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Across 50 years, bond with patients is constant feature of Rice dialysis program

WILLMAR -- In the 50 years that Rice Memorial Hospital has provided hemodialysis to people with advanced kidney disease, one thing has not changed: the bond between patients and staff. Bev Schafer, who ran the program from 1968 until retiring in ...

Briana Sanchez / TribuneNurse Tammy Quenemoen talks to Stephen Frank before he goes into the dialysis unit Thursday at Rice Memorial Hospital in Willmar.
Briana Sanchez / Tribune Nurse Tammy Quenemoen talks to Stephen Frank before he goes into the dialysis unit Thursday at Rice Memorial Hospital in Willmar.

WILLMAR - In the 50 years that Rice Memorial Hospital has provided hemodialysis to people with advanced kidney disease, one thing has not changed: the bond between patients and staff.

Bev Schafer, who ran the program from 1968 until retiring in 2007, said those early years were like being a family.

"You became so close to those patients," she said. "We wept with the family when someone died. On the other hand we also had a really good time. We had a lot of parties."

Dialysis today uses more advanced technology and offers better outcomes with fewer complications, but it's still all about the patients, said Mary Beth Potter, unit director.

"One of the things I see in the unit is how engaged the staff is with the patients. I see them really giving their all to make sure the patient experience is the best it can be," she said.

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When the dialysis program was established at Rice in 1966, it was a leap of faith. There were few places outside the metro area where Minnesotans could be treated for advanced kidney disease, recalled Hans Dahl, then the administrator of Rice Hospital.

One day he got a phone call from Hennepin County General Hospital, asking if Willmar would consider becoming one of the first dialysis sites in greater Minnesota.

It was a time of expansion for the hospital and Dahl saw an opportunity. "So I said yes," he said.

Dialysis, which mechanically filters waste products from the blood in people whose kidneys are failing, was still relatively new in 1966. It had been successfully used on a patient in the Netherlands in 1945, but the first permanent dialysis center in the U.S. didn't open until the early 1960s.

Rice Hospital's program was at the leading edge of the spread of dialysis services. It opened with just two beds. Dialysis was at night so patients could work during the day. Each treatment lasted 14 hours.

In those early days, a four-person committee decided which patients would receive treatment - essentially choosing who would get a chance to live.

John Jeffers, a longtime nurse practitioner with the Regional Kidney Disease Program, was one of those on the committee.

"The whole emphasis was on rehabilitation," he said. Most patients were employed young males. Being married and having children was a plus, Jeffers recalled. Patients also needed good health insurance or private funds, because Medicare didn't start paying for dialysis until 1972.

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Few women made the cut. Retirees and anyone with a co-existing condition such as heart disease were ineligible.

But even for those who were selected, survival times were not long. Most were on dialysis one to two years "and then we lost them," Dahl said. "It was tough. Bev and I spent many hours talking about it."

Fast-forward to 2016 and a whole new era.

On a recent afternoon, the unit is quiet except for the soft hum of equipment. Some patients nap under blankets on heated recliners while their blood, carried through IV tubes, is filtered and returned. One person uses the time to exercise; someone else watches TV.

Deb Buffington, operations coordinator, and registered nurse Tammy Quenemoen prepare a patient for treatment - checking his weight and blood pressure, reviewing his medications. Because flu season is around the corner, they are also offering flu and pneumonia vaccines to every dialysis patient.

They settle the patient in his recliner, start the IV access and the clock begins to tick: three hours and 45 minutes of dialysis.

Buffington makes sure he's comfortable. She repositions his arm and asks if he wants the recliner adjusted. "Would you like your feet up?" she asks.

Amid a proliferation of for-profit dialysis centers, Rice is one of only a few nationally that are hospital-owned and hospital-based. It scores well on quality measures and patient satisfaction. A staff of 18 keeps the unit going around the clock, 365 days a year. Medical direction is by a nephrologist.

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The unit has expanded to 13 stations while treatment times have shrunk to an average of three to four hours. Peritoneal dialysis, introduced in 1996, allows some people to be dialyzed at home.

Restrictive selection criteria were dropped long ago. "Any patient that wants to do dialysis can do dialysis," Buffington said.

People are surviving much longer. It's not unusual to have long-term patients who receive dialysis for 10 years or even 20 years, Buffington said.

New protocols and care improvements have greatly reduced the incidence of anemia, once one of the troublesome side effects of dialysis. A few years ago an innovative exercise program was launched to help people maintain core strength.

"Quality of life is huge," Buffington said. "Our definition of quality of life is very personal to each patient."

The biggest change is patient empowerment, she said. "We really try to teach them to participate in their care."

The one constant remains the connection between patients and staff who spend so many hours together, often for years. Birthdays are celebrated and schedules rearranged for vacations.

One measure of the bond is the number of patients who graduate from dialysis after receiving a kidney transplant yet continue to come back for visits.

"Each patient is different. They feel like they're an individual here," Buffington said.

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