“Through dialysis, the blood is cleansed of urea and toxins that accumulate when the kidneys no longer function properly,” Siemers explains. There are two kinds of dialysis: peritoneal dialysis, which can be carried out at home but is not suitable for every patient, and hemodialysis. In peritoneal dialysis, the peritoneum, or membrane lining the abdominal cavity, is used as a natural filtering organ to remove toxins from the body. In hemodialysis, the method used for Barbara , a shunt — an artificial passage between veins and arteries — is used to drain blood from the body. The extracted blood flows through a device known as a capillary filter, which is the heart of the dialysis machine. “The blood flows through many fine capillaries, where it is rinsed with a dialysate containing clean water with the required electrolyte content,” says Siemers. “Through the process of osmosis, the dialysate absorbs the toxins and is then removed from the machine. The purified blood is enriched with the electrolytes and then returned to the body.” Dialysate is offered by several different manufacturers; they in turn obtain the needed additives (such as calcium chloride, magnesium chloride, sodium chloride, potassium chloride, sodium bicarbonate and sodium acetate) from Chemische Fabrik Lehrte (CFL), a Merck Group company.

Barbara is well aware of the vital service the machine next to her bed performs. Every step in the process was explained to her and she is still quick to ask questions whenever changes are made. She is surprised by the fact that many patients simply lie down and let the doctors and the machine go to work. Others are afraid and spend most of their time trying to fathom their fate. Barbara is pragmatic, though. When asked if she doesn’t sometimes despair about the fact that she’s been saddled with this affliction, she replies, “One mustn’t think like that.” She wants and accepts no pity — not from others and certainly not from herself. “How in the world is that going to help me?” she says with conviction. “It is what it is, and now I’ve got to make the best of it.”

Last year Barbara was also diagnosed with breast cancer. This condition eliminated any chance of a transplant, which is why she quickly decided to have both breasts removed. “I don’t need them anymore; they just would have caused me to lose time,” she says. She means the additional time that would have to be spent on the dialysis machine instead of enjoying things like taking walks, meeting friends, and traveling. That’s because cancer patients are removed from transplant lists until they are considered cancer-free — and that takes at least five years after a successful chemotherapy treatment. With her radical decision, Barbara was able to shorten this time to two years. So she will continue to wait, to watch the passing of winter and the arrival of summer, and to set her alarm for five a.m. three times a week.