Wednesday, February 15, 2006

Off my game

Did my first "ask" yesterday since I've been back. Didn't go well. It was worse than a no would have been, because the family was noncommital-they wouldn't give me a straight answer. To make it worse triage sent out the orientee to watch me. And she's great! The type of person who, immediately after meeting, you want to be just like them. Good personality, lots of energy. I felt unkempt and uncouth next to her and didn't even blame her for felling that way.

Probably it wouldn't have made a difference how I asked the family, but I felt very passive when I did it. And they were very passive about giving me an answer. There was a culture thing, too, going on. They were not from the US originally. They kept saying,"He's not healthy enough to donate." Over 2 days I tried 3 times to get an answer but they just wouldn't give me a yes or a no. Finally, they just shook their heads no.

Last week I spent 2 days on a case and the patient coded(see "Like Wading Through Taffy"). Then I had 2 days on a case I was SURE the family was going to say yes. At the end of the second day they said no because they felt that if the patient wanted to donate, she would have told someone, because that's the kind of person she was. Since she had never mentioned it, they felt she didn't want to donate and they wouldn't go against what they perceived to be her wishes. I mean, there's really no debate when it comes to following the person's last wishes. It's not like they had a skewed conception of what donation entailed, like people who think we're gonna mutilate the body or that they have to pay for it, etc.

I'd be lying if I said my pride wasn't hurt. Dammit, I should be able to get a consent, at least one out of three, not 3 swings and misses. It's not about me, though, and that's where the guilt comes in. In "It's a Wonderful Life" Zuzu says, "Every time a bell rings, an angel gets its wings." In my job, every time someone says no, another person dies. Today, that responsibility hit me hard. What could I have done different? How could I have gotten them to say yes? Then I'll have the Monday morning quarterbacks telling me what I should have done differently (pride, again). One of my coworkers put it succinctly. The people that need organs can't come and tell families how badly they need that organ, so we have to speak for them. I just wish they'd all say yes.


may said...

i just had to. i linked you. right away. after i read this post and been to your blog for the first time, through emergiblog.

i feel very strongly about donation. and "transplant coordinator" is one area i'm trying to look into. i've only met a transplant coordinator once, when i had my orientation in ICU. organ donation is still in it's very young stage in the philippines; the idea is fresh and interesting to me.

i can almost feel your frustration; and it makes me feel inadequate, like i don't think i'll ever be good at it.

i'll surely be back to hear more of your stories.

sorry for a very long comment.

Kim said...

TC, this is an unbelievable blog and you are going to get linked to "Emergiblog". What an wonderful perspective to have; one that we as health care workers don't usually get, at least in the ER.

A college friend of my son is now alive because FOR THE SECOND TIME, she has been able to receive a transplant.

This time it was liver, pancreas, stomach and small intestine. God bless the donor and their family.

I used to have to ask the family about organ donation, in the ER. I would always preface with the question, "Did Bob ever talk about how he felt about organ donation?"

By the way, my dad died suddenly at the age of 62 of a massive pulmonary embolism after having a massive stroke. He was an organ donor and they were actually able to harvest muscle and bone. It was great.

Thanks for the work you do, TC. There are people alive today directly because of you.

TC said...

God bless you and your family for donating. Most nurses I work with are either very, very pro donation and eager to find out all they can, or else they're like"oh, no. The organ people are here." Whenever I have a donor, I'll tell the nurse, "Someone is going to get the best Christmas (Easter, Mother's Day, etc) ever, because of the gift they're going to get."

Mama Mia said...

My husband is a living kidney donor. The recipient is a good friend of ours.

I cannot imagine the agony of needing an organ knowing that there are perfectly good ones being buried. Thank you for your work in this field. Trust me that everyone in my immediate family is listed as a donor on their health cards, and that our close family knows it.

Daniella said...

Thank you for the work that you do. It sounds like you are facing much challenge, education is definitely the key but I don't know how much you can tell people about the very sick patients who are waiting for a second chance at life.

It is terrible to bury a gift of life. People say no because they don't understand that they are inflicting the same loss on someone else's family.

Personaly I feel that it should be mendatory most people have their loved ones embalmed and that is a harvesting and without real benefits.

Internal Medicine Doctor said...

cool stuff. tough break on the "no"s but I'm sure it'll turn up sometimes.

One thing though, the first thing you learn on this job is that you can't blame yourself for these things. you give it your best shot, which is better than others have done. People don't die because you failed, they die because they have a horrible disease, and that's life. It sucks, sometimes.

Carrie said...

I sympathise.

But I have to say I'm appalled at the comments here for two reasons.

1. Complete lack of regard for the person who is dying, has died, or will die.

2. Lack of consideration that the prospective donor's family is suffering emotionally. To be expected to make that kind of decision, to hurry up and let their loved one die because oh, someone else will live who deserves to, is very upsetting.

Emotions are as much a part of healthcare as is the physical body. Why is there such disregard and disrespect for a family or individual who chooses NOT to donate?

I am very glad to see Internal Medicine Doc's comment. The truth is, without all these advances in medicine, people would die in greater numbers. If a person dies because they do not receive a transplant, that means it was their time. It's very tragic and upsetting for all concerned. But to devalue the life of one person over another, simply to make a sale (get a yes on a donation request) is heartless.

That Girl said...

Dear Carrie,

As a parent who might see both sides I dont see anything wrong with the post. You blithly assert that "it was their time" if someone dies because they dont get a transplant in time - where's all that blitheness when it comes to the donor.
No one is forcing people to die faster for organ donation - they dont take organs from people that are effectivly dead.

My son has a congential heart defect which made it very likely he would die soon after birth.
I wrote a letter and carried it with me throughout my pregnancy making it clear that he was an organ donor (in case i was incapacitated).
No one else even brought it up, which I thought was odd.
I think it's a shame that those kind of decisions are left for you to discuss with greiving families rather than people considering these things ahead of time when emotions are not running high.
Im sure I would've been very hard to talk to if the first time organ donation occured to me was when my son was dying.
I also find it incomprehensible that mothers do not get this issue right away - if your own child dies its horrible but how wonderful that a tragedy could allow you to "mother" someone else - literally give them life.
Ironicly, the fact that my son lived makes it possible that one day he will need a donated heart.
I can only hope that if it comes to that another "mother" steps up.
Thanks for doing the hard stuff TC!

Keith, RN said...

Great blog. Just found you via Grand Rounds. A link is in your future....

It's not a failure on your part---it is simply human nature and the complexity of such. You are doing an amazing job that many wouldn't do for any salary. Just stay faithful to yourself and your principles and the right people will come along at the right time.

Thanks for doing such important work in the world.

Anonymous said...

I'm glad Kim mentioned her father's donation at age 62. I'm several years older than that and in general in excellent health, though I did have polio as a child and now have post-polio syndrome, though primarily just in weakened legs and fatigue. I've wondered if elderly persons have anything worth donating when we die. I've discussed it with my family and signed the DNR. Now, I think I'll sign the donor cards. Who knows? There may be something within me when my time comes that can be used. I think it's up to me to prepare my family and friends to be really okay with my donating, right?