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Hurricane Katrina made private illness experiences and health vulnerabilities shockingly public, and nothing more graphically captures this fact than the drama surrounding dialysis patients in the days after the storm. Their commonplace and everyday problems were thrown open to deeper scrutiny, framed as a metaphor for the tragic moment and, as I shall argue, a metaphor for the nation’s unfulfilled political and economic commitments. Many commentators rightly connected the story of these patients to the uneven and endemic health vulnerabilities that long predated the storm. “How many of the dead will turn out to be dialysis patients?” asked one expert. One July 2007 study answered that “the best guess is that of over 5,800 Gulf Coast dialysis patients affected by Katrina, 2.5 percent died in the month after the storm—although given the high mortality rate among dialysis patients, it is difficult to determine how many deaths were storm-related.”1 Commentaries placed dialysis squarely in the center of political analysis. In one ironic letter in the San Diego Union Tribune, the writer voiced deep disdain for the delayed and incompetent federal response: “And across the ocean in his supposed cave, I can picture Osama bin Laden, who can manage to get dialysis while, on Thursday, Charity Hospital in NO had only fruit punch to offer its patients.”2 In this telling, the story epitomized government ’s broken promise to its most needy citizens. This chapter examines what the appearance of dialysis patients in the story of Katrina reveals about race, health, region, and the nation’s commitments. In the hours and days following the storm, diabetics and patients whose kidneys had failed and who depended on dialysis technology figured prominently in news coverage. They were unable to move themselves out of harm’s way for want of transportation and further immobilized because of their health challenges . “Thousands of victims of Hurricane Katrina face homelessness and devastation ,” announced the National Kidney Foundation, “but kidney patients 34 3 VVVVVVVVVVV A Slow, Toxic Decline Dialysis Patients, Technological Failure, and the Unfulfilled Promise of Health in America KEITH WAILOO A SLOW, TOXIC DECLINE 35 without access to dialysis treatment face life-threatening danger.”3 They needed what had become over the previous two decades a standard medical treatment to cleanse their blood, but the instrument itself depended on clean water, running electricity, and medical staff and facilities. Many of these patients were diabetics whose kidneys had failed. Requiring regular dialysis treatments, such people found themselves stranded in airports, in homes, in the Superdome— tethered to a city without electricity and lacking medical services—suffering from a slow, toxic demise as impurities built up in their bodies. This small subset of victims symbolized a peculiarly American kind of vulnerability arising from poor access in a technology-rich environment. Among the most vulnerable of the vulnerable, they became—along with the elderly in nursing homes, the residents of Charity Hospital, the cancer patients, and other infirm citizens of the region—a graphic symbol of Katrina’s toll. One Washington, D.C.–based kidney specialist predicted in the Washington Post on September 13, 2005, “It’s going to take months, if not years, to actually find out what proportion of the dead were actually dialysis patients.”4 As one physician in the Tulane University Department of Nephrology later stated, the dialysis machines were part of a more extensive technological system that failed: “I had a group of about seven or eight patients that we needed to take care of, then we got ten additional patients from the Superdome brought by the police, and a few people walked into the ER needing dialysis, . . . [but in the immediate wake of the storm] we didn’t have enough water pressure.” At first, only two machines could be run, but then “about six or seven hours later we lost the pressure completely.”5 The other problem for such patients was that, even if the pressure returned, the water was not potable. And clean water was also essential for running these machines that do the essential work of the kidneys—removing toxins from the blood that build up slowly in the course of normal life. As another New Orleans specialist later noted, “People didn’t understand the extent to which they were a special needs population.”6 In these stranded patients, even those who were evacuated “were very worse off for the trip they had to make under the conditions. . . . People were lined up...

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