Without them, there is no balance of fluids, electrolytes, or minerals. As kidney disease progresses, blood values become 'deranged,' and the organ's crisis becomes a systemic one, radiating outward, causing your legs to twitch uncontrollably at night, your mood to pitch and list on shifting chemical currents.

After receiving the news in Toronto, I wanted to crisscross the continent to get second, third - hundreds of other opinions. An unfortunately dire pamphlet a nurse had given me described a transplantee as a potentially hirsute creature with a fat belly and emaciated limbs who might tremble and suffer night sweats as he slowly went bald. Therapies that I'd scoffed at - acupuncture, herbal cures - didn't seem so quackish anymore. Moreover, the kidney would be transplanted not in its original place - out of sight, behind the ribs - but next to the bladder, above the thigh, creating a new and substantial lump up front, in my groin.

There were only two other options besides death, and both were too depressing to consider for long. One was living with a tube sunk through my peritoneum - the tough membrane covering the intestines - that would be hooked up to a bag four times a day to flush the toxins from my blood. The other was four-hour dialysis sessions three times a week. And today, having experienced dialysis once immediately before my transplant, I find it even more difficult to imagine living for years that way, as many patients with kidney failure must. For four hours, unable to read or sleep, I watched as one tube drew my body's blood away from me, pushed it through a dialyzer that 0separated the good from the bad, and as another tube brought it back to me, more purified than before. Across the room, a shadowless reticulation of sluicing blood, a sleeping man groaned awake now and then to deliver himself of fluid that had collected in his lungs. An elderly woman in a neighboring bed blinked at me, her mouth a rictus of mute exasperation. It was my birthday, and as I munched on the stale cupcake the nurses had given me, I wondered whether survival was worth this. After it was over, I returned home and, as most of those to whom I have spoken about their first dialysis session do, wept.

After six months of vacillation, I made a decision that seemed insane to Dr. Cole, but made perfect sense to me: I would return to New York, where I'd grown up, earn a degree from the school of journalism at Columbia University, and deal with my failing kidney along the way. I was defying, not denying, the disease. It all came down to where I wanted to put the accent on my life: Was I the vessel of a failing organ, or a man with a life to live? This thought and the Canadian winter helped me to make my decision. Anyone who has suffered through that interminable season will understand the urge to flee south.