and since a kidney transplantation program requires a population of dialysis patients, P & S could not start such a program.  Dr. George Humphreys, the Chairman of Surgery, was unable to persuade Dr. Bradley to change his mind, so he decided to start a dialysis program within the Surgery Department. 

 

Dr. Frederic Herter, the Director of Surgery at Francis Delafield Hospital, agreed to place the dialysis program at that hospital and appointed Dr. Joseph Buda to direct it.  They bought a Travenol machine, installed it at Delafield, and hired a nurse who had done some dialysis work.  In September 1968 they started looking for patients and found AW, a 35-year-old man who had lost his kidneys from hypertension and could not get into one of the scarce dialysis slots elsewhere.  Dr. Buda admitted him to Delafield, placed a Scribner shunt in his arm and then realized that AW needed ongoing medical care.  The medicine residents and attendings were not allowed to be involved with dialysis patients, so he was immediately turned over to the senior medical student who was just starting a surgical subinternship at Delafield--me!  I walked onto the surgical ward in my whites and was told, "Congratulations! You're going to take care of our first hemodialysis patient!" 

 

I had no idea what to do for this man.  There were no books on dialysis in the library.  There was a book on uremia but it didn't mention dialysis.  I did find a few articles in Index Medicus, all of which were experimental (there were no computers and no Medlines).  Twice a week I wheeled AW down the hall and watched the nurse hook him up to the machine.  I prayed that nothing bad would happen; fortunately it didn't.

 

Two weeks later, I received a second uremic patient, a woman with severe lupus whose kidney function had failed despite medical therapy at the private Harkness Pavilion.  Since patients with systemic diseases such as lupus were excluded from the few dialysis programs available, she was clearly going to die without this treatment.  Transfer to Delafield was seen as a last-ditch effort to keep her alive.  Unfortunately, she also had severe thrombocytopenia, and attempts to place a working Scribner shunt led to copious bleeding, so she never received dialysis. She was eventually transferred back to Harkness.

 

I felt as though I was flying blind.  The surgical attendings and residents were sympathetic, but they couldn't teach me much about either dialysis or uremia.  I remember saying to myself, "If I get out of this without a major disaster, I'll never have anything to do with dialysis again."  It just goes to show one should never say never.