Emotional see-saws are experienced by the patient approaching end-stage renal disease (ESRD). Behaviors exhibited by the patient-learner are often complex and unpredictable. The physiologic changes of a toxin-filled body dull the sensorium, distort and cloud the memory, interfere with concentration and disturb sleep patterns. Under such conditions of physiological stress, mental stress is added as hemodialysis nears. All too often, educational preparation for treatment starts here.