Chapter 4: Eat a dick University of Washington

Filed under: @ 6:16 pm

Cover it with malaria and leeches, sprinkle on some dengue fever and eat a big God damned jungly DICK!
(With apologies to Uncle Jeff for the use of the language and to Archer for the use of the quote.)

Andrew was first listed through the University of Washington’s transplant center because his primary nephrologist is associated with the University of Washington’s health system.

We started the process through UW. By the way, I say “we” because while it was Andrew having the tests done it was me that was driving him to however many of them required a driver and because the primary caretaker of the transplant patient has to attend more than one orientation session and at least one 8-9 hour series of appointments with everyone from God on down.

When we went to the first of these marathon appointments we were both a little put off by the transplant coordinator that had been assigned to Andrew’s case a woman named “A”.
Andrew’s beef started with A insisting that he have a pile of paperwork filled out, but then not giving him time to fill it out. A plonked us down in front of a video presentation and, granted, Andrew was supposed to be giving it his full attention, but when you’re dealing with an adult and you wish him to watch the video now and fill out the paperwork later you tell him that. You don’t, wordlessly and almost absentmindedly, twitch the paperwork out from under his hands as if you were removing a 6 year old’s finger from out of their nose. Andrew was supposed to have the paperwork filled out for the rest of the appointments that day and he never did have the chance to complete it because A never gave him the time to do it. I filled out most of it while Andrew was being examined by medical personnel.
My major issue with A was that she seemed disbelieving of my role as a medical professional. A was giving us the preliminary “pets are a constant source of contagion for an immunosuppressed person” speech and asked about our cats’ vaccination status. I told her that they were both fully vaccinated completely indoor cats. A asked who their veterinarian was and who had given them their vaccines. I told her that I had given them their vaccines and *I* was their veterinarian. Now to be fair I am interpreting A’s response to that statement based on her facial expression and not anything that she said, but when someone looks like they’re about to roll their eyes at you the fact that they don’t actually roll their eyes at you doesn’t change the expression on their face. I still don’t know what her issue was with regards to our cats and/or me being their veterinarian, but I did take them to work with me the next day and ran a battery of tests proving that they weren’t parasite ridden bacteria farms.
The rest of that appointment was pretty straightforward with regards to our interactions with the UW transplant service. The pharmacist, social worker, and financial advisor answered all of our questions. The medical personnel were polite and thorough. The surgeon, in fact, not only was enthusiastic about me being able to understand his medical jargon, but was quite interested in being able to discuss the organ transplant process with me from the standpoint of a surgeon. Near the end of the appointment the surgeon told Andrew that he needed to lose some weight. Andrew was carrying a lot of fat around his abdomen and abdominal fat, subcutaneous or intra-abdominal regardless, makes abdominal surgery more complicated. Or at least more annoying.
That, however, was all the surgeon said. “You need to lose some of this man-belly, but I don’t see any reason why we shouldn’t proceed.” I remember that part very clearly. This was also the surgeon who told us that even if all of the testing had been done and we had a properly vetted donor right outside the door that it usually takes at least 2 months to get from there to the surgical suite because they’re so busy doing transplants for people who are matches to deceased donors. Under the circumstances having 2 months warning, as it were, seemed perfectly reasonable. 2 months is plenty of time to get the rest of your life organized when you’re going to be spending a month in and out of surgical suites and recheck appointments.
So Andrew was placed on the deceased donor list conditional to completion of the required testing and, and I quote the paper work, “ongoing weight loss”.
Fast forward a few months. January to be exact. All the required testing was done, Andrew, who had lost 10 plus pounds, went in for another appointment with the transplant team.
Here’s where our serious complaint with the UW organ transplant center begins.
The interpretation at that January appointment was that Andrew hadn’t lost sufficient weight with the implication being that he had been given a specific goal – a BMI of 30 – and that he was deliberately being non-compliant about that goal. Andrew would continue to climb the deceased donor list, but he’d be put “on suspension” for 3 months. This meaning that should a good match come up during this time he’d be passed over, but when the suspension was over he wouldn’t have to start at the bottom of the list again.
Andrew was referred to a nutritionist, who basically suggested that he remove the skin from the chicken that he ate (we almost always eat skinless chicken) and start measuring the amount of olive oil that he uses when he cooks. As much as was possible for a guy who has other medical issues AND was prone to being anemic Andrew tried to increase his exercise. So for 3 months we kept on keeping on as much as was possible and Andrew got his weight down to the point where his BMI ranged between 30.5 and 30.9.
Come May and the follow up appointment with the U.W. transplant team Andrew was told that despite all he’d done his BMI was still too high, but they dangled the one last hope of a follow up appointment with one of the transplant surgeons as a Hail Mary. If the transplant surgeon was okay with going ahead with the surgery with Andrew at his current weight then he’d recommend that to the transplant team. The whole team has to be on board with the procedure. The surgeon’s opinion means a lot, of course, and the opinions of Andrew’s primary care provider and his primary nephrologist meant a lot, but if the whole transplant team doesn’t agree the surgery doesn’t get scheduled.

The appointment with the surgeon came and the world came crashing down. Andrew’s BMI was still too high, he needed to have a BMI *under* 30. The surgeon was too concerned about the excess abdominal fat being a predisposition for complications and postoperative infection to be comfortable recommending surgery.
This is bullshit by the way. I do abdominal surgery on obese patients all the time and while it is annoying to the Nth degree it doesn’t predispose to postoperative infection. Also the fact that Andrew had to be on steroids for immunosuppression during the transplant process was going to SEND HIS DIABETIC CONTROL INTO A TAIL SPIN (despite Andrew’s primary care provider having contacted the transplant team stating that he was, based on his experience over the previous 25 years, certain that it wouldn’t). The surgeon recommended that Andrew consult with the bariatric surgery service and undergo gastric bypass surgery so that he could lose a whole bunch of weight – like 80 pounds – and then try again.

Andrew called me when he got done with this appointment. I literally had to leave work in the middle of the day.

It would have been a month before Andrew could have gotten an appointment with the bariatric surgery service. Add a couple of months before gastric bypass would have been able to be scheduled. Call it a year of postop recovery and weight loss before Andrew would have been able to re-present himself to the transplant team again. And for all of this, round numbers, 18 months or so Andrew would have to be doing hemodialysis because ain’t no surgeon anywhere in the world who is willing to have a patient bathe their intestinal surgical incisions in peritoneal dialysis fluid and metabolic waste products every night. To say nothing of the complications of maintaining proper nutrient intake for a patient on dialysis while he’s only able to eat about a cup of food at a time.

Didja notice up above there where I emphasized that the University of Washington transplant service wanted Andrew to have a BMI of under 30?
Didja know that Dewayne “The Rock” Johnson’s BMI in 2015 (the latest information that my super fast Google search could find) was 34.9?

I would have thought that either Andrew or I had mis-heard at some point, that we’d really been told that Andrew needed to have a BMI under 40. Except for the fact that at one of Andrew’s appointments with A she told him the specific number of kilograms he needed to lose to bring his BMI from 31 into the 30 range. When Andrew told her that he could lose that amount in a couple of weeks she then said that the BMI needed to be *below* 30. Both of us remember different appointments on different days where different medical personnel had told us that the BMI needed to be under 30.

In summary then: the University of Washington’s organ transplant service gave us a list of very specific targets that needed to be hit prior to transplant EXCEPT one. The one target that didn’t get hit didn’t get hit because it was initially presented as a vague recommendation. When it became clear that a vague recommendation hadn’t been enough to scare us off they gave us a completely unachievable goal.

I believe the University of Washington transplant center’s promotional literature when it says that they’re the most successful transplant center in the U.S. I believe that they have the highest number of successful transplants in the nation because they refuse to consider anyone for transplant who has, as we call it in medicine, significant co-morbidities. If you’re a guy in his early 20s who has mashed his kidneys in a dirt bike accident then yeah, University of Washington transplant center is a good place to go. If you’re anyone else who needs a kidney transplant for any other reason don’t bother to waste your time.

So yeah. Eat a dick University of Washington transplant service. Eat an overflowing bucketload of syphillitic dicks.

One Response to “Chapter 4: Eat a dick University of Washington”

  1. YakBoy Says:

    I probably(?) mentioned this at the time but it bears repeating.

    Admittedly I haven’t payed any serious attention to how things work at UW for a long time but your experiences lead me to believe that not much has changed. The UW had (has?) one of the highest rates of turning people away from their heart transplant list and had one of the highest rates of turning down donor hearts in the country. They only accept the least complicated patients and the healthiest donor hearts so it’s no wonder their program looks as successful as it does.

    If you reject everyone that’s actually sick you can make it look like you cure everyone.

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