“DAYS OF FUTURE PAST” a recollection:
Duarte has taken the liberty to assemble documentation of some of the projects he feels privileged to have been a part of over these many years. As we review the collection of documents he reveals that in the course of thirty-six years he has performed over 12,800 dialysis treatments for more than 5000 patients.
His Major in High School was “Science-Math College Prep”. Unknown to his parents and counselors until graduation, he quietly completed every course in advance mathematics, physics, chemistry, and physiology that Sylmar High School could offer. He also completed all of the advanced senior courses in composition and met the foreign language requirement for a Major in that discipline if he had so chosen. He did so by taking advance courses in summer school. Duarte recalls his counselor saying that he had qualified for five different Majors but that only one could be recognized on his diploma. He chose Science. Because he maintained high marks in his classes he was awarded one of Sylmar High School’s first Scholar Athlete Awards for Lettering in Varsity Football and maintaining his grades at a higher level. Upon Graduation he was selected as a speaker to represent his Class.
He worked as an Orderly for 2 years while he studied to become a Licensed Vocational Nurse (LVN), then worked as an LVN for 2 years as he completed his Registered Nurse (RN) training. The RN program at Los Angeles Valley College were 2 full academic years in Nursing and 2 full academic years in General Education which amounted to 4 years of College compressed into 2 years. Students are no longer allowed to take these Nursing courses concurrently with lower division GE courses. Upon Graduation he was selected to be a speaker of their Nursing Class.
Because of his background in Science and Math and his interest of anatomy and physiology it was no wonder that upon completing his RN training he chose to apply for employment at the “melting pot” of the medical world, Los Angeles County USC Medical Center. In 1971 it was affectionately referred to as "BIG G". Renal Ward 4000 was where miracles happened. The training was 2 years in length requiring the graduate nurse to establish and display ICU/CCU skills. The first leg of the rotation began with the care of the patient undergoing kidney transplantation. These renal nurses in 1971 became proficient in every aspect of renal replacement therapy – kidney transplant, peritoneal dialysis, and under hemodialysis, they were trained in self-care, home care, in-patient care and acute care hemodialysis. This type of training does not exist any longer and Duarte feels fortunate to have experienced it. Duarte says, "I owe a debt of gratitude to Eugenia Orellanos, RN and Dr. Benjamin Barbour who were two of the primary designers of this marvelous program."
With apologies to Charles Dickens “IT WAS the best of times, it was the worst of times” in 1971 for anyone who cared about there fellow human beings in service of renal replacement therapies. This particular service in the United States brought together rich and poor patients, people of all races, creeds and nationalities because treatment for kidney failure was limited and difficult to obtain. This was the time when names were drawn out of a hat to determine who might live and who would die. This was also the time when many that are now treated with dialysis and kidney transplantation as a routine matter would have not been chosen at all.
At the time Duarte was hired he was cautioned that there was a 25% probability he could contract hepatitis with a 1% probability of mortality. Recently it has been determined that newly trained professionals have a 40% probability of morbidity in the first year with a 10% probability of mortality over all. The nurse recruiter advised Duarte at the time of newly developed principles and procedures for “Universal Hazards” in infection control to be implemented and strictly enforced. In short there were no guarantees of his safety as he proceeded with his training in this field. Having already toured the renal unit and so moved by the courage of these patients, all he wanted was the privilege to be of service. Few realize the risk he and his colleagues face each day they go to work. Life has it challenges.
In 1971 the treatments for the most part were 6 hours long. Their staff of technicians assembled the dialyzers (artificial kidney filters); these artificial kidney filters were primed with formaldehyde and rinsed with sterile normal saline. Because they were using plate dialyzers no blood pumps were required for patients with Scribner Shunts (patients with Cemino Fistulas and Grafts did use blood pumps). The technology for air foam detection was non-existent, and therefore the nurses, technicians and patients were ever vigilant and fearful for air in the lines with blood flows at a rate of 300 to 500 cc a minute. The patients were taught to know, as much as possible, and in some cases as much as the nurses and technicians knew to participate in there own care. Ruptured membranes in the dialyzers (or kidney filters) were a common occurrence and the blood loss was so great that blood transfusions were always required. Training in this area was frightening. There were so many steps to learn in the care of the patient; nothing in the way of equipment was automated, and the nurse had to react competently and without hesitation in all emergencies even if still not fully trained– they were incredibly short of staff. "I felt fear as I began my training, cognizant of the many things that could go wrong", says Duarte. "My hands would not shake, my concentration intensely focused, I would then begin to perspire profusely." It was a non-verbal physiological response that, though most uncomfortable, communicated to his patients without any words that he cared and wanted nothing but the best for them. The only way he could promote his comfort and more importantly maintain the integrity of his sterile field was too design a system that now has become his trademark. Ergo the Gray Hat! At County they had Green surgical hats – a sweatband with one of these hats over it took care of Duarte's needs, and maintained the integrity of a sterile field.
In 1971 there were many unanswered questions in renal replacement therapies – dialysis was still much in its infancy with research being done at every level. It is because of Duarte's strong background in Critical Thinking that he started designing research projects to attempt answering some of the questions. He has approximately 30 abstracts presented at regional and national conferences, nine manuscripts in print, and has been successful in acquiring one research grant. But his first love, his forte if you will-is to be at the bedside with the patient. In the last analysis, "none of my accomplishments" says Duarte "would have occurred without the help and support of the many professionals I work with." Duarte's research work impresses significance. Post cards calling for reprints start arriving from all over the world. It was only then he realizes the significance of his research work in his effort to help the dialysis patient.
"I believe in growing F A T with passion", says Duarte. " F - A - T - FOCUSED, ATTENTIVE, and committed to a TEAM effort. This has always been my formula for success."