Chapter 3- Bid Whist

Edgar Lerma gives his thoughts on the third chapter of Hundreds of Interlaced Fingers

"The card game of Whist has been said to originate in Turkey and was brought to the US during slavery, although the Encyclopedia Britannica originates the game of whist to start in Europe in 1529 as the game “Trump”.  Black slaves weren’t allowed to read or write, but slave owners believed that the game of Whist would help them count the cotton barrels and produce, so they were allowed to play. As the game evolved, so did the name – thus the birth of Bid Whist, Spades and Bridge. As the years evolved, Bid Whist became a favorite among Pullman porters on the railroad cars. The men were model citizens of the African American culture so many looked up to the practices of the prestigious sleeping car porters. The Pullman porters adopted the ‘travel game phrases’ used to describe the plays of the game like ‘going all the way’ and ‘running a Boston’ when a team takes all the bids."

Source: Black America Web

As a nephrologist, it is part of our job description to care for patients receiving renal replacement therapy, be it hemodialysis or peritoneal dialysis or kidney transplants. A typical encounter with a patient includes talking about laboratory tests and other parameters, e.g., dialysis adequacy (the controversial Kt/V), as well as access issues (AVF, AVG, Catheters) and for some, candidacy for kidney transplantation. We talk about medications, fluid gains, dietary K and PO4 restrictions among others. Every now and then we'd go a bit deeper than those discussions. We talk about recent or previous hospitalizations, even advanced care planning, and the like. Some patients prefer to talk a lot, whereas others prefer not to be bothered.

But where does one draw the line? How does one determine when it's OK to be a bit more 'acceptably' intrusive or when to back off. Certainly, with us living in a very litigious society with all legal ramifications of our actions, no matter how innocent or well meaning it is, most tend to be less involved in that sort of way. Is that good? Or is that bad? There's no right or wrong answer; perhaps the answer can only be determined with a retrospectoscope. 

As a clinician, you do have the unwritten obligation to talk and discuss about all of the preceding but, as a human being, there's so much more in life to talk about and reflect. Perhaps it's this humane aspect that makes the mundane more interesting, the unbearable more acceptable, etc.

In this chapter, Bid Whist, the author delves into the perspective of being a clinician as well as being 'more personally' involved in the care of a patient on hemodialysis who later occupies a special part of her personal life. 

Knowing the intricacies and some of the epidemiological aspects of patients on hemodialysis gives the author a unique perspective as she discusses in this chapter. She presents a nice and eloquent discussion of the melding between her clinical acumen and personal involvement with a "person" on hemodialysis. 

As the relationship evolves between the author and Robert ... "He laid down his cards, face up... most decided the game he presented was too complicated... like Bid Whist when all they were up for was a game of Go Fish..."

Knowing and having a deeper understanding about the implications of having a chronic illness as opposed to just knowing one has it gives a unique and challenging situation for the author. There is so much at stake going forward ... the good and the not so good ... 

There's a saying "what you don't know won't hurt you..." or should it be "what you know will help you ..."