Renal Failure Prevention and Treatment in the 19808 It appears logical to juxtapose in this volume prevention-low cost and nonmorbid-with uremia therapy, which is very morbid and very high cost. Treated uremic patients constitute an important, complex, and demanding group of survivors of a formerly universally fatal disease. Throughout the developed nations of the world, an increasing fraction of the health care budget is devoted to sustaining lives by dialytic therapy and renal transplantation. In the United States, for example, patients in renal failure comprise 0.2% of those eligible for support by Medicare, but consume 5.0% of the Medicare budget. Economic stresses in funding kidney patients have, in some countries such as Great Britain, forced a return to restrictive selection policies abhorrent to empathetic physicians. For third world residents, attention to nutrition, sanitation, and infections such as malaria must take a higher priority than costly uremia therapy. Thus the solution of one problem (retarding death from uremia) created several equally vexing other dilemmas (who should be treated and at what cost?). While sociologists, economists, and ethicists struggle with the new field of psychonephrology,1 a group of investigators and clinicians convened to examine medical aspects of long-surviving treated uremic patients. These proceedings represent the first American analyis of those unique patients who have lived for ten or more years beyond what would have formerly been certain death in uremia.
Morrell Avram, born in Bucharest, could have easily become one of the 200,000 Romanian Jews killed by the German Nazis or their Romanian allies. I AM THE STORM is the riveting true story of how he survived—and later triumphed as a pioneering doctor—through a combination of grit and persistence. At age 11, Avram was separated from his mother and baby sister because the US Embassy would only allow them to immigrate on the condition that they leave Morrell and his father behind. What the family hoped would be a brief separation became six terrifying years. Amid the horrors of the war, Morrell had to fend mostly for himself, shuttling from relative to relative, hiding place to hiding place. Among his close calls: He longed to buy a ticket on the Struma, a ship taking Jewish refugees from Romania to Palestine, that was torpedoed and sank along with many of his friends. He walked into his bar mitzvah ceremony with dozens of Nazi soldiers stationed outside the synagogue. He was strafed and nearly killed by an American warplane. Upon finally escaping Romania and reuniting with his mother and sister, Avram faced a host of new challenges in New York. After getting through high school with minimal English, he was thrilled to get into college but found it impossible to juggle classes while working to help support his family. By age 21, it looked as if his dream of becoming a doctor was doomed. But relief came from an unlikely source—a draft notice from the US Army, which transformed him from an anxious “subway rat” into a focused soldier, driven by the words of his drill sergeant: “You are the storm! You are invincible!” Avram’s unlikely journey continued as a med student in Brussels and Geneva, as a young doctor in Brooklyn, and as one of the leaders of the new field of nephrology. He became a pathbreaking specialist in dialysis and kidney transplants, saving tens of thousands of patients personally and millions more through treatments he helped devise.
Morrell Avram, born in Bucharest, could have easily become one of the 200,000 Romanian Jews killed by the German Nazis or their Romanian allies. I AM THE STORM is the riveting true story of how he survived—and later triumphed as a pioneering doctor—through a combination of grit and persistence. At age 11, Avram was separated from his mother and baby sister because the US Embassy would only allow them to immigrate on the condition that they leave Morrell and his father behind. What the family hoped would be a brief separation became six terrifying years. Amid the horrors of the war, Morrell had to fend mostly for himself, shuttling from relative to relative, hiding place to hiding place. Among his close calls: He longed to buy a ticket on the Struma, a ship taking Jewish refugees from Romania to Palestine, that was torpedoed and sank along with many of his friends. He walked into his bar mitzvah ceremony with dozens of Nazi soldiers stationed outside the synagogue. He was strafed and nearly killed by an American warplane. Upon finally escaping Romania and reuniting with his mother and sister, Avram faced a host of new challenges in New York. After getting through high school with minimal English, he was thrilled to get into college but found it impossible to juggle classes while working to help support his family. By age 21, it looked as if his dream of becoming a doctor was doomed. But relief came from an unlikely source—a draft notice from the US Army, which transformed him from an anxious “subway rat” into a focused soldier, driven by the words of his drill sergeant: “You are the storm! You are invincible!” Avram’s unlikely journey continued as a med student in Brussels and Geneva, as a young doctor in Brooklyn, and as one of the leaders of the new field of nephrology. He became a pathbreaking specialist in dialysis and kidney transplants, saving tens of thousands of patients personally and millions more through treatments he helped devise.
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