BERNE — Instead of “problems,” Sandra Kisselback prefers the word “challenges.” She works at the Stempel Saw Mill, her family’s enterprise that has endured despite heavy snow that collapsed a roof, a broken motor too costly to repair, and a stubborn recession that has cut back on construction.

“I don’t get all worked up about problems, because they’re temporary,” says Kisselback. She is sitting on a grayed picnic table outside of the Stempel home where the smell of fresh lumber is carried by the chill spring winds. Kisselback, 55, wears a white sweatshirt spelling out the name of the mill and her father — Rudy — in fabric paint. A pair of black and white sneakers is placed beside her.

Kisselback was diagnosed with kidney disease when she was in her thirties. With her kidneys unable to fully remove wastes, minerals, and fluids from her blood, she has had different forms of dialysis since, and had a kidney transplanted from her brother, Brian Stempel, that lost function after nearly 12 years.

Each night before going to bed, Kisselback goes through a gratitude list. On it, she includes family, people she calls her “health team,” and her ability to do dialysis at home.

At the Clifton Park Rubin Dialysis Center, Kisselback meets with a nurse, a dietician, and a social worker once a month. The vital function of kidneys is performed five hours a day, five days a week, with a dialysis machine at home.

“I never had that feeling before,” Kisselback said of the time before her sickness. “I’ve never thought about the people in my life in that way, that I’m grateful for them.”

One of the people she’s grateful for is social worker Brenda Cassidy. She remembers the day Cassidy came to her with an envelope.

“She says, ‘We’ve noticed your shoes, and we want to see you dancing in style; and we’ve got $50 for you to go out and buy yourself a pair of shoes,’” said Kisselback. She began to cry, she recalls. She wears her new sneakers only on visits to the dialysis center and when she volunteers at the Berne Library.

Kisselback’s essay about the exchange was among the winners of the Renal Support Network 2012 essay contest.

Twice a year, patients at the dialysis center have their feet checked.

“You’re focusing on your feet because you have to take your shoes and socks off, and there’s my ratty old shoes you have to take off to check my feet,” said Kisselback. “And she saw that, and she wanted to help me out. They have a fund at the center where they help people who are in trouble.”

Since the recession started in 2008, local construction hasn’t been as healthy as before, eroding the sawmill’s income. Most of its business, says Kisselback, is in pine and hemlock. Business for hardwoods used by furniture companies in Canada or the Carolinas dropped off with the recession.

Gas money is a priority. Kisselback has been taking care of her parents for the past several years, driving them to doctors’ visits and watching their diets and medications. Her father, Rudolph Valentino Stempel, died last year at 82.

Stempel bought the mill in the 1950s. He became known as Rough-cut Rudy, a Hilltown icon who provided affordable lumber for locals. Seven months before Stempel died, when the motor for a 20-year-old, automatic saw had broken and needed a $36,000 repair, he revived the century-old saw he’d used to start his business, which Kisselback says is more accurate.

She remembers the date, May 25, 2011, and marks her father’s deteriorating health from that point. Two years before, a snowstorm collapsed the roof on the mill. Stempel rebuilt and was back in operation within two weeks.

“My father couldn’t handle health issues as easily as I could,” said Kisselback.

“Maybe, because I’ve been living with it since 1992, it doesn’t seem like that big a deal to me,” she said. “Although, it is. It’s definitely life-changing.”

A visitor, some advice

At the beginning of April, Rufus Varin visited the sawmill to ask Kisselback’s health advice. Less than a minute after stepping down from his red pickup truck, Varin told Sandra Kisselback that he had started treating his failing kidneys, a path she has been on for over 20 years.

“Three weeks ago, I almost died, and nobody knew that it was my kidneys that were killing me,” Varin said. Varin’s mother, sister, and niece cried by him in the hospital, where he was told he would stay until a dialysis center had an opening. A minister talked with him for over an hour.

Varin told Kisselback that doctors think a stroke a year before led to his kidneys’ failure to filter his blood. He now uses a machine three times a week at a dialysis center in Amsterdam.

“It gets in your head, that you don’t think that you’re going to be as good as you were,” Varin said on Tuesday. “You get this thing in your head, ‘God, I’m a sickly person. I’m going to be dependent on different people.’”

When he was younger, Varin worked for Harry Garry and his wife, Hilltown doctor Margery Smith, on their East Berne dairy farm. Trees logged on his own farm first brought him to know the Stempels.

During Varin’s recent visit, Kisselback recommended he do hemodialysis at home, as she does. Needles in her arm’s artery circulate her blood through a dialyzer as she sits in a chair, making cards or reading, for several hours, five nights a week. Her diet is not strict.

Varin said his sister, who died 10 years ago, worsened for years with her underdeveloped kidneys after contracting an infection. She was the first patient of Dr. Thomas Schumacher, now the nephrologist for both Varin and Kisselback.

“I’m trying to get over that way of thinking, but it’s pretty tough. Especially when the doctors come to you and you know about these infections…and you’re like, ‘Man, what do I do now if that happens to me?’” Varin said.

“You can’t live in that world of ‘if,’” said Kisselback.

“Still, a lot of that ‘if’ comes at you,” he responded.

When Kisselback first met Cassidy, in 1992, she had just been diagnosed with kidney disease. The social worker was speaking at an informational meeting about the disease.

“She calmed your fears,” said Kisselback. “Like Rufus is doing right now, going into a situation that is totally new to him, it was totally new to me. She made me more comfortable with the idea that this sickness is something that, they can’t cure it, but they can give you treatment that will extend your life and will allow you to live a normal life. I was very fearful of what to expect. Even in terms of getting an actual transplant.”

Two years later, Kisselback was on peritoneal dialysis, but her health was worsening. The Stempel home had burned in 1988. In 1994, Kisselback and her brother, Brian Stempel, were looking at an upstairs room with a freshly laid floor and new Sheetrock on the walls when he offered his healthy kidney to replace hers.

“He saw how sick I was getting,” said Kisselback. Tired by high concentrations of toxins in her body, she would sometimes fall asleep in the loader she used at the mill to move lumber.

“I actually kind of refused him at first, but he was serious,” she said. “He had no qualms about it whatsoever.”

Bartholomew

Growing up, Kisselback played field hockey and tennis. After she recovered from receiving the transplant, she was able to be active again. She and Brian competed in the Transplant Games sponsored by the National Kidney Foundation. She won a silver medal in racquetball in 2000 and competed as part of the New York team three more times.

Money for their team was collected in bake-sale and silent-auction fund-raisers with music and crafts at the sawmill.

Kisselback named the kidney from her brother “Bartholomew.” It lasted until 2006.

She was back to peritoneal dialysis, but an injury sledding with her niece ripped the inside of her abdomen. She was told she would have to wait in a hospital bed until space opened at a dialysis center. That’s when she started dialyzing at home.

Currently undergoing tests, Kisselback will find out if she can be put on a waiting list for a new kidney in the fall. It could take at least a year before she gets the surgery.

Under Medicare, she will get most of the costs for expensive immunosuppressant medication — to keep her body from rejecting the transplanted kidney — covered for three years. With the disregard for pre-existing conditions brought by the new federal Affordable Care Act, she is hoping in 2014 to switch to a private insurance company to cover her costs.

“I’ve seen enough improvement out of this dialysis that, if there’s a good chance with a kidney, and there’s a good chance to progress along further, I’m willing to try it now,” said Varin on Tuesday. Speaking with Kisselback, instead of reading a pamphlet, gave him some hope.

Kisselback says she feels better now than when she had the transplant, but her doctor has told her it would be better for her health to have a new kidney. She still plays tennis and goes for regular walks over the hill behind the mill.

“I went sledding just this past winter,” said Kisselback. “My niece came up. There was a little bit of snow left. We had a ball.”

Kisselback wants to revive a garden in memory of her father at the end of the long road leading up the hill.