You will recall that at MGH they dialyzed 20 lbs. of fluid off me in 5 days. They explained that with right heart failure the key to treatment was not fluid restriction, but frequent intensive dialysis several  days a week. The MGH nephrologist, Dr. Goes, spoke to Cottiero, my "nephrologist" here, whom I have seen three times and faxed him records and recommendations.  Cottiero said he would do it. But when I returned to his money pit, the nurse who runs the place (and turns off the heat at 3 PM with a thermostat in a lock box to which only she has the key) told me she would let me know on Wednesday when my extra day would be. On Wednesday, she didn't show up,  and a junior nurse told me that Dr. Cottiero thought that three times a week was sufficient.

In two weeks I gained 15 lbs. of fluid. Last Thursday I didn't pee for 18 hours and was very uncomfortable. I thought I had prostatic obstruction and that he would draw off 1000 cc. But all he got was 150 cc, which meant I was in renal shutdown, due to the inadequate dialysis which I had been receiving.

I dread the catheter, but I love Harry. He and I go back a long way. We were interns together. Then we served together in the Navy at Quonset Point, me as as a psychiatrist, he as a SeaBee battalion doctor who served in Vietnam. Our favorite story involves an older man he sent me to Section 8 out before they took him to Vietnam. To go to Nam, you had to qualify on the M-16 and the 45. At the firing range, this guy stood up and started firing in all directions. I told the man I could send him home with an honorable discharge. He began to cry, "Please, Doc, I'm 40 years old. I'm a drunk. I've lost every job I ever had. I lost my wife and kids. This is my last chance." He told me that something happens to him when he has a gun in his hands. I asked him if he could fire the weapons if I were right next to him. He said he could. We lay down on adjacent mattresses. I'd fire and he'd fire. I hit the bullseye every time, thanks to my training at Camp Alton and the Kaplans. The battalion commander pinned marksmanship medals on me. I wore them to my next inspection, and my Captain ripped them off my chest. Disgrace. As to the man, they sent him home 6 months later, a hopeless drunk.

I was admitted directly to Miriam where they dialyzed the hell out of me--8 liters the first day, 5 the next. Once more Carol was totally devoted to me, upbeat. Andy came in to spell her on Monday.

Duffy came and took me home on Tuesday. I was getting many conflicting opinions as to whether or not I should stay another day, so I went home. Larry brought me breakfast, and he'll take me to dialysis later today. I'm a bit uremic, making very little urine (they focused on fluid, not removing toxins). I'm on a new antibiotic for my prostatitis.

I have an appointment with a new nephrologist this week.