The return of Mr. Rudis

Lahore, Pakistan, doesn't exactly make anyone's Top 10 list for vacation destinations.But it's exactly the place Lincoln resident Richard Rudis needed to go to complete another, far more arduous, journey - a topsy-turvy trip through medical woe, a sidetracked career, personal loss and ethical debate.Now, as he stands on the other side, Rudis has no doubts he made the right decision. A functioning kidney filters the blood coursing through his body for the first time in six years, and, though the recovery process continues, he can look forward to a future that includes dialysis-free travel, a return to work and, perhaps, a bit of volleyball.Rudis, a 53-year-old fitness junkie, suffered renal failure as a result of what he calls a "stupid" decision to use a supplement containing the stimulant Ephedra. Ephedra has been linked to medical maladies before, most prominently in the case of Baltimore Orioles pitcher Steve Bechler who died in 2003 after taking the herb. "Taking it twice a day for a year, what it did was give me high blood pressure, which I never had before," he said. "The high blood pressure forced my kidneys to go on overload. They eventually just couldn't handle it and they started to scar up. There's no reversing it, once it scars over, the kidneys are pretty well done."His kidney problems forced Rudis, who was living and working in the Bay Area, to undergo painful and life-altering dialysis treatments. Still, his health got worse. "Dialysis was maintaining me," Rudis said, noting that he went on a transplant waiting list maintained by the University of California-San Francisco shortly after receiving his diagnosis. "But, after about three years, I had to go to my employer and say, 'I'm going to have to go on disability. I just can't work and do a good job.'"Shortly thereafter, Rudis moved back to the Sacramento area and decided on a home in Lincoln. His case was transferred to the UC Davis Medical Center. He said he was on track to get a kidney there when a patient-care decision dramatically altered his path.Rudis' health care provider, Kaiser Permanente, undertook a short and, ultimately, failed effort to provide transplants to its own patients, said Rudis.Upon his return to UC Davis, Rudis was told he lost his place on the transplant list and would have to wait another two years."I said, 'I can't do this any more,'" Rudis said. "I told them 'You said it would be four to five years in 2000. Now you're telling me it's going to be eight years?"Dr. Mehul Gandi, nephrologist who works with transplant patients at UC Davis understands where the frustration comes in. "There's not a certain time period (wherein it happens)," he said. "But I'm going to say that dialysis does take a toll on the body."So, in light of the physical and emotional toll, Rudis took a long look at his options.In short order, he found an Internet link for the hospital in Lahore while reading an L.A. Times article on Kaiser Permanente's transplant woes. Other links turned him on to transplant programs in China, India and Peru. But for numerous reasons, Pakistan seemed like the best fit. According to Rudis, who insists he didn't buy his kidney, the Lahore hospital obtains donors through its charity work. The for-profit hospital donates millions of dollars for the care of city's poor. In turn, residents - many of them prompted by religious conviction - perform a good deed in return. The result is a large volume of donors."There's not payment," Rudis said. "It's just a payment to the charity, which oversees the (care) of the whole (populace), not just an individual."Still, Gandi said that at first blush he would have qualms about supporting Rudis' decision."(I hesitate for) two reasons," he said. "First, who's looking out for the donor in the foreign country? This is a surgery where, ultimately, two people are undergoing a surgery for the benefit of one individual."(Second,) depending on the place where you go, how well are those donors screened for infectious diseases?"Rudis said he received the same line of questioning from his Kaiser physician. But, as a patient, he felt statistics supported his call."The hospital was rated, according to some kind of international rating for hospitals, five stars," he said. "That signified that the hospital has the equipment and has the qualified personnel to operate this equipment to perform all these certain surgeries."(Plus), they've done 1,900 transplants in two years," he added. "I looked at the Kaiser doctor who was trying to tell me about conditions in Third World hospitals and said 'How many transplants have you done in two years?'"So, within weeks of making contact with the hospital staff that would change his life, Rudis applied for a visa to travel to Pakistan.Looking back on it now, he admits to being a bit squeamish regarding his decision at first. He stepped off the plane to find a largely filthy city steeped in poverty. The hospital building in Lahore was not much better. The façade appeared to be precariously attached to a crumbling building and, in the rear of the hospital, Rudis discovered workers drilling for the facility's water supply."They were back there pounding this giant piston into the ground again and again," he said. "After awhile they would move it to another place and do it again. After they told me what they were doing, I realized there was no citywide water (supply)."Inside the hospital, the picture was similarly bleak. Rudis was ushered to a dank room with two cots."That's when I asked to see the operating room," he said. "I didn't really feel comfortable until I saw the operating room."With qualms giving way to comfort, Rudis settled in for his three-week stay and began making friends with the other expatriates awaiting transplants at the facility."It was kind of a mini-United Nations," he said. "There were people from Germany, Britain and Canada. All of them were there because they had similar problems getting kidneys in their home nation."But Gandhi said Rudis would have benefited from another familiar face."Let's say if I'm the patient's doctor, his nephrologist," he said. "The first thing I'm going to say, first of all, is that it would give me much more comfort to make sure that the donor is a relative or a friend of his."The main problems that I have with this is the welfare of the donor."When all was said and done, Rudis paid $17,500 for his surgery, his donor's surgery, his three-week hospital stay and medication for both him and the donor.To him it's money well spent."My car's cost me $20,000," he quipped. "I'm worth more than a car."So far, both Rudis and his state-side doctors are pleased with his recovery. It will probably be nearly two years before he can consider going back to work. In the meantime, he's considering doing some traveling."Maybe (I'll go to) Europe," he said. "That's something I wasn't able to do when I was hooked up to a dialysis machine."