Enjoy the world and travel with NN&I correspondents, ESRD patients, as they travel the globe. This is a new feature for the Nephrology website. As they travel, contributors will keep us apprised of their ventures and how their ESRD experience is going "on the road!"
Bill is a dialysis patient living in Seattle, Washington who has traveled around the world despite his thrice-weekly need for dialysis care. In the March 1997 issue of Nephrology News & Issues, Bill gave readers a detailed look at how he made arrangements for a trip to Europe.
Now Bill is offering a more detailed account for NN&I ’s website viewers on a trip now underway. Installments on his trip abroad will be added to this site as he completes different aspects of his European adventure. Bill is willing to help you with any questions you might have in planning your own trip. You can e-mail him at bpeckham@speakeasy.org.
Bill was first diagnosed with kidney disease when he was 22 years old. He received a kidney transplant from his brother in 1988 which failed in 1990. Now, 34, he has been on hemodialysis since September 1990.
In the 16 years Ray and I have known each other, we’ve been roommates and vacationed together. But a tour of Europe had never gone beyond the day-dreaming stage. That changed last spring when he decided to get married, with a date set for November 1997. In a couple of weeks we went from years of talking about what we should do, to talking about what we were going to do. And Europe was the destination.
I pack for the trip by trying to imagine each of the 26 days I'll be traveling. First a day in London, then on to Lisbon: bullfights and a nightly paseo. Seville: flamenco and tapas. Granada: the Alhambra. Madrid: the Prado and Toledo. Barcelona, the coast of France, Genoa, Pisa, Florence, Sienna, Venice, Rome. So much history. So much to see. So much to eat. And dialysis time will be worked in, too.
Yes, the itinerary is full. The first two weeks, from London to Barcelona, will be busy. During this part of the trip, Ray and I plan to hustle, seeing as much as we can. My expectation is that we will happily spend our time exploring each new city, taking in as many sites as we can absorb before continuing on to the next town. I don't expect to spend more then two nights in one place during this part of the trip. In Spain we plan to take three night trains, saving the expense of a hotel and maximizing our sightseeing days.
From Barcelona to Rome, the options are so tempting it will be hard to choose. Follow the French Riviera to Florence or go to Chamonix and ride a ski lift over the Alps into Italy? In Italy we can continue to see it all, or we can slow down. During our last full week in Europe, I have three dialysis treatments in a row scheduled in Florence (Monday, Wednesday and Friday). So we could stay in Florence for nine days (that sounds great) or we could take in the Tuscany Hill Towns and beyond, going as far as Venice. And finally the great dessert. The trip topper. Three or four days in Rome.
Whew! I decide that I must pack very light and be ready for anything. There will be no baggage check for me. After tonight I will have two precious days next weekend to tie up loose ends. There isn't much left to do: buy film, copy all my important documents, get travelers checks. I did all the real work months ago.
Europe is a big place. It took all of the month of May to select our itinerary. Many hard choices were made. A trip to Morocco and a weekend on the Cinque Terre both, reluctantly, fell by the wayside. We relied on the advice of travel author Rick Steves to plan our route. Of Rick's suggested travel destinations I guessed which ones would have dialysis. I then sketched out an itinerary keeping in mind every Monday, Wednesday and Friday I would need to visit my own ‘European Backdoor.' Once I decided which cities I would prefer to stop in for dialysis, taking into consideration train connections and travel times, I contacted Holiday International. Holiday International is a division of Fresenius of Italy. They can set up dialysis for you anywhere in the world, particularly Europe. Best of all you can arrange everything through one office via e-mail and fax.
This is easier then calling each unit individually from the USA, especially if you would have to use a translation service. Holiday International's Ms. Carmen D'Alessio and her assistant Ms. Gandini arranged dialysis for me in each of the cities that I requested. I was even given my preferred times. Turns out that setting up dialysis in Europe is as easy or easier then setting up treatments away from home in the USA.
I had scheduled 11 dialysis treatments, at seven units, in four countries by the end of July. By mid-August, Ray and I had our plane tickets and companion Eurorail passes. I spent August dotting my medical ’I's: making sure each unit received my medical records. Cheryl Lake, the travel coordinator at my unit, did the faxing of the medical records. One hitch was that I personally had to fax my HIV test results to each unit. My dialysis unit by law is not allowed to fax anything concerning a patient's HIV status.
During the summer I got more and more excited as I read about the rich history and culture of Spain and Italy This trip was beginning to look as good or better then last year's trip.
By writing for Nephrology News and Issues' web site, I can share the trip while it happens. I'm going to write as your reporter; how it will turn out is a mystery, but I promise to relate it all. Along the way I'll stop in at Internet Cafes to update the story. I'll fill you in on the good and beautiful and even the bad and ugly, although I expect there will be little of the latter. I hope I'll be able to post a few pictures too. I promise to write at least once a week. I'll report about each dialysis unit, trying to illuminate the similarities and differences. I'll also let you know how the trip in general is going, what Ray and I are seeing and doing. I know this is an ambitious trip. I'll cover many miles and see alot. Train connections will have to be made, and dialysis appointments attended. However, there will be plenty of time to kick back and savor the experience.
When I travel I am free. When I travel, everyday responsibilities of work and home, disappear and my attitude towards dialysis changes. When I travel dialysis is no longer one of life's chores to be done. When I travel, dialysis becomes an opportunity to enrich my travel experience. My eyes open, and I see a new dialysis unit as another way to gain insight into the culture I came to visit. Like visiting a museum, only more interactive.
First stop: London.
Ray and I could not wait to start our trip – so we didn't. Wednesday night I dialyzed in Seattle an hour early so we could stand by on the red eye to Dallas and then stand by again on an early flight to New York. This gave us five hours in Manhattan to stretch our legs and eat a gigantic sandwich at the Carnegie Deli. I was tempted to order a corn beef sandwich on white bread with mayo so I could get berated by the famous surly waiters, but I was tired and hungry, so, I just went for the roast beef. It was the largest, tastiest roast beef sandwich I have ever enjoyed. Afterwards we tried to walk off the meal in Central Park before catching a cab down to the financial district, where we enjoyed the view from the top of the World Trade Center. Then it was back to the Sheraton Hotel where we had stored our bags in their bag room. Then we headed out to Kennedy Airport for our overnight flight to London.
As it happened we were able to stand by again and leave an hour early for London. We arrived at 7 am at Heathrow and by the time we cleared customs and took the tube downtown it was 9 am. Following Rick Steves recommendation, we found a nice hotel near Victoria Station and we were back on the streets by 9:30 am.
I had four hours before my first dialysis appointment, more then enough time for a quick tour of the British Museum. The British Museum is huge so with only two hours we had to pick just a few of the many things to see. The Rosetta Stone was at the top of my list but we also had time to see their Egyptian and ancient Greek rooms. The last stop was their display of historic clocks and watches. The clocks were ingeniously engineered and fascinating to see.
After a quick stop back at our hotel, the Astors, I jumped back on the tube and headed off to dialysis at St. Elizabeth Hospital. Dialysis went fine. It was in a large ward style room with a dozen stations. I dialyzed on a Gambro machine with a Gambro Allwall GFS Plus 16 dialyzer for four hours. Instead of the chairs I am used to, I dialyzed in a bed. That worked out fine as I slept through most of the run. My only complaint was the lack of air-conditioning but the heat did not effect my sleep. I was a little surprised that there were no TVs for the patients to watch but we were given sandwiches and tea. The nice thing was that they just let me sleep, waiting to take my blood pressure when I would periodically stir. The cost was 180 pounds for the treatment and another 60 pounds for the 4,000 units of EPO I was given. I was pleased that they took VISA so I could conserve my travelers checks. All and all, it was a fine first run.
After waking Ray back at the hotel, we headed out for a three-hour walking tour of London's monuments. Buckingham palace, the Tower of London and the Tower Bridge, Parliament and finally we sat on the wharf and listened as Big Ben struck nine. It was such a nice night that it was hard to go back to the room with so much left to see. The rest of London will have to wait for another trip.
Next stop: Lisbon
I'm in Lisbon on a funky key board at a out of the way Internet cafe, at the end of a great day. Up before dawn in London town and then on to the tube to Heathrow. The three hour flight to Lisbon was uneventful. On arrival we put ourselves in the hands of Mr. Rick Steves, so the tourist information booth called ahead and made sure our preferred hotel had room and then we hopped on the airport bus into town, found our hotel and then hit the streets. First stop was the train station where we made our reservations on the Sunday night train to Madrid. We will have couchette so rest will be possible.
After the train station we headed into the old sailors section of Lisbon, a tangle of streets known as the Alfama. Up the hill on cobblestone streets we walked in the sunny 80 degree heat. Following no plan in particular we stumbled on the Saturday flea market. What a tremendous selection of junk, ...er I mean treasures. Lots of old home fixtures but I decided against the ten pound lion's head door knocker. Somehow lugging that around Europe did not sound appealing. Then we wandered to the top of the hill where we found a military Museum and a great view of the city. We also spotted the castle on the hill across from us so we made our way over and explored the beautiful grounds soaking in another great view.
Well, you can only take so much beauty all at once so we decided to join the locals in a little nap and made our way back to our $60 hotel. Now it is about nine and the city is coming alive. We took the funicular up to Barrio Alto (another Rick suggestion) and started to wonder when we stumbled across this neat Internet cafe. There are several restaurants within smelling distance, so it won't be long 'till we eat. Wow, is this FUN! I know it this is only our second night but other then the long flights this has seemed easy. Even the long flights are just a hazy memory now, like a bad dream it gets fainter each hour.
From Lisbon we started our travels by train. While we slept to the rocking motion and rattle of steel wheels following the ribbon of track across the plains, we passed from Portugal to Spain and woke to find ourselves in Madrid. Then we sped, as if on a cushion of air, at two hundred kilometers an hour, to Seville in plenty of time for me to make my first dialysis appointment on the continent. The Seville dialysis unit is very nice, air-conditioned, with 18 chairs and a friendly and accommodating staff.
Dialysis is such a routine back home. How the needles are taped to the arm, the way the lines are hooked up, when blood pressures are taken, etc. Of course there are differences in these routines between any two units, even in the United States. In Seville the most significant difference was that they do not flush the lines after insertion. I suppose there are scenarios where this would present a problem but I stick myself and seven years of dialysis experience has taught me what a good needle insertion feels like. Also I noted that none of the patients use lidocane. I do not use it myself, but that could be a problem for traveling patients.
European units do seem to have some things in common that are different from what I have experienced in the states. For one, you always get food during your run. I am not sure what all is available, but since I know the word for ham in Spanish, each run I received a ham sandwich. European patients also run at slower pump speeds then what I am use to in the states, but for me they cranked it up to 450. Also, patients seem to talk amongst themselves more during their runs, even across the room. Of course what is on TV is also different. During my first run in Seville on Monday, there was a bullfight on all six of the shared TVs. I found it very interesting to watch, even though I have a hard time understanding bullfighting as a sport. Mostly, I slept during each of my runs. I would have liked to talk with the staff and the patients; there was a genuine interest on their part to know more about me and for me to know more about them. However, we each knew just a few words of each other´s language. I passed around some pictures of Seattle, my house and my dog, but I know I left many of their questions unanswered. I left after my second and last dialysis run on Wednesday thinking that I would be happy to have my home unit in Seville. They have modern Fresenius machines and use F80 kidneys (no reuse), but it would also mean that I was living in Seville, a truly beautiful city.
Ray and I stayed at a very pleasant $40 a night hotel, right in the center of town. We were just a minutes walk from Seville´s two great sights: the third largest cathedral in Europe and the Alcazar, a palace built for a Christian king, but obviously strongly influenced by the Moors. Seeing the Cathedral and the Alcazar, one after another on the same day, we could ponder how each religion - Christianity and Islam - express their belief in God.
Water, so rare in most of the Arab world was everywhere in the Alcazar and the Alahambra. The art of the Christian cathedrals both in Seville and Granada left little to the imagination. Stories from the Bible and Spain’s Christian history were presented in beautiful and explicit paintings and sculptures. Also in place of water, the Cathedrals use light to represent the purity of God.
Besides these incredible attractions there were mazes of cobblestone streets in all directions. Around any corner there might be another square with tables under umbrellas, a beautiful building or an ornate fountain or all three. There were plenty of formal sit-down restaurants but these were outnumbered by tapas, bars and counters serving coffee or drinks to locals. This was true of both Seville and Granada.
We took a four-hour bus ride to Granada where we found much of the same thing. Not that we were tired of this grandeur but the similarities reinforced my impression. In Granada, the Cathedral that houses the bodies of King Ferdinand and Queen Isabella was smaller then the Cathedral of Seville, but still very impressive and ornate. Granada´s Alahambra on the other hand is massive and one of the top tourist attractions in Europe. It is actually several structures but the most impressive, the Palacios Nazaries, is a Moorish showcase of intricate designs in tile, stone, and water.
After just a week of travel, it seems as if this is the only life I have ever known. Travel is intense; it is everyday living to the tenth power. As Ray and I move across the south of Europe, every moment seems important and worth mentioning. Every time we turn a corner or enter a cafe our senses are bombarded with new sights and smells. As we walk the cobbled streets of Spain, under beautiful sunny skies, our ears hear the unfamiliar rhythms of other languages and our eyes gaze upon ornate buildings and the plain but interesting homes that line the curving, narrow byways of these lovely cities. We are not in Seattle any more.
Next stop Madrid and Toledo.
As I write this in Barcelona, Ray and I mark two weeks of travel. At the risk of jinxing us I have to say that we have had great weather. Sunny hot days and cool fall nights, the one time I was rained on was as I walked to my first dialysis treatment in Madrid. It was friday night, Ray and I had arrived in the morning on a night train from Granada. Instead of a pleasent slumber with dreams of the Alahambra dancing in our heads we were kept a wake by a borish drinker, who came and went from our compartment several times, noisely. For some reason he insisted on lecturing me in Spanish even though I kept repeating ¨no comprenday¨. It wasn´t that he was speaking about me or even to me for that matter, he was just a drunk.
Well, as I walked in the rain to my first treatment in Madrid I was wondering if our luck was changing. The answer is an infatic NO. Dialysis in Madrid went well. The staff at the unit is excellant and the lovely Mirabelle hooked me up and we tried to communicate as best we could. Her English allowed us to do pretty well and I found out that this eighteen chair unit is one of many in Madrid. She also said that the majority of patients there are older then my 34 years and that none of the patients stick themselves though she thought it was a good idea. I mentioned that I expected to go to a bullfight that Sunday and found out that opinions of bullfighting were sharply divided in Spain. The younger generation does not share the enthusiasm of the older generation towards the ¨sport¨. Still Ray and I had decided that we would go and see what all the fuss is about. Turns out there is quiet a bit to be fussy about. The bullfight was on Sunday, we spent Saturday on a day trip to Toledo.
Toledo is a city that is a Spainish national monument, one hour from Madrid by train. If Ray and I had started our trip in Toledo we would have been overwelmed by it´s beauty. The narrow cobble stone streets are right out of the middle ages. The city specializes in producing swords and knives so we browsed the shops and actually went behind the scenes of one shop to see the forges where the blades are manufactured. Toledo has a great and beautiful Cathedral and several other attractions but to be honest we were a little underwelmed after seeing Seville and Granada. By 4PM we were ready to get back to Madrid. Ray had been battling flu like symptoms since Lisbon and had seemed to worsen on our night train adventure. We had changed around the schedule a little to spend four nights in one place so Ray could rest up. This would short change Barcelona but Madrid definately held our interest. We could have spent a week.
Our Hotel, Hotel Europa a fantastic Rick Steves suggestion, was right on Puerta del Sol, the center of the Madrid and Spain. Spanards keep amazing hours. At midnight there were more people in the square then at three in the afternoon. Dinner starts at about nine but most locals don´t eat untill ten or latter. We tried to keep local hours taking siestas in the afternoon and eating tapas (or McDonalds, Madrid was where we broke down but Ray needed some comfort food). Sunday was busy though because the Tour of Spain bike race was ending that day in Madrid. We woke up early, 8am, to see the start of the final stage just a few blocks from our hotel. Then after buying our bullfight tickets for that afternoon and walking through the El Rastro, the biggest flea market in Europe if not the world, we caught up with the peleton (pack of bike riders) as it raced by on the Grand Via. The street was lined with people. The peleton was proceeded by helocopters, and many motorcycles and cars with extra bikes on top and then whoosh the bikes raced by to cheers and it was over. Then after a stop at a cafe we went back to the Hotel for a siesta before the bullfight at 6PM.
The bullfight was the most bloody thing I have ever seen outside a Hollywood action picture, only this was real and the first Matadore of the six bull event was badley hurt. I have never seen a man get killed and thankfully I still haven´t but that night I thought I had. During the first fight of the evening the bull got the guy, flung him in the air and then had his way with him while he was helpless on the ground. As it turned out the bull severed his Femoral artery and the Matadore will live but with out one leg. There was pomp and ceromony and the crowd was interesting to watch. Mostly older men, must have been like fight night in the 50´s, cigars and whiskey served right at you seats. However, I would not attend another one of these events. I just can not see the point. When I get home I will read ¨Death in the Afternoon¨ by Hemingway but I doubt that will change my view.
Monday and Tuesday were much more acceptable to my American sensibilities. We saw great art at the Prado and the Royal Palace, including a stop at the Centro Reina Sofia to see Picasso´s Guernica, a very powerful painting. Monday´s dialysis treatment went well, there wasn´t even any rain during my walk to center. Tuesday afternoon we hopped the train for Barcelona arriving at 8:30PM. I had a dialysis treatment scheduled the next morning a 7:30 so after checking train connections for our next leg of the trip to Marseille and grabbing a bite to eat we turned in, it was Midnight and the streets were full of people. Loud people.
I did not sleep very well last night and as a consequence I can not tell you much about the dialysis unit I ran at this morning other then they dialize you in beds. I got there by cab, stuck in my needles and then slept for the next four hours. I guess they woke me to take my preasure, at least my run sheet showed they did but I do not remember. I guess no news is good news, the run was uneventfull. In the afternoon Ray and I walked topless with everyone else along Barcelona´s beaches. I waded in the Medateranian but did not swim. Tomorrow we leave for Marseille and then it is on to Italy. I wish we had more time for Barcelona, the streets are full of life, our hotel is on one of the main streets the Ramblas and just people watching could occupie your whole day. I know some day I will return to Spain, it is a facinating and beautiful country.
Next stop Nice.
