Nancy was dying. Her body had been failing her in one way or another for many years. She had received a diagnosis of breast cancer in the 1970s, and bilateral mastectomies had held the cancer at bay for 20 years. The multiple insults of hypertension and diabetes had taken their toll by the time Nancy was in her 60s, resulting in the development of kidney failure by her 65th birthday.

Nancy and I met when she started on hemodialysis. The fluid buildup in her legs had gotten so bad that she needed to use a wheelchair. As we dialyzed off the fluid, replaced the protein, and straightened out her electrolytes, Nancy felt better than she had in years. She was out of her wheelchair. She had a family at the dialysis center to watch over her. She had friends on the transport bus to gossip with, and she was making plans for the upcoming holidays. But—isn't there always a “but”?—the cancer that had been hidden for 20 years was reactivated when her immune system was down, compromised by the renal failure. The breast cancer came back as metastatic hot spots visible all over the bone scan. Chemotherapy was the only way to save her life.

When Nancy began her chemotherapy to treat the recurrence of breast cancer, she felt terrible. We started daily dialysis to improve her symptoms. Removing the fluid helped her breathing, dialyzing off the poisons allowed her to eat again, and Epogen and intravenous iron increased her energy. Against all odds, the chemotherapy treatments worked. The hot spots on the bone scan resolved, her hematocrit improved, and her white counts stabilized. Unfortunately, however, because the chemotherapy attacked her immune system so violently, an old case of tibial osteomyelitis was reactivated and spread along her entire left leg. Nancy was back in the wheelchair.

Nancy began a slow slide—both physically and emotionally. The physical therapists said that she needed to get up and try to walk. Nancy just sat there. To make matters worse, Medicare deemed physical therapy unnecessary since no progress was being made. So Nancy was left to live out her life sitting in a wheelchair, and she became understandably depressed. The oncologist gave Nancy a prescription for Prozac, but she couldn't afford the $25 co-pay, so the prescription was never filled.

But—there goes that “but” again—just when I thought there was nothing more to be done for Nancy, destiny stepped in. One of my dialysis technicians became pregnant, and the head nurse casually mentioned to Nancy that she wished someone could make a baby blanket for the tech. Although the nurse never intended that Nancy be the crafter, what she hadn't realized was that Nancy used to be an avid knitter. Nancy blamed the combination of poor eyesight and the high cost of supplies for why she had quit knitting. Reluctantly, she now agreed to try to knit the baby blanket for the tech—but because she did not have the financial resources to pay for the yarn, the staff chipped in to cover this cost.

When I came back to the dialysis unit a week later, Nancy was sitting up in her chair with her fingers flying as she knitted a baby blanket. There was a smile on her face and a gleam in her eye. Within a week, she had finished it and indicated that she was ready to start a new project.

At that point, the nurses and techs in the dialysis unit told Nancy about KIDney Quilts, a joint program that has been established by the National Kidney Foundation (NKF), the American Academy of Nephrology PAs, the AAPA, local quilting groups, various providers of dialysis and manufacturers of dialysis products, and patients and staff from dialysis units throughout the United States. KIDney Quilts supplies quilts (crocheted, knitted, or sewn) for children attending “kidney camps” that are run or sponsored by the NKF. Only some of the children attending these camps have kidney disease. Others have blood diseases, transplants, diabetes, asthma, or HIV disease.

Nancy had always been the giving type, and she told me that her experience with her cancer and dialysis was very frustrating because she always seemed to be on the receiving end. She said that it seemed futile for her to try to find a way to give something in return to all those who had helped her during her illness. Then suddenly there was an opportunity; knitting the baby's blanket was a way for her to give back. Now she wanted to knit quilts for camp. The dialysis staff collected the money, I went to Wal-Mart to buy the yarn, and Nancy started knitting a bright, happy quilt that matched the smile that spread across her face.

Nancy's story made me pause to think about the whole notion of “giving back” and how difficult it usually is for many patients to change roles when they become ill and become receivers rather than givers. I realized how important it is for patients to have tangible ways to show that the clinician-patient relationship is really a two-way street.

As with Nancy, finding projects for dialysis patients can often be difficult. These patients often have multiple medical problems and disabilities that limit what they can do. Many cannot walk distances or do outdoor activities. Vision, money, and, especially, energy are often in limited supply.

Interestingly enough, against all these odds, some of my patients do find ways to give back to the community. Quite a few of them are in groups that donate time to church activities. One lady makes flower arrangements for the dialysis unit to make it “look pretty.” Two patients take in foster children, since “we're home all the time anyway.” Even those patients who seem to be on the receiving end find that they still have something to give.

Nancy is dying, but she seems to have decided that now is not the time. Nancy wants to make enough quilts so that no child will go without during summer camp. As I watch the yarn flying through her fingers, I think she might just reach that goal. JAAPA

The author is a PA working in nephrology at Metropolitan Nephrology, Alexandria, Va, and Clinton, Md. She is the liaison for the AAPA to the renal community and in this capacity runs the KIDney Quilts project for the National Kidney Foundation and the American Academy of Nephrology PAs. She is always looking for more quilts. She can be reached at kidneyquilts@aanpa.org.