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 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.

Genres: Nonfiction, Medicine, Medical, Memoir, Health, Science

272 pages, Hardcover

Published June 13, 2017

Reviews

[Carol]

Many of us are card-carrying organ donors. In most states it’s an easy thing to do. Just check off a box when you renew your driver’s license and it’s done. This assumes that your organs will be harvested if you die. We’re comfortable with the idea that if we’re dead our organs can possibly provide lifesaving transplants for the many waiting on donation lists. But what about donating one of your healthy kidneys to someone in need, someone in end stage renal failure, on dialysis for what remains of the rest of their life.

Vanessa Grubbs, a resident in the field of nephrology never intended to fall in love with Robert, a man just beginning the dialysis journey. Robert’s only chance for survival was a kidney transplant but his odds of receiving one were complicated by the large number waiting and to Grubbs dismay, his color. Grubbs decides Robert’s only real chance is her kidney and she is determined to make it happen. Grubbs makes us privy to far more than the transplant of her kidney to Robert in this fascinating memoir. It is a striking example of the power of love, the path to becoming a doctor, an examination of the intricate workings of an organ we take for granted, and a call to even the odds for equality in your rank on the list. One’s color should have little bearing in the process. Blood type is far more of an issue.

As I read I highlighted many passages but none stuck out more to me than the initial visit of Robert and Vanessa on their first visit to a clinic to investigate the possibility of a donor kidney. Vanessa’s sugarplum dream” of a few day wait and even her MD did not prepare either for the reality. Cost, blood types, African American propensity to rejection, all were unforeseen barriers. ”Each statement was like a sobering slap to the face.” And then this sobering message they took away

”The kidney transplant system doesn’t like Black people.”

”National data said it wasn’t just our imagination or where we sat. I soon learned that though Blacks and Whites each made up a third of the kidney transplant waiting list at that time, Whites received every other donated kidney and Blacks received every fifth one, which meant that on average, Blacks waited nearly two years longer than Whites for a kidney transplant. As a primary care doctor at the time and not aware of the realities of nephrology, I didn’t know that two year s could mean never having to be on dialysis at all. That two years could be the difference between surviving in body and spirit. Or not."

My sincere thanks to GR friend Marika for making me aware of this title to be published by Harper Collins, June 2017. E-galley provided by Edelweiss. Passages quoted may change in the finished product.

[Rebecca · Rating 3 out of 5]

Grubbs is a nephrologist and assistant professor of medicine at San Francisco General Hospital. Well before she made the kidneys her clinical area of expertise, a personal encounter made them special to her. In 2003 she met Robert Phillips when she was an attending trying to get support for her Office of Diversity Affairs; he was a hospital trustee. She only later learned, after they started dating, that due to FSGS his kidneys had failed in his twenties and he’d been on dialysis for years. In 2005 she donated him one of her kidneys. Robert’s health was touch-and-go for a little while there, but he proposed to her soon afterwards. I read about a third of this and then skimmed the rest because I wasn’t all that interested in their separate histories. However, I did like the context Grubbs gives, such as a brief history of dialysis, nephrology case studies, and a great set of FAQs. She also notes that minorities are less likely to get organ transplants, a disparity she is working to rectify.

Favorite line: “The kidneys are like the Rodney Dangerfield of vital organs—they get no popular respect.”

This memoir grew out of an essay for Health Affairs, Good for Harvest, Bad for Planting.” Releases June 13th.

Reviewed along with three other kidney-themed books for World Kidney Day (March 9th) on my blog, Bookish Beck.

[Marika · Rating 5 out of 5]

A touching memoir of a young medical resident who fell in love with a man who suffered from end-stage kidney disease. The path his disease leads them is unpredictable & challenging and relationship threatening. Much like "Black Man in a White Coat." this book will highlight the hurdles that people of color face, as a medical professionals, and also as organ recipients. This book also serves as a call to action for poc to register as organ donors.


I read an advance copy and was not compensated.

[Megan Laplante · Rating 5 out of 5]

kidneys! I love all things kidney! really though,this was an interesting read and she explained things in a way I could understand and actually felt like I was learning about kidneys.

[Jiaying · Rating 5 out of 5]

"Since dialysis can be a life-saving treatment in many circumstances, we develop a false sense that sudden bouts of illness serious enough to land our dialysis patients in the hospital are temporary when, truth is, dialysis cannot change the reality that the path of kidney failure is a continuous one toward death. A path that is littered with sudden illnesses and setbacks, and recovery is never back to the level of function that the person enjoyed before."

Another 5 stars from me, an incredibly brave memoir (sensitively) outlining the process of dealing with kidney failure. Similar to Paul Kalanithi's "When Breath becomes Air" as Paul battles with cancer, this book also gave me the chance to immerse myself in the lives of patients undergoing kidney dialysis or those under palliative care.

I appreciated how Grubbs (the author) sheds light on essential ethical issues medical professionals will face in the course of their career. Sometimes, all we are left with is to respect the wishes and reality of those who are suffering. No doubt, it is often the hardest when it comes to those whom we truly care about. Her conversational style makes me even more so 'hooked' despite the medical jargons embedded.
"I can't help the way I see the world," I responded. I probably would ask different research questions if I weren't a Black or had different experiences, which is the very reason why it is important to have people from different backgrounds doing research."

What's intriguing about this book was the time when Grubbs was in the nephrology department ever since she donated a kidney to her husband, Robert Philips. It's also worth noting at certain points her personal opinions and grievances about the medical system that she believes discriminates against Blacks even at the point of diagnosis or when it comes to treatment (the part when Grubbs brought up about Mrs Lee). Particularly what I found admirable is the fact that her questions are not raised with resentment but with concern, which all the more makes me want to earnestly read up about the prejudices that underlie health care.

[Nic · Rating 3 out of 5]

This one fell short of my expectations. I was expecting more of a medical nonfiction specifically about kidney transplantation. I would say this book is 50% love storey. In the title it states, A Kidney Doctor's Search for the Perfect Match which I'm thinking, now, refers to Vanessa Grubbs search for the perfect mate. Very little of this book regards finding a perfect kidney match, and touches lightly on donation of kidneys. Mostly, the book refers to Grubbs falling in love to a partner with CKD and donating her kidney to him, and her career trajectory to nephrologist. Her points aren't always clearly made, which left this reader confused at times. I guess I was hoping to learn more of the nitty gritty of kidney transplantation. It feels more like a memoir, at times. Hundreds of Interlaced Fingers is a reference to the filtering system of the glomerulus as well as to the hundreds of interlaced fingers involved in the complex process of kidney transplant.

I was mesmerized by the beauty in its design. The glomerulus was stripped of its cap and looked like a ball of tightly coiled yarn. Each strand like interlaced fingers. 160

Her opinions come across strongly as well. Some of that derives from being a new, younger, passionate doctor, perhaps. Grubbs suggests this herself, "She made a rookie mistake," a Black transplant nephrologist at another institution who was sympathetic of my predicament explained to a colleagure, 263

Vanessa Grubbs refers to the kidney in the feminine, which was distracting, while reading. For example: ...but we don't really see evidence that She can't keep up with her responsibilities until the estimted function drops below 12 teaspoons (60 milliliters) per minute. 194 I'm reading this scratching my head and wondering who she's referring to with this "She" and "Her" - it's the kidney she's referring to. Also, there are some awkward sentences, for example: As chronic kidney disease worsens over time, we try to replace the functions kidneys stop being able to do. 198 and Because once eventually comes, all that is left to do is to try to replace the kidneys with a transplant or dialysis, because we can't live without Her. 198

Overall, this book doesn't have a sharp focus, it's kind of here and there. It's hard to grasp exactly what the author was trying to convey. She does emphasize some interesting points, though.

Patients with end-stage kidney disease make up less than 1 percent of the Medicare population but consume about 7 percent of the Medicare budget. So I can't help but wonder, what price--in human effort and dollars--is too much to pay to maintain a life that is actively, repeatedly trying to destroy itself?....Many transplant centers require obese patients to lose weight and patients with drug or alcohol addiction to show they can get and stay clean and sober before they can be considered appropriate transplant candidates. Morbidly obese patients are required to lose significant weight prior to bariatric surgery to demonstrate commitment and improve continued success after surgery. It would seem logical to require patients with end-stage kidney disease and drug addiction to actively engage in drug rehab programs as a part of maintenance dialysis care for the individual's good and for society's good. 234- 235

[Ms. Tongate, TLC Librarian · Rating 5 out of 5]

For readers interested in the kidneys, those who see a nephrologist, and folks who have a loved one diagnosed with chronic kidney disease to learn more about dialysis and transplants.

Notes:
*It is true there aren't enough kidneys to go around in the US. Only 17,000 kidneys are transplanted yearly though more than 100,000 people are waiting for one.
*13 people on the waiting list die every day waiting for a kidney.
*Blacks have higher muscle mass than whites, therefore higher amounts of creatinine.
*The bigger the body, the higher the muscle mass. More muscles produce more creatinine.
*Nephrology was considered one of the most, if not the most intellectually difficult of specialties.
*It ain't going away, never ever ever --kidney disease.
*Since people are less likely to think that any badness can come from natural remedies/herbs, they don't tell their doctors they are taking them. For example, acai berry juice. Acai berry has the same effects as NSAIDS-aspirin, motrin, aleve, ibuprofen. Taking a lot can worsen kidney function, especially in people who have CKD.
*In America, peritoneal dialysis costs about $67,000 per year and hemodialysis $85.000 per year. Here we assume cheaper is worse when really it just means there is no staff or building that must be paid for.
*Dialysis has gone from a miracle to mundane to be avoided at all costs to what Americans cling to. What is really guarantees is more suffering.
*Over 75 years old with medical issues and advanced kidney disease are likely to live as long without dialysis as with it and often with a better quality life.
*I was taught that transplant is better than dialysis and that dialysis is better than death.
*Dialysis cannot change the reality that the path of kidney failure is a continuous one toward death.
*The more protein (albumin) a person has in their urine at any stage, the more at risk they are of worsening chronic kidney disease.

[April Stephens · Rating 4 out of 5]

Summary: Hundreds of Interlaced Fingers begins by alternating between Dr. Grubbs' and her husband, Robert's back stories, their love story together, the story of her donating a kidney to him (focusing on describing the surgeries), a brief history of nephrology, and some discussion of how nephrology compares to other disciplines. A medical drama, it chronicles many of Robert's experiences as a patient and the author's experiences with interesting patients throughout medical school and beyond. 135 pages in, the narrative backs way up to kidney basics. Then it goes into some more detail about procedures like the kidney biopsy, the mindset of people facing chronic kidney disease, the history of dialysis (including the so-called "God committee" that decided who would be saved by the first, limited number of dialysis machines), and the differences between the two different types of dialysis. The book concludes with considerations for allowing patients to decline dialysis. One of the major themes throughout the book is race.  Dr. Grubbs observed racism in the system firsthand (Robert, who's black, was passed over to receive a kidney transplant while white patients received transplants before him, and the circumstances behind the poor care he received during the transplant were possibly racist), so she started looking into institutionalized racism. She noticed it was bad science to adjust patients' numbers from their bloodwork based on race alone. Her first research mentor criticized her because "she wants to do a project to show that the transplant system is racist."

I picked up this book searching for a Sign that I should donate a kidney, but I didn't find it here. There are no pleas to donate, nor instructions on how to donate. I'm impressed with how balanced it is, allowing readers to make up their own minds based on the big picture. A story only Dr. Grubbs could tell, this book has a unique perspective.

As you might be able to tell from the long summary, the book is all over the place. I think she chose to jump around to keep it exciting, but the author's voice and the subject matter are interesting enough that the book still would have held my attention if it was all told in chronological order. 

Parts were disturbing for different reasons. Some of the descriptions of medical procedures brought out my squeamish side, and it was disturbing to read about racists and doctors who seemed detached and lazy. Disturbing--and illuminating. 

The brief chapter titled "Babies" explains how Dr. Grubbs tried IVF. She writes that after they spent their savings on three rounds, "I could no longer bear the painful shots only to be left heartbroken weeks later. If we got pregnant, it would have to be on our own. Unlikely, we knew, but still we tried and hoped." I thought this explanation was helpful when applied as an analogy for the case made at the end of the book about sometimes forgoing aggressive measures to save a patient's life. The aggressive measures have a huge cost: money, pain, and heartbreak that often end in futility. I could see how her experiences informed her philosophy.

The book impacted me positively. Years ago, my close family member was under the care of a nephrologist, who happened to be the best doctor I'd ever met (the best listener and the most thorough). At the time, I didn't grasp the stakes of kidney illness. Reading this book made me better informed and much more grateful for that doctor. 

Hopefully future editions will include an index, sources, and further reading. It's disappointing that it's missing those. I look forward to reading Negligent by Design when it comes out. 

[Cat · Rating 3 out of 5]

This is to a great extent a true love story and I'm not generally a fan of reading romance, but it is also very much about kidney disease, dialysis, kidney transplant, and life after the latter. As a kidney transplant patient, I really appreciated the detail regarding Robert's journey and was interested in some of Vanessa's perspectives as she went from someone without any background in the area to a researcher in nephrology. The statistics were very interesting. I also found it interesting that in the book, both donor and recipient are in surgery at the same time. For my transplant, my donor and I were surprised that our surgeries were actually quite staggered. I was out of surgery before hers started.

Anyway, just so much interesting information. Probably not my cup of tea as a love story, but from a patient standpoint, I found it riveting.

[Leah · Rating 1 out of 5]

I have complicated feelings about this book. I struggle to reconcile a clinical researcher who devotes her work to studying why people of color are less likely to receive a kidney transplant, but in the next chapter laments the financial cost to the healthcare system of allowing people with untreated substance use disorder to receive hemodialysis, and who visits another patient admitted for emergency dialysis to say "I told you so" about not preparing in advance. Dr. Grubbs has an incredible experience of donating her kidney to her partner, but even in this book she is not the only wife to have done so, and looked down on that couple because the wife had to remind her husband to take his anti-rejection meds so not to lose her kidney.

[Melody · Rating 5 out of 5]

This story hit close to home, I believe I won it as a goodreads winner for a divine reason. I've struggled with a family member with a similar condition, and can relate to the fluctuation of the cycle of pain and healing. It's comforting to know I am not alone in my struggles. Thank you.

[KM · Rating 5 out of 5]

Right now, I’m preparing a talk on health literacy. And, interesting, Vanessa Grubbs is the lead author of a study I quoted. This book is a must read for kidney disease patients who wish to be equipped with health literacy. A good choice for doctor, too.

[Tena · Rating 3 out of 5]

I won this in a GOODREADS giveaway.

[Carolyn · Rating 5 out of 5]

I won an advanced copy of this from goodreads.com. I found this book very interesting. I never knew what was involved in kidney care.

[Janel · Rating 3 out of 5]

Interesting read. Sometimes felt very choppy. I didn’t vibe with the author’s doctor sensibilities all the time(patients feeling grateful for example) but I did appreciate her research and topic.

[Debra · Rating 5 out of 5]

This was an interesting and enjoyable book. The love story was inspiring. Being single and a kidney patient, I sometimes wonder if my illness will prevent someone from falling in love with me. This book gave me hope. I also was amazed at how Ms. Grubbs took complicated information and made it interesting and understandable. This book is a good read if you like biography’s (or autobiographies), love stories, medical stories, non-fiction, or social commentary (how race plays a part in getting a transplant and how you are treated by doctors). A must read if you or someone you love is diagnosed with kidney disease.

[Anne Goodwin · Rating 4 out of 5]

A woman's professional and personal lives are transformed when she decides to donate a kidney to a man she's only recently started seeing. I read it to learn more about kidney disease and it didn't disappoint. Another shocking angle is how assumptions about Black bodies lead to health inequalities. (Basically, the estimate of kidney function can be distorted by muscle density; African-Americans tend to have higher muscle density; nephrologists tend to apply a 'correction' based on skin colour rather than measuring or even guessing at muscle density. So severity of the disease can be underestimated in small unmuscly people if they also happen to be Black.)

[Anannya Das · Rating 4 out of 5]

I really enjoyed this book about kidney donation, being a doctor, and being in love. I went into this book, expecting a physicians perspective on kidney donation, but did not expect this to be a memoir about a woman who fell in love with someone with end stage kidney disease. This book movement in ways I had an imagined and gave me a new perspective on the patient-physician relationship, race in medicine, and how small events can change the way that we see life forever. I highly recommend this book for students or upcoming physicians who want to understand both perspectives of being a kidney physician and a kidney donor and understanding how love can change the way that we see the world.

[Deborah Stevens · Rating 5 out of 5]

I work in the medical field and have a personal goal of maintaining the ability to empathize with my patients, despite all of the pressures which can drive caregivers to become callous and distant.

These medical memoirs are super helpful in understanding the experiences of patients and their loved ones as they navigate the terrain of symptoms, diagnoses, and the whole unfamiliar world of medicine.

This is a good one, and Grubb's vantage point as a physician is particularly helpful in giving depth and credibility to her narrative.

[Juhi · Rating 4 out of 5]

A really lovely memoir. Dr. Grubbs touches on kidney failure, palliative care, racial disparities, and emotional adversity in a thoughtful and honest way. I really enjoyed how she blurs the lines between professional and personal realms, delving into how her perspective shifts when she's the doctor or the family of a patient. She's got a vivid and refreshing voice. I definitely laughed AND cried more than once. I also learned a lot. So glad I read this!

[Suzanne Kelly · Rating 5 out of 5]

As a kidney recipient I have a special interest in the topic of "Hundreds of Interlaced Fingers". I loved the easy style of the writing, the mix of honesty as she describes her personal life and her straightforward yet compassionate approach to her profession. Her CKD facts at the end of the book were not the same old-same old that is listed everywhere else. Dr Grubbs opens the door to the end-of-life discussion that so badly needs to be talked about.

[Kathryn · Rating 3 out of 5]

Mostly enjoyable autobiography of a young doctor's journey from GIM to nephrology pursuing the study of health disparities in medicine. I heard the author on the radio and was very interested in her topic re disparities in access to renal transplants so downloaded the book for Nook from B&N. The book was an enjoyable read, but I was expecting less of a personal narrative of her life, and more of a narrative of her area of study, thus it fell short of my expectations.

[Jeanne · Rating 4 out of 5]

A very personal account of kidney transplant and dialysis from both patient and doctor's point of view.

[Adrienne Strait · Rating 5 out of 5]

Very moving story, would highly recommend.

[Scott · Rating 4 out of 5]

Good story, good read, well written, enlightening on dialysis. All at UCSF and Delphine is in the credits.

[Joey Garcia · Rating 5 out of 5]

A poignant, moving, and at times, laugh out loud hilarious story that offers insight into the intricacies of love and of medicine.

[Helen · Rating 4 out of 5]

Love a bit of nephrology among a love story