Lee Blackbird

Ode to my kidneys

Until recently, I didn’t know you were there. I didn’t think about you or worry about you. You were my unsung lifeline.

But now, you are showing signs of exhaustion. I feel you, nestled somewhere beneath my rib cage, one of you on each side, breaking a little bit more each day. I feel you, dying.

Do you see I am stuck between a rock and a hard place? My medication is killing you, but without it I’ll go mad. I’ll go mad again. I’ll go more mad. Without it, I can’t be mom. I can’t be me. I won’t survive.

I’ve tried different meds, but they are monsters. They tie my muscles in painful knots. They knock me out. They zombify my brain.

So I am stuck with the meds that are killing you, and it’s a choice between your life and my sanity.

I asked a kidney doctor to help me save you. On the first blood draw, she said you were exhausted. On the second blood draw, she said you were a little bit more exhausted. On the third blood draw, she said you were, again, even slightly more exhausted. It went on like this. This is the nature of progressive disease.

But the kidney doctor didn’t prescribe drugs to help you. She didn’t tell me what to eat or what not to eat. She didn’t say whether or when to stop the medication. It’s like she gave me a climate report with no climate agenda, and all I could do was watch the world burn. All monitoring and no action.

I requested a different kidney doctor, somebody who could inform my decision making instead of just monitor my proximity to death. Somebody with experience commanding troops in my kind of war, the meds versus the kidneys. The hospital said no, absolutely not.

Once you’re assigned a doctor, you’re stuck with them. All of our doctors are superb, they said.

Well, you’ll be glad to know I’m not new at this. I can find my way around medicine. I called the patient relations department and asked for help. The nice lady in the patient relations department went to bat for me against the hospital. Several months later, they assigned me a new doctor.

The new doctor didn’t ask about the meds, how badly I need them, whether I have options to get off them. To him, all of this was irrelevant; the kidneys are his department, not the medications killing them. He gave me a medication that protects you, to some extent, from the meds. Like a mediocre raincoat; you don’t get soaked, but you’re not dry either. When I asked how long you have, he said he doesn’t have a crystal ball.

I asked a shrink to help me save you. You really need those meds, he said, or you’ll go mad.

You’ll go mad again. You’ll go more mad than you already are. So stay on the meds. It’s theclimate denier approach. Burn the fossil fuels, to hell with the atmosphere. Forget about prevention – deal with catastrophe when it’s imminent.

I asked a nutritionist for help. She said to eat less sodium, less protein – and especially less animal protein. If it will help you, I will live on cabbage and quinoa and bread made from sprouted grains. And I do.

So where are we? We have a kidney doctor, and a shrink, and a nutritionist on our team, and I still don’t know how to save you and save myself at the same time. It’s an impossible tradeoff.

I’m not a praying person. All I can do is cross my fingers for you, for us, and try not to think about the crystal ball.

Long-term use of Lithium, the drug of choice for Bipolar I, can lead to decreased kidney function and chronic kidney disease. If you want or need to take medication, and you don’t tolerate other options, you are basically stuck between a rock and a hard place: stay on Lithium and watch your kidneys decline, or go off Lithium to save your kidneys, but risk relapse. It is an impossible choice. Exploring the options, and monitoring both mind and body, require navigating psychiatric, renal, and psychological systems that are not always knowledgeable or respectful. This piece explores some of the complexities.

Lee is a psychiatric survivor who writes to disrupt and rebuild cultural narratives around madness.