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The Silent Tremors of Survival
Salma had always been careful—careful about what she said, what she showed, and what she hid. A five-year post-transplant recipient, she had spent years learning how to blend in. Diagnosed with chronic kidney disease in grade 7, she had endured six months of peritoneal dialysis before receiving her renal transplant. Now, in her first year of B.Sc. Biochemistry, she had perfected the art of invisibility.
No one at college knew about her past. The scar on her neck, where the dialysis catheter had once pierced her jugular vein, remained hidden beneath the folds of her hijab. The tremors in her hands, she dismissed as nervousness. The immunosuppressant pills, she took in the privacy of her home. Even her hospital visits, scheduled on Wednesdays, were easily concealed because she had a day off.
That Monday, her chemistry practical required her to identify an unknown organic compound. The choices were phenol, aniline, benzaldehyde, glucose, benzoic acid, phthalic acid, urea, and benzamide. Salma got glucose, and she recognized it immediately—just from its physical appearance. She carefully performed the solubility test, then proceeded with Molisch’s test, Fehling’s test, and Tollen’s test. The results were unmistakable. The violet-colored ring of the Molisch’s test and the silver mirror formed in the Tollen’s test were almost beautiful, shimmering under the laboratory lights.
Satisfied, she stood in line to report to the professor. She had gone over the procedures in her mind, confident in her explanation. But when it was her turn, she lifted her first test tube—and her hands began to tremble.
The professor, seeing her struggle, didn’t press her for answers. Instead, he simply asked for her roll number and the compound she had identified, then sent her away.
Salma walked back to her seat, her heart sinking. She should have been relieved—she wasn’t questioned, she wasn’t embarrassed—but all she felt was rage at her own hands.
She wasn’t nervous.
So why did her hands betray her?
That afternoon, she lay on her bed and cried herself to sleep, hating her body for refusing to stay silent. She imagined her hands trembling even in death—as if they wouldn’t stop until the whole world knew her story. Until everyone understood what she had survived.
But was it truly her fault?
No.
Her tremors weren’t a sign of weakness, but the lingering effects of survival. The culprit was Tacrolimus, the very drug that kept her transplant safe. A powerful immunosuppressant, Tacrolimus disrupted calcium signaling in neurons, causing them to fire excessive, uncontrolled impulses, leading to hand tremors and neuropathy. Years of kidney failure before the transplant had also exposed her brain to uremic toxins, altering neurotransmitter balance in ways that couldn’t be undone overnight.
And then, there was the adrenal connection. The kidneys sat close to the adrenal glands, which controlled stress hormones like adrenaline and noradrenaline. The trauma of surgery, the long battle with CKD—something in her autonomic nervous system had shifted, making her body overreact to stressful moments.
The tremors weren’t hers to control. They were the silent echoes of everything she had been through.
And yet, here she was. In a lab coat, performing experiments, building a future.
Her hands trembled, but she was steady.
Her body still carried traces of her past, but she was moving forward.
And that, more than anything, meant she had already won.#chronic #renal #diagnosisjourney
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