Hundreds of Interlaced Fingers: A Kidney Doctor's Search for the Perfect Match

By Vanessa Grubbs

A young, hopeful doctor’s memoir—an unforgettable love story and an informative journey into the world of medicine and kidney transplantation that ultimately asks: What does it mean to let go of something that you love, even if it is life itself?

When Vanessa fell in love with Robert, she had no idea that the relationship would thoroughly transform her life. Robert suffered from end-stage kidney disease, which required him to endure years of debilitating dialysis to stay alive, at least until his failed organ could be replaced by a kidney transplant. Although Vanessa was a primary care doctor, she developed a deeper understanding of the difficulties Robert faced with dialysis and in finding a donor. Despite their being early in their relationship, she volunteered one of her own kidneys—and discovered that she was a match. This life-affirming experience forged a bond that would become a pillar of Vanessa and Robert’s marriage—and the beginning of her new career.

Motivated by Robert’s experience and her newfound knowledge, Vanessa became a nephrologist—a kidney doctor—and discovered far more about the realities of the specialty. Shaped by Vanessa’s remarkable experiences as a doctor, a woman of color, a mother, and a kidney donor, Hundreds of Interlaced Fingers is a love story, an exposé, and a clarion call for us all to consider the dualities of both loving and letting go.

• Language: English
• Publisher: Open Road Integrated Media
• Release date: Jun 13, 2017
• ISBN: 9780062418197

Book preview

Part I

If He Only Had Her

1

Someday Comes

Twenty-six-year-old Robert Phillips made an appointment to see his primary care doctor. He didn’t feel well and he hadn’t felt well for a couple of months. He was exhausted. When he wasn’t in a work meeting or working out, he was sleeping. He blamed all the travel he had been doing for work lately. He had a headache that he couldn’t shake. Maybe the stress was getting to him. There was a strange metallic taste in his mouth that reminded him of the time he was five years old and tasted rebar when the men were working on Big Mama’s house. His stomach, back, legs, and hands cramped when he wasn’t walking around. Maybe he was just really dehydrated, he thought. He had been working out a lot, yet he was gaining weight. He had been peeing more often too, getting up several times a night to go to the bathroom. Maybe that’s why he was so tired.

Your chest doesn’t hurt? asked the physician assistant as she looked up wide-eyed from the blood pressure gauge at Robert. She was used to seeing patients with high blood pressure—in the range of 150 to 180 over 90 to 110—in the clinic. They struggled with her recommendation for a low-salt diet and didn’t like taking the one or two blood pressure medicines she had prescribed. But now she stared at 220 over 120. She had never seen such high numbers before. It must have been hard for his heart to continue pumping blood through his body when it was meeting with that much resistance. His chest had to hurt.

No, but my head really hurts, Robert answered. His head hurt so bad he didn’t care that he was seeing this person instead of his primary care doctor, Debra Daniel. He liked Dr. Daniel. She was a tall, pretty Black woman, maybe in her mid-forties he thought. She was cool, like a big sister. She would always see him within two days. And with his busy and erratic schedule, he often needed an appointment within a short window of time. It had been a year since he had seen her, but she had been his primary care doctor since he aged out of Dr. Santoyo’s pediatrics practice. He didn’t know who this plain-looking thirty-something-year-old White woman was. He had never seen her before.

I’m going to take your urine and blood and I’ll call you with the results. Go home and wait for a call, she said.

Two hours later, just as Robert was bringing a slice of the Round Table pizza he had ordered to his mouth, his phone rang. It was 1 p.m. and he was starving, but he dropped the slice to answer the phone. It was Dr. Daniel.

I made an appointment for you at the ER. I need you to go right now. Do you need an ambulance? Do you have a car? Can you go right now? I need you to go right now, she said without pause or even a breath.

OK, he said, having never heard this level of urgency in her voice before. He hung up the phone and immediately headed to the ER, his pizza forgotten. The only thought he could hold in his pulsating head was What is going on?

Dr. Daniel hadn’t mentioned his kidneys, but after getting more blood tests the ER doctor asked Robert who his nephrologist was. He was staring at the ceiling from his gurney, still wondering what was going on, when Matty Kravitz walked up. Kravitz had been his nephrologist for nearly nine years, when his first kidney doctor, Barry Gorman, retired from his San Pablo, California, clinic practice and transferred Robert to Kravitz’s care.

As much as Robert liked Gorman he disliked Kravitz. Gorman wanted to see Robert every three months. He wanted him to get blood and urine tests before the appointments. At the appointments Gorman seemed genuinely interested in him as a person. He reviewed the test results ahead of time and explained them.

Kravitz was content to see Robert once a year and ordered tests at the visits, then never called with the results. And even worse, Kravitz never remembered Robert from visit to visit. This day was no different.

How did you know to ask for me? Kravitz asked. The bags beneath his eyes and the beak nose were the same, but the crescent moon his receding hairline left behind had widened and he had lost what Robert guessed to be about fifty pounds since he saw him the previous year.

A wave of heat seared through Robert’s chest. "Because you saw me, he responded, incensed. How much weight did you lose?" Robert asked, in hopes of jogging Kravitz’s memory. He needed his doctor to remember him.

Oh, I guess you did see me. Kravitz nodded slowly, his eyebrows lifted and mouth turned down, conceding the point.

Robert wanted to punch him. You’re lucky I’m cramping, he thought.

Do you know what happened to you? Kravitz asked as he flipped through the pages of Robert’s ER chart.

No. What happened to me?

Your kidneys are failing.

Now Robert felt like he was being punched. Ten years ago he was warned this day would come. He just didn’t think it would be this soon. And he didn’t know this is what it would feel like.

We’ve got to put you on the dialysis machine, Kravitz went on. We’re going to put a catheter in your chest. Later we’ll look into getting you a fistula, an access in your arm.

Catheter? Fistula? Access?

All of these words were foreign to Robert. He had never heard of any of them before.

But he did know what a dialysis machine was. He remembered the words he said when he was sixteen years old and walked past a dialysis unit with his mother on his way to Dr. Gorman’s office the first time—If I gotta do that, you might as well kill me. It wasn’t hypothetical anymore, at some vague point in the distant future that might not even come. It was now. And it was irreversible. Do this or die, he was being told.

Hours later he woke up to find himself in the hospital’s acute dialysis unit tethered to a dialysis machine for the first time. The room had six beds, three against each wall. Each bed had to its left a dialysis machine that with its tentacle-like tubing looked like a five-by-two-foot monster to him. One other patient, Dr. Kravitz, and two nurses were there.

He thought he would feel the push and pull of his blood through the tubing and the wastes leaving his body, but he didn’t. His chest ached from where the catheter had been tunneled under his skin, but the soreness would be gone in a day or two, he was promised. Dialysis wasn’t as bad as he thought it would be.

Again he stared at the ceiling, this time wondering what was to come. Just yesterday he was dreaming about the next steps in his budding career in politics and wondering if the next woman he dated would be the one he’d make his wife. Now he wondered if he would have to move back in with his parents. How he would be able to do this dialysis thing and keep up his work pace. If any woman would even want him now that he had this catheter hanging out of his chest. Now that he was sick.

Maybe I won’t have to do this for long, he hoped.

2

Ulterior Motives

It was 2003 and the culminating meeting for the Alameda County Medical Center (ACMC) strategic planning exercise. I was invited to participate because after my internal medicine residency at ACMC’s Highland Hospital in Oakland, California, I stayed on as faculty. As an attending physician, I was working to build a meaningful program to address issues of diversity in the medical center. I called it the Office of Diversity Affairs (ODA). My vision was that ODA would recruit more doctors of color to mirror the mostly Black and Brown patient population we cared for, train the staff and doctors already there to be more receptive to learning about cultures not their own, and expand interpreter services to more effectively engage the dozens of languages spoken within our walls. An effort of this magnitude needed the support of the hospital leadership, and I had the CEO’s backing. I wanted the support of each member of the board of trustees too, and I made it my mission to meet each one.

Robert Phillips was a trustee.

The meeting was soon to begin, so when I saw Robert walking across the room, I headed toward him. He was younger than the other trustees. He wore a dress shirt, no tie, and slacks and appeared to be in his early thirties like me. He was tall and had the whole impeccably groomed goatee and mustache with a shaved head look going. He had a linebacker’s build and a belly that looked like a small keg. My ideal was a slender build with a six-pack, and what was worse, he had fair skin and green eyes, which were major affronts to my deep color issues that dated back to childhood. I blame my father and his side of the family for them.

My family is like a box of crayons with only shades of brown, from sandy tan to almost black, but nearly everyone at the family reunions on my father’s side was in the earth tone to almost black range. One family reunion in particular stood out. I couldn’t have been more than six or seven. My five siblings all seemed to be vying for a legitimate excuse to be spared the ten-hour ride from Spring Lake, North Carolina, to Dothan, Alabama, near the Florida border, but only two were successful: Milton, sixteen years my senior, who had joined the Army right after high school, and Cynthia, who had some school event that could not be missed. The rest of us piled into the station wagon along with our bags and a cooler full of sandwiches, fried chicken, even pineapple cake, because stops were only for buying gas and peeing. I was probably the only one who didn’t mind the hours in the car. As the baby of the family—the surprise baby, not the accident, as my siblings often teased—I was allowed to spread out across everyone in the backseat (seat belt laws and booster seats did not yet exist). Michael, at eight years my senior, was the closest in age to me. But from Michael to Milton, my siblings were like stair steps, eighteen to twenty-four months apart.

I remember standing with Janet, my oldest sister, and Regina, the next-to-the-youngest girl, in the park on the day of the reunion. I looked up as the women gathered around in groups of three or four at a time to dote on Janet.

"Ooh, you so pretty!" they said over and over again. Janet smiled and giggled thank you again and again. Regina stood silently. No one was talking to her.

I had always thought of Regina as the prettiest of us girls. I didn’t follow why they weren’t telling Regina how pretty she was, with her smooth skin and petite features rather than the not-so-petite nose and pimples that Janet and Cynthia had and that I would soon develop. But I soon realized that Regina’s mahogany skin made her less pretty in their eyes.

Back home, a similar theme was playing out. My father didn’t like the TV shows with Black people. Good Times, The Jeffersons, even The Cosby Show. When one of them was on, he grunted his disapproval and often made us change the channel. And, to my mother’s chagrin, my father fawned over his brother’s biracial wife as if she were the most beautiful thing on the planet. As if he wanted her for himself. If only Uncle Roosevelt would just hurry up and drink himself to death already.

I resented the notion that fairer skin was prettier or better. I railed against it. Even in myself. When my first cousin teased, Why you got blond hairs on your arms? I took to lying in the swinging bench in the backyard for a few hot summer days in an attempt to get darker. My baby dolls had to be brown. Only Baby Alive and Holly Hobbie got a pass because one pooped and the other came with an oven that baked cakes with a lightbulb. And as I got older, as rebellious as the nerdy child I always was could be, never even considering stunts like sneaking in and out of the house late at night, I resisted in the men I chose. Enter my first husband, almost black. Robert was the opposite. I would not acknowledge his attractiveness.

Hello, I’m Dr. Burt, I said, my married name at the time. I lead the Office of Diversity Affairs. I offered my hand for a shake and smiled innocently. Innocent, wide-eyed smiles. I gave these smiles instinctively to men to avert or avoid sending any hint that there would ever be some kind of sexual energy between us.

Hello, Dr. Burt, Robert returned, shaking my hand. He tilted his head slightly to the right as he blinked once slowly and gave me a strained closed-lip smile that communicated Now what do you want from me? but said nothing else. No Ah yes, I’ve heard about your efforts or Oh, I’d like to hear more about that, as the others had.

Not expecting this response, I didn’t quite know what to say, so I nodded a smile and walked away, feeling that he was blowing me off.

The next time I saw Robert was a few months later—in a mini-documentary titled Worlds Apart, a four-part series on how culture impacts health care. I used the ten-minute video featuring Robert as part of an ODA training I organized for the Highland internal medicine faculty. I hadn’t put it together that the Robert in the video was the Robert I had met. In the video, Robert spoke about the two and a half years of his life on dialysis. It didn’t occur to me to question why Robert was on dialysis. Rather, my full attention was captured by what he was saying in the video. He spoke about the mistrust of doctors among the Black community. About how it seemed like the Whites in his dialysis unit either were going to get a transplant or already had one, while the Blacks were in the dialysis unit for the long haul. About how the transplant center staff made him feel like he was no more than an irritating file they had to pull out every time he called to ask about when he might get a transplant. We’ll call you, they would say.

Afterward, my assistant connected the dots for me. Robert video was Robert trustee. I thought he had nice eyes, she added, and I rolled mine in response. My father would think his eyes were nice too. But not me. I would not be impressed. He wasn’t that engaging in the video. And he only barely made me smile in spite of myself.

Not long after the training, it was announced that he and several other trustees resigned abruptly in protest of certain decisions made by county leadership, and Robert faded into the depths of my memory.

Hello, it’s Dr. Burt, I answered brightly, still typing on my computer keyboard. My office was an eight-by-eight-foot box with furniture that was too big for it. It was located about a mile and a half away from my colleagues’ offices in the department of medicine suite, but it had a window and a separate space for the quarter-time assistant ODA could afford. It was mine and I was happy to have it.

Uh, hello, this is kind of awkward, but, an unfamiliar female voice returned, are you married to Joe Burt?

I stopped typing. Yes.

I’ve been dating him for the past several months.

I looked at the phone, as if it had betrayed me. What?

She went on to provide a few details of her involvement with my husband. Things he had told her. Facts he had reshaped. It felt like someone had just hit the replay button on my first few months with him seven years prior, with just the names of the son and estranged wife he claimed changed. The rest of the script was the same.

I knew this mistress wasn’t his first, but it was hard to catch my breath. My peripheral vision had left me, so I stared between my knees at the floor beneath my office chair. The dark blue carpet tiles appeared to be receding like crashed waves on a beach.

And then it dawned on me—This is my chance to be free. Because this one called me. She had given me an airtight reason to leave my marriage that no one (except his mama) could fault me for taking.

I almost thanked her.

I hung up the phone gently and turned to the window. Sunlight streaked across my expressionless face as tears streamed down. Splats on my blouse roused me like a snap out of a trance. I wiped my face with the backs of my hands and pushed the buttons to call Melanie Tervalon’s home.

Melanie was in her early fifties and a huge, international, phrase-coining figure in diversity work. Her medical school class valedictorian speech calling out institutional racism in medicine made her a legend in my mind. And she was my friend.

In my first efforts to launch ODA, I reached out to her for help. I was naive and clueless, and she was generous with her time and advice. Melanie had a regality about her when she walked, her shoulder-length blond-silver hair and chin tilted up just so. But she would also not hesitate to tell it like it is, with a certain realness in her voice. I loved that she shared this part of herself with me very early on in my knowing her. It helped me see that the part of me that felt at ease with the janitorial staff was as important as the part that might someday command the most elite of audiences like she did. Both were strengths. Both were parts to be embraced.

As a very junior person in my work, I felt lucky just to know someone of Melanie’s stature, let alone call her a personal friend. But because of Melanie’s reputation for frankness, I soon learned that dropping her name to gain some advantage could backfire. People had strong, usually extreme reactions to Melanie—adoration or disdain and nothing in between—and you could never predict which. But that was work. This was personal.

Melanie answered her phone on the second ring. Minutes later I sat with her at her kitchen table. I wanted her to tell me what to do. But as free-flowing as Melanie was with her advice for work, she was tight-lipped when it came to personal matters. Instead she offered her house keys and a futon to me and my three-year-old baby for as long as it took me to figure it out.

Nearly a year later, I found an unfamiliar male voice on the other end of my phone. It was Robert.

Melanie was his friend too and had encouraged him to call me to get the skinny on a few of the doctors at Highland. He was still on dialysis, for more than four years by then, and was trying to elicit the support of physician advocates in his effort to get a kidney transplant.

I spoke frankly about my colleagues at Highland as Melanie told him I would, and he chuckled as I spoke. The conversation ended with his