Episode 21: A Dialysis Nurse Shares Her Transplant Story
This National Donate Life Month, hear directly from a former dialysis patient and beneficiary of a kidney transplant. Bridgette Chandler, HTRN, discusses her journey coming full circle from home dialysis patient to home dialysis nurse with Fresenius Kidney Care.

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Brad Puffer: Welcome, everyone to this episode of Field Notes. I'm Brad Puffer, on the Medical Office Communications team at Fresenius Medical Care North America and your host for this discussion today. Here we interview the experts, physicians, and caregivers who bring experience, compassion, and insight into the work we do every day. We wanted to dedicate an episode of Field Notes to hear directly from a former dialysis patient of Fresenius Kidney Care who was the beneficiary of a kidney transplant and then became one of our own employees and a home dialysis nurse. It's quite a story and I haven't even given away some of the best parts. While dialysis is life sustaining, successful kidney transplant can mean an even better life for the hundreds of thousands of people living with kidney failure and our company is implementing many new initiatives to help make transplant a reality for more patients. Bridgette Chandler is a registered nurse in our Home Therapies division. She has incredible insight and passion for both home dialysis and transplantation. Bridgette, welcome to Field Notes.

Bridgette Chandler: Hi, Brad. And thanks for having me.

Brad Puffer: You have such a great story to share with us. Can you take us back to the beginning of your journey with kidney failure, what was it like to be told you needed dialysis and how did you come to find out your kidneys were no longer working?

Bridgette Chandler: I had actually had issues with my kidneys pretty much starting from the time when I was young, about 12 years old. I had some intermittent issues, but never really thought too much about it. I was like most people, it just kind of was something that happened. In 2008 I got very, very sick though. I thought I had a really bad case of the flu. I was running high fevers, chills, aching all over, that sort of thing. I ended up in the emergency room at our local hospital and was totally shocked when the doctor came in and told me at 25 years old that my kidneys were failing, that I was in end stage renal failure.

Brad Puffer: That must have been really hard to hear that. And then I assume at that point you had a choice to make, why did you choose to go to home dialysis?

Bridgette Chandler: At the time I had two small children. My youngest daughter was two and my oldest daughter had just started kindergarten. She was only about two weeks into kindergarten. Immediately, I was faced with this decision, I had no option, I knew I had to go on dialysis. So it was a choice of whether I wanted to go in center or whether I wanted to be at home and spend the time that I had at home with my family. So beyond a shadow of a doubt to me there was no question, I needed to be able to schedule my life around dialysis. Nothing changed in the sense of me being a mother or a wife, I just became a patient as well.

Brad Puffer:  And so what was your journey like waiting for a transplant, how long did that take?

Bridgette Chandler: I actually waited five years for a transplant. I spent five years on home dialysis and I'm very thankful for those five years because of course, I got to watch my children grow and got to be at home with them and do the things that they needed me to do. However, I had a fantastic support system and a fantastic nursing team that absolutely just supported me and rallied around me and really kept me going the whole time I was waiting.

Brad Puffer: And now you've come full circle, you're now a registered nurse with Fresenius Kidney Care working with our home therapies team and working for the same home nurse who cared for you, correct?

Bridgette Chandler: So I spent about five years on dialysis and in February of 2013 I was actually contacted by a stranger who had heard about me and had heard my story and was interested in being a possible donor. And so again, we started the process in February of 2013 and later on that year, in June, late June, early July, I found out that this stranger was actually a perfect match. And so we proceeded with the transplant. I had the transplant in September of 2013 and my very first checkup after the transplant I actually told the physician, I said, I want to know how soon I can become a nurse and how soon I can help dialysis patients. And he kind of chuckled and he told me, he said, well, give it a year until you start feeling a little better, start feeling more yourself. And I gave him nine months and then I started back to school. I went straight through and got my RN and knew I absolutely wanted to work with dialysis patients.

Brad Puffer: Well, we are so glad to have you as part of the Fresenius Kidney Care team. I want to spend quite a bit of time during our discussion today talking about the transplant process, talking about what we've learned about transplant and how you work with patients. You had a donor just randomly come and offer their kidney, but for a lot of patients that's very difficult to get a living donor. There's also a real issue right now, with just not enough kidneys available. How do you start to talk about this with patients?

Bridgette Chandler: The answer is always going to be education. So often I have patients that come into my office and they talk to me and they feel like it was such an easy process. Oh, you were young, and things were fine, and you had a family and that's how you got your transplant. As I said, I had been on the transplant list for several years. I have had many other people who were tested for living donors as well and I put quite a bit of time in. When patients come in and we start talking about transplant, I always tell them if they tell me they're too old or they feel like they're too sick or whatever the situation may be, to still continue, still be evaluated. I mean, obviously, if you're on dialysis you don't feel well to begin with, go ahead and start the process, get things going so that the transplant team can actually make that determination and evaluate any potential donors as well.

Brad Puffer: There must be a lot of frustration that patients have through the process, as it can be a really long wait. How do you counsel your patients through that frustration?

Bridgette Chandler: Well again, I'm going to rely on my own experience in this. There were so many times when I would think to myself, it's just never going to happen for me. I've been waiting and waiting and waiting. And it's so easy to get wrapped up in the why me and kind of the sad story and that kind of thing. I would look at my kids and every holiday, I would wonder is this going to be the last one. Is this going to be the last birthday I'm going to get to spend with them and it was so easy to get down.

And this again is where I relied on the fantastic nurses that I had, that one nurse in particular, I mean, she just absolutely lifted me up and supported me every time. Any time I felt like I wasn't making progress and that I wasn't moving forward, she was there and she supported me and so I always look back on that when I have my patients who are waiting or my patients who are frustrated or my patients who are upset. I think about how my nurse made me feel, how she supported me and how she kind of held me up when I didn't have the energy or I didn't have the strength to hold myself up, she supported me. And so, I always try to do that for my patients as well.

Brad Puffer: That's awesome to hear that you had that experience and so great that you can offer that to other patients. What do you hear from patients sometimes about some of the predispositions about who should be on the wait list and who shouldn't. You mentioned that some patients themselves feel well, I couldn't get a kidney because I'm too old or too sick.

 

Bridgette Chandler: Unfortunately, I do think that is something that we struggle with. Again, like I said, I will always encourage my patients regardless of what I think the situation is, I always will encourage them to go be evaluated. Oftentimes when they go in for these transplant evaluations, they will be given a list of tests of things that the transplant center will want them to complete prior to actually being listed on the transplant list. And so what will happen is they will see oh, I have to have cardiac clearance, and I have to have pulmonary clearance, and I have to have this and I have to have that, and they think that that means that they're not a good candidate. When that's not the case at all.

The goal is to make sure that you are healthy enough to not only receive the transplant but also to thrive once you get it. So that is why I definitely tell patients to pursue the transplant and why I always tell physicians, let the transplant team make this evaluation whether they're a good transplant or not. I will refer everyone, regardless of who it is, I will refer them so they can at least meet with the transplant team and see what's needed.

Brad Puffer: Well improving the organ donation process and the transplant process in the US is really an important effort and it's one that our company is doing its part to support by rolling out many new initiatives. How is that entire process being made easier for patients who are in critical need and how are some of the new procedures in place at Fresenius Kidney Care making a difference?

Bridgette Chandler: Well, Fresenius really went above and beyond with this. Years ago when I first was listed, it was basically the physician's choice. The physicians would come in and talk to the patient and say, do you think you would like to pursue a transplant? If the patient said no, they just kind of dropped it and that was really the end of it. With Fresenius, they have really gotten the nurses involved, the social workers involved, our dietitians are on board. Everyone is really part of the process and we understand that dialysis is so overwhelming that they're not really thinking about a transplant, they're thinking about what's going on currently, let me get through what I have going on right now and then we'll talk about a transplant, and that's where Fresenius does so great about not just the initial talk of transplant but follow up. They come back in a few months later, make sure you're supported, make sure you're comfortable with the dialysis process and then ask again, would you like to be re-evaluated, would you like us to make this referral. They make it such an easy process for patients and I just think that's fantastic. I can't brag about that process enough. It's amazing.

Brad Puffer: I wanted to ask about your personal experience, do you think home dialysis can play a role in preparing patients for transplant and did it make a difference for you?

Bridgette Chandler: With me, with my personal situation, the transplant facility that I was listed at, they actually work on a point system for patients. So if a patient is being evaluated for a transplant and they have not had a hospitalization in the last year, that may be a point. If they are not a diabetic, that could be a point. So they use this kind of point system to rank people as far as who are the best candidates for transplant and one of the things that they looked at was home dialysis. And the reason that this was so important to them is because patients who do home treatment, often they have more charge in their treatment. They don't miss as frequently as patients who go in center because again, they can make that dialysis schedule fit their life, as opposed to their life fitting the dialysis schedule. So all of these factors played in and as I said, for me, it definitely played a huge part in my transplant because they knew that I was a reliable patient.

Brad Puffer: And it sounds like from your experience and what you've said about the role that Fresenius Kidney Care is playing in helping more patients get wait-listed for transplant, that the nurse really does play a critical role, it did for you personally, and it sounds like you're continuing to do that for other patients as well.

Bridgette Chandler: It is one of those situations where I don't always tell my patients my personal experience. However, you kind of get a feel after a little while who needs to hear, who needs to know that you've been there and that you've experienced it. And so I do judge it based on each patient but oftentimes when they hear that I have had that transplant, that I've been through the transplant process and I have went through these things the same as they're going through, they're a lot more apt to say absolutely, I want to be listed. I want someone else to make this decision for me as far as if I'm a candidate or not.

Brad Puffer: And finally, I wanted to ask if you had any other messages to physicians who may be listening to this and what role they can play in helping patients and encouraging them and supporting them for transplant. How big a role do they play?

Bridgette Chandler: They obviously play a huge role in the transplant process. Oftentimes the nurses are kind of-- they're the ones that are always there with the patient. However, the patients are always looking for that reassurance from their physician. So regardless of if I tell the patient every day for two weeks in a row that I think that they should be listed, I think that they would make a great candidate for transplant, they really want that reassurance from their physician who's been following them all this time. So absolutely, physicians play a huge role in this. And again, I would also encourage the physicians that even if you don't feel like they may be the best candidate for a transplant, let's go ahead and refer them to the transplant center and see what they need to become a better candidate.

Brad Puffer: And before we finish up, just wanted to check in, how have you been feeling post-transplant, how have things been going, how long has it been, and have you stayed positive?

Bridgette Chandler: I have. There has been a lot of changes of course since my transplant. I had my transplant in 2013, September of 2013. I will be coming up on eight years this year. I of course, have started in the home program at Fresenius and there has been a lot of growth in the home department. So I'm very, very thankful for that. As far as my health, I have done fantastic. Kind of the way that I describe it is if you have a toy with two sick batteries and then all of a sudden you pop a new battery in, that toy feels a whole lot better and that's kind of how I look at it. So I'm definitely doing well these days.

Brad Puffer: Well that's great to hear, Bridgette and really appreciate you joining us to make for another great episode here of Field Notes. Thank you.

Bridgette Chandler: Thank you for having me.

Brad Puffer: And to our audience, thank you for joining us. Please know that your feedback is always welcome and if you have comments on today's episode, topics of interest to you, or speakers you want to hear from, let us know by clicking the feedback link featured on the Field Notes website on fmcna.com. And don't forget, you can find Field Notes in the Apple Store or Google Play or on fmcna.com. Or you can also find our annual medical report and other featured articles. We hope you'll come back and join us as we have many more topics to discuss in the weeks ahead. Until next time, I'm Brad Puffer and you've been listening to Field Notes by Fresenius Medical Care. Take care everyone.