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The Price of Tomorrow

Before humanity learned to write, oral tradition (the retelling of stories) gave us cohesion and identity in the face of overwhelming environmental odds. Mentoring was the way of our world. Fathers taught their sons, mothers taught their daughters, whole tribes taught the youth to hunt, fish, farm, and defend their families. We listened to those who were older and wiser and we passed down their stories. So we survived and grew.

The story of humanity is written by mentors.

Yet that long chain is rusting. History books are filled with great women and men praising those who guided and believed in them. But with each decade, those stories seem to grow quieter. Fewer.


Debbie’s nursing career has spanned four of those decades, and it stands as a rebuttal to the rust on that chain. This is Debbie’s story, and the story of a woman named Susan. But instead of Debbie telling it, I’m going to…

And there is a very particular reason why…

The economy was booming in the late 80’s. Champagne-guzzling, Lamborghini-driving socialites were investing heavily in new medical technology, but somehow AV access care got left behind. Debbie worked at a hospital in a large outpatient and inpatient dialysis program. Endovascular intervention was, shall we say, limited. It wasn’t uncommon for days to pass between cathether placement and access declotting with no treatment of the underlying cause. The AV graft placements themselves were usually standard PTFE.

They had dedicated, talented staff, but a limited toolbox, which left each person straddling a care-gap or two. Debbie worked closely with the general surgeon, who looked after most of the patients’ vascular accesses. When an outpatient presented with a clotted access (remember, this was before any formal monitoring/surveillance programs), they had no choice but to page the surgical resident on duty, who would then take a stab at (no pun intended) inserting a temporary non-tunneled subclavian catheter by intuition alone. The residents struggled, so Debbie would act as a scrub nurse, and the resident would wrestle blindly with insertion in the closet-sized procedure room.

Frustrations built until even the surgeon cracked, making loud, fully-justified complaints about the high rate of AV graft thrombosis, repeat catheter utilization, and poor outcomes post-thrombectomy. Debbie silently cheered him on. She’d had her fill of blind stabbings in janitor’s closets.

The surgeon used W.L. Gore PTFE graft material for his AV graft creations and revisions, so Debbie reached out to the W.L. Gore regional associate who connected her with the AV access support nurse.

That nurse was Susan Boothe.

She was a God-send. Or at least a Gore-send. Susan was intriguing. Kind and welcoming to the point of disarming, yet fiercely intelligent. Graceful in mannerisms and speech, yet pragmatic. All of it was wrapped in the calm insightfulness of those who have traveled the world—and paid attention while doing it.  

Susan connected Debbie with Dr. Mitchal Henry, a transplant surgeon from the Ohio State University Wexner Medical Center. His resonant voice was the first tremor of the tectonic shift that would not only redefine Debbie’s career, but would reshape their corner of the hemodialysis world.

Dr. Henry chaired the Hemodialysis Vascular Access Symposium, which, at the time, was the only national professional meeting focused on HD access. Susan continued to work behind the scenes, making connections and continuously handing Debbie gems from her treasure chest of clinical knowledge and medical social savvy. As they all collaborated, Dr. Henry invited Debbie to be a faculty member for the Ohio State IV Hemodialysis Symposium in May 1994. When Debbie was invited to speak at a Gore-sponsored symposium at Ohio State, it was the first time a nurse had received that invitation. Afterward, since Dr. Henry turned each meeting into a book, Debbie’s presentation was published as a nurse-created chapter. This also had never happened before. (Brouwer D. Hemodialysis: A Nursing Perspective in Vascular Access of Hemodialysis IV, eds M Henry, R. Ferguson p, 131-151.Precept Press and W. L. Gore & Associates, Inc. 1995.)

As Susan guided and Debbie worked tirelessly, attitudes began to shift within the male-doctor-dominated VA world. They began to express such sentiments as: “In my dialysis unit, I’m expected to know everything. I couldn’t consult with a nurse even if I wanted to. But you’re outside of my institution, and you really know what you’re doing. I’d like to ask you a couple questions about procedure…” The more Debbie learned from Susan and from her own work, the more Debbie became a “safe” resource for male physicians. Eventually they began to joke that she had somehow become one of them without anyone realizing it.

In 1995, Debbie achieved her first journal publication—another first of its type for a nurse. (Brouwer D. Cannulation Camp: Basic Needle Training for Dialysis Staff Dialysis and Transplantation 24 (11): pp. 606-612, 1995.) The article used illustrations from W.L. Gore, and with Susan’s support, Gore granted permission for continued use of the illustrations as slides and hand-outs during cannulation training. They became foundational to a hands-on training program (Cannulation Camp) that Debbie hosted with various professional organizations for many years.

As a result of Debbie’s first two publications and the resulting presentations, she was asked to participate in the initial DOQI Vascular Access Guidelines Work Group, which started work in 1995 and was published in 1997.

As they continued to gain momentum and recognition, the Ohio State Symposiums led to the formation of The Vascular Access Society of the Americas (VASA) in 2005. The DOQI was changed to the KDOQI, and Debbie continued as a Work Group member for the 2000 and 2006 versions.


So success builds on success, like an avalanche of progress. But rarely will even the first stone begin to roll without a mentor to nudge it. Are Susan and Dr. Henry the only mentors who have touched Debbie’s life? Certainly not. And when she began to list them, I realized I could never thank them all in this blog. That was when I realized that thanking mentors isn’t about saying the words as much as learning the lesson.

So let me say this in closing:

You may still be wondering why—since this article is about Debbie—that Debbie isn’t writing it. Surely that would be simpler? But the true test of mentoring is giving to another the same gift of support, education, and belief that was given to you. The true value of mentoring is the same it has always been, since before we learned to write, since before we laid the first brick to build Babylon—since the time of those oral traditions, the stories told by elders around fires at the end of a long day of hunting and gathering.

Only those who have truly learned the value of mentoring can keep that chain strong.

So I am writing this for someone who has mentored me, someone who has done far more than help my career. Someone who has helped me become a better version of myself.

Her name is Debbie Brouwer Maier.