Monday, November 16, 2009

As my pal Mazen says from time to time,

"Deez? Eez bool-cheat."

Yes, it is. It is indeed bool-cheat.

I fear my gallbladder is on the fritz. (Slightly used, low-mileage gallbladder: anybody got one?) After my twice-monthly cheezburger last week (nom nom nom nom), I was down for two days with abdominal pain, nausea, vomiting, a low-grade temp, and other things you really don't want to hear about. Since then, my right upper abdominal quadrant has hurt like a son of a bitch, and I really don't have a lot of appetite.

Friends came over last night for homemade bread, beef stew, and apple crisp, and I didn't want any of it. That, my friends, is how bad it is. That is how much bool-cheat we're dealin' with: When Mama don't want to eat, you might as well kiss the world goodbye.

I see the Muppet Doctor tomorrow for what I hope will be a diagnosis. I sincerely hope it's not a toomah.

So I wasn't in the best of moods when I showed up to work today.

I was in even less of a good mood once I saw my patient.

Eight drips.

Eight. Freaking. Fluids. Going. At Once.

Lasix. Insulin. Levothyroxine. Bicarb. Two pressors. Fluids. And a rider for the mag and potassium and everything else we had to hang.

My bad mood turned worse when I found out why this poor guy had eight drips on him:

One of those "devastating" bleeds.

Young kid, mid-thirties (anybody younger than me is a "young kid"), two little children, loving wife, close enough to his coworkers that they consider him part of the family.

And a devastating bleed with no history of anything: no hypertension, no diabetes, no nothing. He was brain dead when I showed up, and did not improve.

It was a bad day for me and for him.

It's gonna be a good day, though, for a whole bunch of people, and here's why:

His kidneys are going to two different folks who have both been on the transplant list for a couple of years.

His liver is going to a guy who was sent home on hospice last week.

His heart is going to somebody.

His lungs? Going to somebody.

His pancreas, amazingly, is going to somebody else. (Pancreas transplants usually work best when the donor is very young; this guy was in great shape, so we can use his pancreas.)

Bones? Skin? Tendons? Intestines? Nerves? (They transplant *nerves* now? The transplant coordinator assured me they can.) Corneas? Check, check, check, check, check, and ditto.

There are going to be at least ten people, by my calculations, who have this one person to thank for their lives, their vision, their ability to produce insulin, and their ease in walking. Never mind the at-least-five people who will have skin grafts thanks to him. Never mind the folks who will get bits of intestine that will allow them to have something close to a normal life again.

It was horrible, and it was wonderful. In the middle of drawing the nearly forty tubes of blood that needed to be drawn prior to "harvesting" (or "retrieval", as some people call it, but I prefer "harvesting"), I realized that this one man, though he was lost to his family and his friends, would *literally make living possible* for any number of people.

Young people make fantastic donors and really, really crappy patients. Inertia will only take you so far, and sometimes the dead are harder to keep breathing than the living-yet-very-sick. This guy, despite all the odds, managed to get off his pressor drips and his insulin and everything else well within the time limits specified by the transplant experts; he ended the day on nothing but plain normal saline. That means that he'll be scooped out (to put it bluntly) like a melon, with wooden dowels replacing his bones and clothing covering his skin donor sites.....

....but there will be a handful of people who have him to thank for their lives. Their LIVES.

Most of us, me included, can't guarantee we'll touch that many people in a lasting way in the course of a career that stretches twenty years. He did it in one day.

It was sad. It was happy. I watched the transplant nurse's computer, and saw how all the acknowledgements came in from various transplant centers. I imagined how it would feel to have that beeper that's stayed silent for so long finally go off, and to know that your second chance came at the expense of somebody else's.

When, not if, but when my aneurysm blows and I infarct at least one half of my brain, do this:

Take what you can. I don't care how tricky or political or corrupt the system is, the ends justify the means in this case. Use my kidneys, my heart, my cruddy lungs, whatever.

Donate the rest to a medical school. They can have fun studying my muscles and my skull, if nothing else.

Compost the rest out in the back yard, and plant a garden over it. In the high summer, when the produce is ready to pick, go out and grab a tomato off the vine, polish it on your shirt, and bite into it. My epitaph will read, "That Jo! She was one heck of a tomato!"


Penny Mitchell said...

I'll do the last three paragraphs for you, if you promise to do them for me if you die first. I am not even remotely kidding.

In order of importance:

!. Harvest, harvest, harvest. The only things I know for sure won't have takers are my corneas.

2. If that's not possible, cadaverize me, baybee. It would be my honor. I'm not being a smart ass. For once.

3. If THAT'S not possible, call these guys:

When you get my ashes back, throw some of them off the summit of Pike's Peak and then get really, really drunk. You have your orders.

Sunflower RN said...

Eh Toots,

Sorry about the Gallbladder. Had mine out a couple years ago in day surgery. Mucho impresso. It was my first surgery ever, and apart from the nurses knowing me, it all went according to the plan. A little ativan pre-surgery, T3's till the nightmares get too much (about 3 days worth) and leave the steri strips on a bit longer than the doctor says (my belly button opened up and took 6 weeks to heal up again).

bobbie said...

Bless your patient, and his family, for having the brains, courage, and compassion to donate ~~
Bless you for helping him live out his last wish ~~~
Off to cry a bit now...

VetRN said...

If it's the GB, don't wait--just let 'em yank the sucker. I held off for close to 6 months, nauseated and in pain. Felt like a million immediately afterward; a completely uneventful recovery, able to eat anything. Took a total of 2 vicodin afterward--one the night of surgery so I could sleep, and one two days later when I overdid the activity because I felt so good. Best wishes!

Gretchen said...

A friend's daughter had leukemia (2 different forms) from the time she was tiny until she was 11. I think she had 2 bone marrow transplants. She's doing fine now. At the time I thought how sad it would be if they couldn't find a match, and what if that match was me and I wasn't signed up. So I signed up. I was already signed up as an organ donor. Remember the marrow donor registry too!

Brian said...

I'm one of the people alive today because of the generosity of another young man much like you describe. I was 30 yrs old in May of 2007 and at the end of a fight with Cardiomyopathy and secondary CHF. I am a veteran and did two deployments to the Persian Gulf which is where they think I came down with my problem. Anyhoo, I'm now starting Nursing school next year and plan to work in the transplant community in one way, shape, or form.
You said it best when you said that people will have reason to thank this young man for the rest of thier lives. I know that I think of my donor on a daily basis.

Best Wishes,

Jennifer Thorson said...

My dad lived an extra 12 years because someone donated a kidney. It meant that he got to see me grow up, see me graduate college, meet my future husband. It meant everything.

I believe in an afterlife, but I don't believe I'll need my body for anything when I get there. I've told everyone who might ever need to make the decision that I want EVERYTHING used. Whatever they want they can have.

Penny Mitchell said...

What Gretchen said!!!!!! One of my dearest friends when I was growing up died of aplastic anemia...the national bone marrow registry was just getting started. I've been registered with them for years. One time I was a very close match, but another donor was closer. I would do it in a freaking HEARTBEAT:

Thank you for mentioning this, Gretchen!

Crabby McSlacker said...

The young man's death was such a tragedy--but it's incredible he helped so many people. Seems like donation should be the default option, and those who want to keep their organs should have to opt out. Too many folks just don't want to think about it.

Love that cartoon btw.

woolywoman said...

Life is good. Giving people more of it, when you really can't have any more yourself- well, that is good, too.

Jo said...

I was about 10 when my father explained what the organ donor register was and what it meant. I was too young at the time to sign up for myself, but my dad promised me then that if the worst should happen before I turned 17, then they would allow any part of me that could be used to be taken to help someone else.
I have not changed my mind at any time in the intervening 18 years. I now live in NZ, having moved from the UK, which means that (until they develop a blood test for CJD), I am restricted on what I can give, but I'm happy for them to have anything they want - it's not as though I will need it!