CAMAGÜEY- At the doors of an operating room, time passes slowly. Even in front of the nephrology center of the Manuel Ascunce Domenech clinical-surgical hospital, the scene has an astonishment that puts one on alert. From a comfortable sofa you can see the nurses in the room preparing the medical records and talking about the order and cleanliness of the medications, a daughter helping her father to support himself with a cane and three patients waiting in the chairs for their doctor to arrive from the handover of the guard... the residents begin to review documents and only one voice rises above the others: “get ready for bed 2.”

A few minutes later, a stretcher squeaks behind me and the slam of the living room door indicates that in bed 2 was the woman from Santiago who would receive permanent vascular access, the reason for our dawning at the hospital. “It is a very difficult and complex surgery. In medical literature it is called the lifeline because it is used in patients who have vascular exhaustion, when other similar acts have failed and this is the only option to keep them alive.

“The procedure is a permanent prosthetic vascular access for hemodialysis. There are autologous ones, which are made from the person's vessels, and there are prosthetic ones, which appear since the 1970s. The first ones are the most recommended, because they last, there are patients here who have had them for more than 17 years; but when there are no longer more options or the disease is diagnosed late, the option is a prosthesis made from a high quality and durable material that allows hemodialysis to be performed three times a week.

“Most of the patents for these devices are North American. Acquiring them and bringing them to Cuba becomes an odyssey and makes the product very expensive, which costs more than 2,000 dollars, and the operation itself has a cost of 10,000. Here all this expense is assumed by the State and allows the Patients aspire to an adequate quality of life in their dialysis regimen. “The specialization of the surgical team is essential,” says Dr. Raúl Romay Buitrago, vascular surgeon. In the kidney transplant surgery in Camagüey, made up of specialists in Angiology, Anesthesiology, scrub nurses, we achieved a perfect team.

“This is a prioritized activity for which resources are guaranteed due to the high sensitivity of the patients, practically throughout the COVID-19 pandemic our modest surgery room did not close and today the kidney transplant program is revitalized. The high professionalism of all the specialists at the nephro-center allows it to be a service of excellence at the national level, which is why we receive patients from Ciego de Ávila to Las Tunas.” In the filter, while we changed our clothes for sanitary ones, the medical team put in context the press team that would be snooping around in an operation that in inexperienced hands could last up to four hours.

The half-open door let in the sterile smells, the unmistakable sound of life support and the voice of Dr. Elvia Galindo, a specialist in Anesthesiology: “think of something nice to put you to sleep”, I instinctively thought of it too before entering. An hour later, the handshake between doctors Romay and Vladimir Ibarra, specialist in Angiology, and Yuneisy Rodríguez, scrub nurse, sealed the “perfect, perfect” result of the placement of a prosthesis that would allow the flow of the blood and life of Loreinis Almaguer Cruz, 51 years old.

During those 60 minutes Bertha Ortega, room manager, walked from one side to the other carrying sutures, gauze... and at times she looked at the surgical field and translated the images for us while claiming that she was no longer ready for these trots with 41 years of work, but her smile up to her eyes assured the opposite. Liuba Well, the anesthesia technician did not leave the side of the patient and Dr. Elvia, who assured that the adrenaline is only controlled after managing to intubate the patient "our work is like taking off a plane until the roads are not secured, there is no peace, meanwhile the patients' breathing is in my hands."

This Nephrology service is one of the largest in the country and cares for 145 patients on hemodialysis, 15 on peritoneal dialysis and 41 transplant recipients, all in stages 4 and 5 of kidney disease. Its staff carries out consultations in all hospital units and provides purifying treatment to patients who require it, not only chronic patients but also acute patients, those who present reversible kidney injury. Due to its high prestige, cases come from Holguín, Guantánamo and Havana.

From this last province is Tomás Arteaga Díaz, a graduate in Nursing, who has been on hemodialysis for 25 years and after receiving two transplants, his primary medical center did not give him many options for stability for his condition of vascular exhaustion. He, and his wife Thalía Línea Sotolongo, are the best spokespersons for this medical team:

“Here they will always give you a chance for improvement, not just the option of a catheter, with all the risks that entails. Whatever you need, Dr. Romay's team can guarantee it, I have gained at least 10 more years of life, and above all we appreciate their manners, their humanity. With them there is always hope.” And this, without a doubt, is the most “beautiful” thought that can be aspired to.

Translated by Linet Acuña Quilez