Joan Corbin's day is governed by the humming box in the alcove off her living room. For nearly an hour in the afternoon and nine hours at night, the Smith Island resident must tether herself to a suitcase-sized dialysis machine to get rid of the waste building up in her body.
A healthy person's kidneys would perform that vital chore. But Corbin's gave out long ago, after being damaged by infections in her youth. She got a new kidney from her older brother 13 years ago at the University of Maryland Medical Center, which restored her health for a time. But the replacement faltered and then failed last year, putting the 44-year-old in the hospital for a week, back on dialysis and hoping against hope for another kidney.
"People think once you're transplanted it will last forever," said Corbin wryly. "Actually, the time [my doctors] told me, it's eight to 10 years. So I've done really well."
But she's not doing that well now. There's no one else in her immediate family able to give her another kidney, so she got on the waiting list for a new one nearly two years ago. She's been waiting for a match from a dying donor or, better yet, from an unrelated living one.
And if joining the growing ranks of people needing a second kidney transplant weren't unfortunate enough, her plight is further complicated by living in a tiny community in the middle of the Chesapeake Bay, where going to the doctor or drugstore requires a 45-minute boat ride, weather permitting. It's where she was born and raised and has lived the life of a waterman's wife — and healthy or not, it's home.
Unless something breaks her way, she could be waiting a long time. The number of kidney transplants has grown sharply since the first was performed in 1954, but so have the number of people needing a transplant. There are more than 90,000 people nationwide on the waiting list for a new kidney, according to the Organ Procurement and Transplantation Network. About 12 percent of them, like Corbin, are in line for a repeat transplant.
"Second kidneys are becoming more and more common as transplantation becomes more common," said Dr. Jonathan Bromberg, head of the transplant division at the University of Maryland Medical Center, and a professor of surgery at the medical school.
There are many patients whose kidneys have "lasted five, 10, 15 or 20 years" who need another transplant, he said.
Even kidneys from close family members can get rejected by a recipient's body or gradually wear out, said Bromberg, who is not Corbin's physician. Diabetes and other diseases contribute to the deterioration, he added.
Corbin has diabetes, which she said she developed after her transplant. She said her doctors told her it was likely brought on by the immunosuppression medications she's had to take to keep her body from rejecting the donated kidney.
Corbin's health issues are compounded by the lack of medical care for the 240 year-round residents on Smith Island. There are no doctors, only volunteer emergency medical technicians and a nurse who visits the island about once a month.
She has to take the ferry twice a month to have her blood tested and see doctors in Salisbury. But, while many dialysis patients must travel to a clinic for treatments, Corbin has been able to treat herself at home.
She undergoes peritoneal dialysis, using the lining of her abdomen to filter her blood, rather than the more common — and complicated — hemodialysis, in which the patient's blood is cleaned directly.
Through a tube permanently installed in her belly, Corbin pumps fluid into her body containing a mixture of minerals and dissolved sugar designed to draw wastes from her bloodstream. The solution stays there for several hours until she drains it off and replaces it with fresh fluid. Needing to exchange three gallons of fluid a day, she can do most of it at night while sleeping but needs an extra, short session in the daytime.
Starting each day's treatment is a time-consuming, meticulous process. She dons a surgical mask and repeatedly washes her hands while preparing the machine and attaching all the tubes. Infection is a big fear, and she got one recently, though it seems to have been knocked back by medication.
"The machine is what's keeping me alive," she said. "So I'm doing pretty well, considering that."
But even before her recent infection, she was having trouble. She used to join other watermen's wives picking crabmeat for sale in the community's cooperative kitchen, but said she lacks the strength for that now. Corbin said she experiences periodic bouts of high blood pressure and muscle cramping whenever her system gets out of kilter. And she feels fatigued all the time, the result of severe anemia she's also battling.
The daily treatments seem to be losing their effectiveness, she said, and she's worried about what she can do to hang on until her number comes up on the kidney transplant waiting list.
Dialysis is a life-saver for many, Bromberg said, and many can carry on more or less normal lives for years. But those on dialysis are at risk for potentially serious infections and other health problems, particularly heart attacks and strokes.
While there were nearly 17,000 kidney transplants performed nationwide last year, according to the transplant network, nearly twice as many people were added to the waiting list. Donations have grown, but aren't keeping pace with the increase in kidney disease and failure, Bromberg said.