AN ATLAS OF THE U.S. DIALYSIS SYSTEMFIELD NOTES 2011–2026
DRAWN FROM INSIDE · N=1 <-> N=550,000

The Access

Dialysis is a small world with a big blind spot. Roughly 800,000 Americans live with end-stage renal disease inside a system almost nobody working in it can explain whole. These are its plates.

THE TERRAIN — DETAIL, CROPPED PAST THE FRAME
START HERE — PLATE I: THE LOOP
01 — THE PLATESTHE CHROMA STAYS INSIDE THE WORKS
02 — THE ESSAYTHE CORNERSTONE
03 — THE CARTOGRAPHERDRAWN FROM THE SEATS, NOT THE ALTITUDE
JOHN CRUZ, RN
TECHNICIAN → NURSE
→ CHARGE → MANAGER
→ DEVICE CLINICAL SALES
→ QUALITY & SAFETY
FIELD NOTES 2011–2026

“I’ve spent 15 years in dialysis. I started as a technician mixing acid and bicarb at 4 AM. I became a nurse, then a manager, then a clinical sales specialist walking into boardrooms at Ivy League academic medical centers, and now I sit in quality and safety at a major academic institution. At every level, I saw a different piece of the system. At no level did anyone show me how the pieces connected.”