Maggie Colin has witnessed five decades of dialysis treatment. In fact, she’s helped make history, serving as one of the longest-working dialysis nurses in the world.
Colin, 76, retired May 9 of last year from her position as a nurse manager at Northwest Kidney Centers. She joined NKC as a nurse in 1963, not long after the nonprofit opened its doors in Seattle. She worked 51 continuous years as a dialysis nurse, taking time away from Northwest Kidney Centers from 1979 to 1987 to work as a dialysis nurse for what was then he Rocky Mountain Kidney Center in Denver.
It wasn’t the career she’d dreamed of as a child. “I was living in Brooklyn, N.Y. and my sister Louise got a scholarship for a master's degree at the University of Washington in 1962,” Colin said. “Louise said, ‘why don't you come out to Seattle?’
“I said, ‘What would I do there?’
“She said, ‘they're doing dialysis.’
“I said, ‘I have no idea what that is and what to do.’
“She said, ‘No one else does either!’”
With that, Colin moved to Seattle and the brave new world of chronic outpatient dialysis, which had begun in March 1960. That’s when Dr. Belding Scribner and Wayne Quinton, both of the University of Washington in Seattle, developed a shunt that for the first time allowed patients with chronic kidney disease to receive repeat dialysis over the long term.
During Colin’s job interview, she got an unexpected question from Dr. John Murray, medical director of the Seattle Artificial Kidney Center, which eventually became Northwest Kidney Centers. He asked Colin if she could sew. When she said yes, he hired her. “You needed to be adept with your fingers to work with the cannulas, connecting and disconnecting,” Colin said. “He wanted to see if I was dexterous enough.”
Colin’s first workplace was Eklind Hall on the campus of Seattle’s Swedish Hospital. Basement space in the former nurses’ dormitory had been remodeled to contain three dialysis beds – the first out-of-hospital dialysis unit in the world.
Colin and the other dialysis nurses quickly began pioneering new roles in the unit where the novel treatment was delivered. They took over tasks that formerly had been the exclusive province of physicians, said Dr. Christopher R. Blagg, professor emeritus of medicine at the University of Washington and executive director emeritus of Northwest Kidney Centers.
“It was a very important step forward. It was the first time nurses had been responsible for dialysis,” said Blagg, who worked with Colin in the 1970s.
Earlier, physicians had performed dialysis on patients with acute kidney failure; most had severe complications that required a physician to be around the entire time, Blagg said. But the shunt enabled long-term, life-sustaining dialysis treatment of patients whose kidney failure was chronic. In the early years of chronic dialysis care, each patient was carefully selected for lack of complications.
“A doctor would spend five to 10 minutes with the patient and dialysis was a very stable process,” Blagg said. “It was the first time nurses were left to do dialysis by themselves and be responsible for dialysis.”
Colin recalled overnight treatments for eight hours, three times a week. “During that time patients would do work or watch TV and then sleep until the next morning when they went to work,” she said. In the morning she would disconnect overnight patients and set up for the daytime group.
With Eklind Hall’s three beds and ability to treat only nine patients, dialysis was an extremely scarce treatment in Seattle – reserved only for the most healthy, productive and lucky patients. The Seattle Artificial Kidney Center allocated the spots in a two-step process: first, a medical advisory committee screened prospective patients, moving along only those between 18 and 45 years old who were healthy other than kidney disease.
Remaining cases were referred to an anonymous citizens’ committee, which chose who would receive the novel life-saving treatment based on a judgment about their prospective contributions to their families and the community. The seven-member committee consisted of two physicians, a lawyer, a housewife, a businessman, a labor leader and a minister.
Colin didn’t realize it at the time, but the whole idea of having a committee choose “who would live and who would die” met with great public controversy once it became widely known through a now-famous article in Life magazine. The debate is sometimes considered the beginning of modern bioethics.
The selection committee remained active until 1971, when financial support from the State of Washington, private insurance, and the community became sufficient for all patients referred by their doctors to receive dialysis.
Looking back on her early patients, Colin recalls people who were extremely grateful for the treatment they received and compliant with doctors’ orders.
“The people who dialyzed cared for themselves. They did what they were supposed to do to make themselves as well as they could be. They didn't miss dialysis,” she said.
The landscape began to shift in 1973, when Congress extended Medicare coverage to dialysis patients of all ages. The entitlement remains universal. Now everyone can receive dialysis, and now they are less grateful, Colin believes.
“These patients that we get today just take it for granted. They are angry patients because they want to be alive but don’t want to do what they need to do to stay alive,” Colin said.
Colin’s responsibilities grew as did Northwest Kidney Centers. She closed her career as manager of one of 15 clinics that serve more than 1,500 patients in the Seattle area.
During her 51 years in the business, Colin has seen changes, but not as many as she would have hoped for. She believes the current practice of in-center dialysis three times a week with high-efficiency machines leaves patients needing more.
“The sad thing is that in-center dialysis treatment has not changed one iota,” she said. “Dialyzers have become smaller and machines have become more automated, but the best treatment is eight hours overnight.”
That makes her a proponent of home dialysis. “Patients feel much better when on dialysis five or six times per week. Infections are down; complications are minimal,” Colin said. “Today I would go with PD (peritoneal dialysis) and at home. It’s less intrusive. The catheter is placed in the belly. I can't understand why more people don't do that rather than be stuck three times a week in their arm.”
Colin also questions whether everyone should receive dialysis. “We have people who are on drugs, don’t show up, don’t care, don’t call. It’s just a different group, a different attitude that they have,” she said.
Other times, she believes inappropriate patients are admitted for dialysis because of unwillingness by the physician and relatives to squarely address questions about letting go.
“Very sick folks don’t have a quality of life. Their relatives want to keep their loved ones alive because they want it,” she said. Colin believes physicians should talk frankly to patients and families about the burden that dialysis imposes. This is an idea that Northwest Kidney Centers is embracing by bringing in a nephrology fellow who specializes in palliative care.
=Looking back over her years as a dialysis nurse – a career encompassing the entire history of chronic dialysis – Colin has a hard time comprehending the impact she’s made on thousands of patients. “I don't know anything else now,” she said. “It never entered my mind that I would be where I am 51 years later.”