At one Fresenius Kidney Care center in Houston, the clinic director noticed that one patient waiting for a kidney transplant had a much more immediate need last week, as the city struggled with the aftermath of Hurricane Harvey. The woman needed a ride home from dialysis. Ambulances were tied up rescuing flood victims, and there was a midnight curfew.
It was getting late, so Dr. Sarah Shearer made an unusual decision: She brought the patient home with her.
"I had a daughter at home who did a quick clean, since I hadn't seen our place for a little while," Shearer said. She and her staff were working 15-hour days to keep up with the flow of patients whose own kidney clinics were flooded or who couldn't get to their usual centers because of impassable roads. "We were both too tired, so when we finally got to my home, we went right to bed."
When hurricanes strike, dialysis patients can have it especially hard. A working medical system is necessary for any functional society, but for patients on dialysis, it's an issue of life or death. They typically need treatment three times a week so that dialysis can do what functioning kidneys do: Keep blood contents stable and help the body get rid of extra fluid, as well as making hormones that help keep bones strong and regulate blood pressure.
Thus, dialysis patients have to be able to get to a clinic, and that clinic has to have running water and electricity -- something not all southeast Texas clinics had after Harvey's heavy rains and floodwaters swept through. Depending on where they are in their treatment cycle, a patient without dialysis may have only a short time before they get sick. They could even die.
"Pardon the horrible analogy, but in Houston, these patients were at risk of flooding of their homes and literally flooding from inside their bodies," Shearer said. Without treatment, "water can build up in their lungs, and it impacts their heart. It is like a bathtub that is plugged. The water has nowhere to go."
Staffers at dialysis centers across flooded areas of southeast Texas had to go above and beyond to keep their patients safe, even when they didn't know about the safety of their own friends and families.
Harvey had terrible timing, hitting over the weekend, when most patients go the longest without treatment. Mondays, usually a clinic's busiest day, got even busier, and Shearer said August 28 was like no other she had ever experienced.
She was the first staffer to arrive after the storm and was immediately inundated with calls from other clinics that needed help. The parking lot soon filled with ambulances, trucks, vans and even school buses.
"The day became somewhat of a blur," Shearer said.
She got out her clipboard and enlisted staff members' help. Social workers started answering phones and doing secretarial duties. A patient technician helped fix a leaky pipe. When someone called who couldn't find a ride to the center, a regional manager braved the water to pick the patient up in his own truck.
She became accustomed to patients coming in at all hours. At one point, she looked up and saw a fuel truck in the parking lot. She thought the truck was bringing in another patient, but Fresenius, the clinic's corporate parent, had sent it to fill employees' vehicles.
"There were a couple of restaurants that delivered food that was provided by Fresenius, and I mistakenly wondered if they had someone who needed dialysis, too," Shearer said.
Dialysis clinics in Texas had prepared when they heard Harvey was coming, learning the lessons of earlier storms. When Hurricane Sandy hit New York in 2012, for instance, one study showed that after storm surge and an explosion at a power plant cut electricity for an entire week, at least 26% of dialysis patients who were surveyed missed at least one session in the week after the storm. Of them, nearly 70% missed one or two appointments, and about 20% missed three to five sessions.
Texas clinics didn't want their patients to struggle. Patients were encouraged to come in early for treatment and got reminders about keeping emergency supplies on hand: drinking water and special food, first aid supplies, three days' worth of medicine, emergency phone numbers for doctors and backup dialysis centers, and a list of the medicines patients were taking.
Most patients who came in to Shearer's clinic were prepared. In fact, some even shared their extra food with the bus driver who brought them in, she said.
It was a tough circumstance, but patients were supportive of the staff and each other. "To hear patients laughing and encouraging each other, it is something you would have to be here to believe," Shearer said.
And although tens of thousands of dialysis patients live across the flood zone, not one person died due to dialysis issues, Shearer said, something she characterizes as "remarkable."
About 30 Fresenius employees were displaced by the floods. This week, as schedules get back to normal and more clinics reopen, the company is sending 40 relief employees to clinics across the flooded area. About 200 people from across the country had offered to fill in.
Richard Alderson, the Fresenius regional vice president who has been working at its command center, said staff members are determined to find temporary housing for those who were displaced. The company has found 48 rental cars for workers who lost their vehicles to the floods as well as additional clothing, personal and cleaning supplies, baby care items, diapers and food: "anything people need," Alderson said
He said the storm has brought out the best in people. On Saturday, a family drove down from Dallas and stopped by with a trailer filled with bottled water.
"They left us with three pallets of water to distribute," Alderson said. "They had three small children, and they wanted to teach their children the importance of caring for other people. It brought tears to my eyes."