KANSAS CITY — He has watched the faces of those who have learned that kidney dialysis was in their future.
"They always have this deer-in-the-headlights look. ... That 'holy-crap-I'm-gonna-die-with-this' look," he said.
Bobby Brim knows because he's been there, too.
When people hear for the first time that they need dialysis or they will die, "that's a very scary thing."
As a volunteer patient presenter, Brim, 52, of Pleasant Valley, tells his story to newly diagnosed kidney patients. He tries to show them that not only can they live, but they can have a life, something he learned in classes sponsored by the Missouri Kidney Program. Volunteering in the classes is his way of giving back.
"Let's put it this way: Without the Missouri Kidney Program, I think I would have lost my mind," Brim said.
The $3.8 million state-funded program was hit this fiscal year with a 25 percent budget cut, or about $940,000. Kidney patients and the social workers who help them already are feeling the effects.
Social workers predict the cuts will lead to increased costs for the state next year. They expect that more sick renal patients will require more intensive medical care.
The National Institutes of Health estimates that every dollar spent on patient education saves $3 to $4 in medical costs. The Missouri Kidney Program's seminars have helped thousands of patients.
But the program is little-known outside the circle of kidney patients and those who care for them, said Beth Witten, a social worker who has worked with kidney patients for 31 years.
"These cuts are penny-wise and pound-foolish," Witten said. Witten is one of the leaders of the Council of Nephrology Social Workers for eastern Kansas and western Missouri.
Too many people are overwhelmed by the diagnosis, Witten said. If they ignore their kidney problems, they get sicker and lose their jobs and their health insurance. They drain their savings and lose their homes. They end up in hospital emergency rooms needing emergency dialysis. The state ends up paying the medical bills.
"Patients who learn about kidney disease and then take an active role in this do better," Witten said. "And the cost savings to the state are enormous."
Perhaps the Missouri Kidney Program's best asset is its seminars, which can prepare newly diagnosed patients or those who soon will be on dialysis for how their lives will change.
Brim shook his head when he imagined what might have happened to him if there had been no class.
He said he probably would have quit his job, having to tether himself to a dialysis machine three times a week for four hours at a time. He worried the medical bills would drain his family's savings, perhaps cost them their home. He thought he was a dying man with no hope.
The two-day seminar changed everything. Brim learned how his kidneys worked.
He learned the pros and cons of different types of dialysis, or perhaps a kidney transplant. Armed with information, he felt confident choosing an at-home dialysis option that he could schedule around his life, instead of him scheduling his life around dialysis.
The Missouri Kidney Program "gave me my life back," Brim said.
More than 3,000 patients, along with families and friends, have attended the free classes.
Last year, the Missouri Kidney Program offered six classes in the Kansas City area, six in St. Louis and several elsewhere in the state. Witten said that because of the budget cuts, only four classes will be offered this year in Kansas City, four in St. Louis and four elsewhere.
The state budget cut is affecting other parts of the Missouri Kidney Program, too. The program reduced the assistance it gives patients to pay for insurance deductibles and transportation to dialysis clinics. It also cut its emergency aid that allowed low-income patients to get medicine.
Now patients scramble to pay costs they can't afford — or turn to the state for care at much greater costs.
Dorothy New, 91, lives in North Kansas City on a fixed $900 a month. The kidney program used to pay $200 a month for her supplemental health insurance. The insurance company pays for her dialysis medications, which cost thousands of dollars a month.
A few months ago, New learned that the kidney program would pay only $100 toward the insurance. She must now pay the other $100.
"But I really don't have it, so I'm not going to worry about it. I just roll with the punches," New said, leaning on a walker. "I've outlived my savings. When you live so long, things like that happen to you. If I don't have it, the state will have to buy it for me. ...You don't suppose they're hoping we'll just die off, do you?"
If New can't make her payments and loses her insurance, the state will end up paying the thousands of dollars each month for her medications.