Chapter 9: Thursday, August 22 3:25 p.m.

Filed under: @ 8:49 am

From the middle of July until the end of September my hospital was playing host to a very green new graduate DVM. His degree still squeaks when he turns around too quickly.

Dr. New was helping out while the other associate was on medical leave and he was intended to continue helping out during the time that I was out surrounding Andrew’s surgery.

We, the other two doctors and I, decided that we’d not be comfortable with leaving Dr. New to be doctoring on his own so we’d arranged our schedule so that he was on duty only when one of the three of us was also on duty. Not that we thought him incompetent, more that when you’re a brand spanking, and very squeaky, new doctor it’s helpful to have someone off of which you can bounce ideas, diagnoses, and treatment options.

I was standing at my desk in between appointments. I’d purposely scheduled my afternoon light that day because I’m the DVM in charge of the hospital’s control drug supply and I wanted to take most of the end of the day to do a control drug inventory. I try to get the inventory done at least once a month (Shhh! Don’t tell the pharmacology wonks. Their opinion is that a multi-DVM hospital should have a control drug inventory done once a week.) and I thought that a very careful inventory would be ideal just before I was gone for a month. I also didn’t want the tail end of what would be my last day at work until early October to be clogged with patients that I’d be starting to work up then having to transfer to another DVM.
So I had a few appointments left on my schedule for that day. Dr. New had a full appointment schedule that was intended to keep him occupied until closing.
I was discussing options for diagnosing and treating a difficult bacterial otitis externa when my phone boinged. My text message sound is a very penetrating boing, so when my phone boings I want to get it to shut up ASAP.
I flipped over my phone while chatting about infected ears with Dr. New.

It is a common literary device to have your protagonist’s voice “just trail away into silence” when they’re shocked by something. I’d always kind of considered the idea a little -well fanciful isn’t quite the word. Fantastical is closer. Surely anyone can manage to at least complete a sentence regardless of how sudden or severe the shock.
I was wrong.

This is what I read:
“Surgery is off. They found another area of potential blockage. They want to do another cardiac cath first. Will call me with the schedule for that ASAP.”

I was literally incapable of coherent speech. Fortunately I have a couple of staff members who are very good at reading my moods and who are experienced enough that they know the diagnostic and treatment steps for simple medical issues. M caught a look at my face and towed Dr. New off into the other room while I shot out the back door (there are no private offices in our building, it’s a VERY small hospital) to call Andrew.
I called Andrew.
I called Dr. Boss who had been on the schedule for the day, but had gone home early with The Crud. Dr. Boss was asleep so I left a message for her.
I called the office manager who isn’t in the office on Thursdays. I told her I had to leave. Now. That I was going to have the front staff reschedule the rest of my day because I couldn’t be of any use to anyone and that I’d be in contact with her as soon as I could to let her know whether I really was going to be starting my leave the following Monday.

I went back into the building, went straight up to my senior receptionist and told her that she was going to have to reschedule the rest of my day because I was going home. My senior receptionist, fortunately, is also very canny at reading my moods and she could tell from my affect that Something Bad had happened.
I went into the treatment area to talk with my two senior technicians. M, who is a lovely girl and a talented veterinary nurse, is also one of the most insecure professionals I’ve ever run across. Looking back on it I can tell that she knew from the tone of my voice and from my actions that Something Catastrophic had happened and it scared her badly enough that she had made herself scarce.
So I talked to H, who is lovely, talented, and pretty much not scared of anything. I told her that she’d have to babysit Dr. New, that she should call our office manager if she needed anything and that I was leaving so I could go somewhere private so I could scream. Incessantly.

And then I packed up my things, got in my car, and drove home.


Chapter 8: Thursday, August 22nd 1:17 p.m.

Filed under: @ 4:53 pm

Again, verbatim from the SMS feed:

“How you doing?”
“Stressed out. There for three hours. Damn good thing I didn’t eat any breakfast because I was supposed to be NPO. If I had [eaten] I wouldn’t have been able to take the test.”
“Christ! Did they say anything?”
“Not yet. The results should be in this afternoon, though when they will actually call me is TBD.”


Chapter 7: Wednesday August 21st.

Filed under: @ 8:54 am

And I quote verbatim from the SMS feed on my phone:
“I have to fucking go back to fucking Swedish at fucking 715 tomorrow fucking morning to take another fucking cardiac stress test because the fucking surgeon fucking doesn’t fucking like the fucking fact that my last fucking test was done exactly one fucking year ago. Fuck.”
“Fuck, that isn’t going to delay things is it???”
“Only if they find any new problems.”


Chapter 6: The Swedish Connection

Filed under: @ 6:31 pm

I’m not certain who it was that recommended the Swedish Transplant Center to us after UW finished jerking us around. Probably Scot who, after all, has pretty impressive experience with organ transplant.

Regardless, we made our overtures to Swedish and got an appointment — one of those all day, talk to everyone from God on down appointments — pretty briskly.

From the get-go the impression we got from the Swedish Transplant folks was much, MUCH different.
At the all day UW appointment we were given the “here’s how this is going down” video to watch at home and then again with Andrew’s charming transplant coordinator. Meaning that if we had questions we had to write them down and figure out who to ask them to or ask them to a woman who really gave us the impression that we were a nuisance to her.
The all day Swedish appointment started out with a small group of transplant postulants and their support people and a moderator. We watched a very familiar “here’s how this is going down” video, but the moderator not only narrated the video, but would stop it and answer questions on the spot when someone had one.
Working through the UW transplant process we were left with the impression that we were being told “Here’s all the ways this can go badly, don’t screw it up!”. What we got from Swedish was “Here’s all the ways this can go badly and here’s what we’ll be doing to help you keep things from going badly.” They made it seem very much more like a cooperative relationship rather than a superior/subordinate relationship.

Every single medical person we saw that day was absolutely gobsmacked at the idea that the UW didn’t want to proceed with the transplant unless Andrew’s BMI was less than 30. Every. Single. One.
We got so many double takes and “A BMI of less than 30?! Really?!!” that we started betting whether or not the next person we saw would say those exact words.
But we ran through the lineup of nephrologists, pharmacologists, social workers, fruit bats, and crunchy frogs. We ended that day with the assurance that, pending the transfer of all of Andrew’s pre-transplant screening test results and all of Curt’s pre-donation screening test results, there didn’t seem to be any major concerns with proceeding with the transplant.

Which leads me to another point about which the UW transplant service can eat a dick.
When we first met with the transplant surgeon at UW he told us that if Andrew’s tests were all complete and we had a properly screened donor right outside the door that it’d still take two months before the surgery could be scheduled because their transplant schedule was so full.
(I have to pause here and say: “HOW?! With all the bullshit you pull to transplant only the healthiest of people who need a kidney transplant, HOW can the UW transplant service be that busy?!”)
We had our orientation meeting at Swedish in early June. The medical records and test results were all transferred by mid-June. Swedish cleared Curt as a donor in early July, and Andrew finished what we thought would be the last bits of the needed testing in mid July.
On August 8th Andrew sent me a text letting me know that the surgery was scheduled for August 26th.
Two months my butt!


Chapter 5: The Gift of Life

Filed under: @ 1:27 pm

I’ve done most of my writing about this process from the perspective of the kidney recipient and someone on the deceased donor transplant list.
If you’ve got a driver’s license you’ve been asked whether or not you want to be an organ donor. Your preference is listed on your driver’s license because not counting the current glut of donors deceased due to opiate overdoses, motor vehicle accidents are probably the #1 source of organs for people who need them.

(I’m tempted to pop in here with a joke about Invader Zim and more spleens meaning that you’re more human, but I’ll leave the low hanging fruit.)

Certainly if you don’t have any moral objection to it you should be an organ donor You’d be amazed at what can be transplanted, even from older people, in the event of your untimely death.

Untimely deaths aside, though, being a living organ donor is the most precious and most impactful gift you can ever give anyone.

When Andrew announced that he was going to eventually need a transplant he had offers from four friends, two family members and me. I don’t count Andrew’s brother’s as an “offer” because basically what David did was to pick us up at the Honolulu airport when we were visiting for Christmas one year and spend the entire trip from the airport along H3, over the Pali mountain range, and over to the windward side of the island explaining to Andrew how he *was* going to donate a kidney and Andrew *was* going to accept it. So it wasn’t really an offer in the classic sense of the word, but I’m not entirely certain what to call it besides incredibly sweet.

For one reason or another most of these very generous offers fell by the wayside. Andrew told me in no uncertain terms that I wasn’t allowed to put myself under consideration because he’d need me to be whole and mobile throughout the process and I wouldn’t be if I were recovering from surgery myself. This did not, of course, keep from contacting the donor registry service to start the process, but when Curt started looking like a more viable option, and when the donor registry people started disliking my family history of essential hypertension I dropped the matter.

Any transplant center that deals with living donors has two branches. The recipient’s medical/social/pharmacologic/social services and the donor’s, and never the twain shall meet. If you put yourself forward as a living donor first and foremost they look at you under a microscope to be sure that you’re neither being compensated nor are you donating under duress. Then the medical testing starts. Of course the transplant center is interested in having the best possible organ for the recipient, but they’re equally interested in having the best possible outcome for the donor. If there’s even a scrap of a predictable chance that you might have adverse complications from having an organ removed you don’t get to do it. I’m certain that there are sound medical and legal reasons for it, but I’m also impressed that, literally, the recipient’s medical team don’t know the donor and probably vice versa. I mean, certainly the physicians and surgeons on one side know the *name* of the person who’s on the other side of the process, but I know that Andrew’s medical team didn’t know Curt to look at and most of them didn’t even know the relationship between the two men.

Another interesting option for living donation, at least in the kidney transplant circle, is a chained donation. If person A needs a kidney and person B wants to oblige but isn’t an appropriate tissue match…. (Please don’t ask me the details on that. I have the barest understanding of the tissue matching process and if you want to know why I, as a medical professional, don’t understand this part of the medical process the answer is that the vast majority of my patients DON’T EVER HAVE organ transplants. That said, there is a feline kidney donor program at the veterinary school at U.Cal. Davis.) where was I?
Chained donations, right.
Anyway if A needs a kidney and B qualifies, but isn’t a match for A, the transplant center can reach out to other transplant centers to look for a match for B’s kidney. C gets B’s kidney and so long as D is a match for A then A gets D’s kidney. If D isn’t a match for A then the transplant center looks for E and F and so on. According to Swedish the longest chain donation to date is five kidneys. Just the thought of the logistics of that organization makes my head spin. 10 patients, probably at least three transplant centers, a couple dozen surgeons, thousands of support personnel, a centralized date book complex enough to need string theory to explain it, and all of it has to be coordinated and completed within the same 24 to 48 hour period.

Of all of the multitude of things that I’m grateful for with regards to this process, one of the largest is that Curt was not only an acceptable match for Andrew, but that we all live within a short (relatively) distance of all of the necessary services.

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