Among the most pressing medical needs facing Houston at the moment: getting people to dialysis treatment.
At DaVita Med Center Dialysis on Tuesday afternoon, nurses tended to dozens of patients on dialysis machines while another 100 people waited their turn. Some were clearly uncomfortable, and a number said they hadn't been dialyzed in four days.
Those delays can be life-threatening.
Typically, patients with kidney failure undergo dialysis every other day, or three times a week, for four hours each time. To try to move more people through, nurses were doing two-hour sessions at this center in Houston, enough to keep patients out of danger.
Dialysis replaces the functions of the kidneys. Healthy kidneys remove toxic waste and excess fluid from the body in the form of urine. For dialysis patients, a filter, sometimes called an artificial kidney, does the job. A patient's blood is pulled through the filter and pumped back into the body.
Dialysis does not cure kidney failure, but it does help people feel better and can extend their life. According to the National Kidney Foundation, average life expectancy for patients on dialysis is five to 10 years, though many patients live as long as 20 years or more.
But it's crucial that patients get regular treatment.
"If they don't dialyze three times a week, they can easily become fluid-overloaded, or they can have a high potassium level in their blood, and they can become very, very sick," says Dr. Steve Fadem, medical director at the DaVita center, which is one of about 100 the company operates in the Houston area, about half of which are open. Muscles, including the heart, can stop functioning correctly. "Over so many days, they can't survive."
In the wake of Harvey, DaVita has opened its doors to all dialysis patients, not just its own. But the company has been struggling with staffing shortages.
"Many of our nurses are locked in, flooded out of their homes, and they're either somewhere else, or they can't get out of our neighborhoods," Fadem says. "As a consequence, we don't have enough nurses to dialyze the numbers of patients that are coming here."
They've been helped by a team from Baton Rouge, La., who showed up with boats to ferry both patients and nurses from their flooded homes to the center.
"This is surreal. I've never seen anything like this ever in my career. I've been doing this for almost 40 years," says Fadem.
After missing his regular Monday session, William Scott and his wife, Teresa, arrived at the center just before 10 a.m. He finally started dialysis almost four hours later.
"It was a long wait, but we could understand because it was a lot of people," Teresa Scott says with a laugh. "It's just good he got in here."
Yesuf Said, a nurse who's worked at this center for four years, says it's been difficult dealing with so many patients at once and so many who are new to this center. "We have to do it, because nobody can do it," he says. "It's life and death for patients."
He's worried about the coming days. Normally, if patients don't show up for dialysis, they get a phone call from the center. Now, Said says, he's not sure they can reach everyone.
DaVita serves around 6,700 patients in Houston, according to Chakilla Robinson White, who oversees operations for the company's dialysis centers in Texas and neighboring states. On Tuesday, she sent a companywide email with the subject line "Rally For Help in Texas," appealing to staff in other places to travel to Houston to help.
Dialysis patients who are unable to find an open center can get help from the nationwide Kidney Community Emergency Response coalition by calling 1-866-901-3773.
DAVID GREENE, HOST:
Here in the city of Houston, the floods have been particularly difficult for people who are already sick or already disabled. For those who have kidney failure, the timing of this storm was especially bad. Many of the people who rely on dialysis to stay alive get that service on Mondays, which was the worst day of flooding in much of Houston. NPR's Rebecca Hersher visited a dialysis center as desperate people showed up on newly opened roads.
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REBECCA HERSHER, BYLINE: Dr. Steve Fadem made the rounds at DaVita Dialysis Center in Houston earlier this week.
STEVE FADEM: How are you feeling? Are you doing all right?
HERSHER: About 50 people were hooked up to row upon row of dialysis machines. Some of them were brought in by teams of volunteers, who went in in boats to get people who were stuck. Larry Caplan came in by ambulance. He usually goes to another facility, but flooded roads made that impossible.
LARRY CAPLAN: I was almost afraid to get in the vehicle to drive on the highway, but my family encouraged me to go.
HERSHER: Hooked up to the machine, he was relieved that he had made it. Teresa Scott tried to get her husband in for dialysis on Monday, when he usually gets it. But by the time the nurses arrived from their homes, her home was flooded in.
TERESA SCOTT: About that time, it was really raining, so we couldn't get out.
HERSHER: They came in first thing the next morning to find more than a hundred people in the waiting room.
SCOTT: Well, we got to sign in at 9:52. And then they called him back at 1:44.
HERSHER: That's a long wait (laughter).
SCOTT: It was a long wait (laughter). But we could understand because there was a lot of people.
HERSHER: Like Scott's husband, most people prefer to do their every-other-day dialysis on Monday, Wednesday and Friday so it doesn't mess up their weekend. Each treatment takes four hours. It's a life-or-death thing. Dialysis machines are sometimes called artificial kidneys. They pull patients' blood through a filter to remove toxins and excess fluid.
FADEM: Without dialysis every other day, patients get very sick. They can go into congestive heart failure. And you can die from that.
HERSHER: There's so much backed up demand that on Tuesday, Dr. Fadem was doing just two hours of treatment for each patient instead of four so more people could cycle through. The limiting factor isn't machines, it's staff. A lot of nurses are also in flooded homes or trapped or have been evacuated. Yesuf Said has been working 11-hour days and taking elaborate detours to get to and from work during the storm.
YESUF SAID: My son is very - 3 years old. He don't want me to go into work, but I try to explain for him.
HERSHER: He says his moral duty is to come to work.
SAID: But we have to do it because nobody can do it, you know. There is life and death for patients, so we have to do it.
HERSHER: Even in a disaster. Rebecca Hersher, NPR News.
(SOUNBITE OF NOSAJ THING'S "ERASE") Transcript provided by NPR, Copyright NPR.