Among the most pressing medical needs facing Houston at the moment: getting people to dialysis treatment.
At DaVita Med Center Dialysis on Tuesday afternoon, nurses tended to dozens of patients on dialysis machines while another 100 people waited their turn. Some were clearly uncomfortable, and a number said they hadn't been dialyzed in four days.
Those delays can be life-threatening.
Typically, patients with kidney failure undergo dialysis every other day, or three times a week, for four hours each time. To try to move more people through, nurses were doing two-hour sessions at this center in Houston, enough to keep patients out of danger.
Dialysis replaces the functions of the kidneys. Healthy kidneys remove toxic waste and excess fluid from the body in the form of urine. For dialysis patients, a filter, sometimes called an artificial kidney, does the job. A patient's blood is pulled through the filter and pumped back into the body.
Dialysis does not cure kidney failure, but it does help people feel better and can extend their life. According to the National Kidney Foundation, average life expectancy for patients on dialysis is five to 10 years, though many patients live as long as 20 years or more.
But it's crucial that patients get regular treatment.
"If they don't dialyze three times a week, they can easily become fluid-overloaded, or they can have a high potassium level in their blood, and they can become very, very sick," says Dr. Steve Fadem, medical director at the DaVita center, which is one of about 100 the company operates in the Houston area, about half of which are open. Muscles, including the heart, can stop functioning correctly. "Over so many days, they can't survive."
In the wake of Harvey, DaVita has opened its doors to all dialysis patients, not just its own. But the company has been struggling with staffing shortages.
"Many of our nurses are locked in, flooded out of their homes, and they're either somewhere else, or they can't get out of our neighborhoods," Fadem says. "As a consequence, we don't have enough nurses to dialyze the numbers of patients that are coming here."
They've been helped by a team from Baton Rouge, La., who showed up with boats to ferry both patients and nurses from their flooded homes to the center.
"This is surreal. I've never seen anything like this ever in my career. I've been doing this for almost 40 years," says Fadem.
After missing his regular Monday session, William Scott and his wife, Teresa, arrived at the center just before 10 a.m. He finally started dialysis almost four hours later.
"It was a long wait, but we could understand because it was a lot of people," Teresa Scott says with a laugh. "It's just good he got in here."
Yesuf Said, a nurse who's worked at this center for four years, says it's been difficult dealing with so many patients at once and so many who are new to this center. "We have to do it, because nobody can do it," he says. "It's life and death for patients."
He's worried about the coming days. Normally, if patients don't show up for dialysis, they get a phone call from the center. Now, Said says, he's not sure they can reach everyone.
DaVita serves around 6,700 patients in Houston, according to Chakilla Robinson White, who oversees operations for the company's dialysis centers in Texas and neighboring states. On Tuesday, she sent a companywide email with the subject line "Rally For Help in Texas," appealing to staff in other places to travel to Houston to help.
Dialysis patients who are unable to find an open center can get help from the nationwide Kidney Community Emergency Response coalition by calling 1-866-901-3773.