Tuesday, October 03, 2006

You think you can handle this?

Sometimes, this is my job:

"We do more before breakfast than most people do all day."
And sometimes, it feels like this:

"Faster than a speeding bullet, more powerful than a locomotive, able to leap tall buildings in a single bound. Look, up in the sky, it's...
Yet other times, it feels like this:

Recently, though, it feels like this:
"The hell you will. He's got a two day head start on you, which is more than he needs. Brody's got friends in every town and village from here to the Sudan, he speaks a dozen languages, knows every local custom, he'll blend in, disappear, you'll never see him again. With any luck, he's got the grail already. "
But in reality, I often feel like this:

"Hello?...Hello?...Does anyone here speak English?"
Recently, someone in the comments section asked me what it takes to be a transplant coordinator. Of course, I didn't read my comments, or surf the web at all, for like a month. So, I thought I make it into a post. Sometimes, it does seem like an army of one. Depending what hospital you're at, you're either surrounded my friendlies or behind enemy lines, but I'll take that analogy no further. Sometimes you do feel like Superman, you hit your groove, you haven't slept for 24 hours and you're going on pure adrenalin. And yes, occassionally I DO feel like the Grim Reaper, waiting around the bedside of a dying person. Although I want to be more like Indiana Jones (I even majored in Archaeology, a long, long, time ago), I usually feel more like bumbling Marcus Brody.
I don't want to be too snarky. It is a good job with a good purpose and I still like it. I will say this-my co-workers and I are an eclectic bunch. We're all idiosyncratic. We spend many hours alone in hospitals where we don't know the staff, don't know the doctors and don't know how the system works and yet, within a short period of time, we've got to get the system working and differing parties collaborating toward a single goal.
An ability to stay awake for long hours helps. It's very common to get a call at 5 or 6am saying that you have to be at a certain hospital in an hour. I've arrived onsite to find that the clinicals are already in progress and sometimes the family is ready to be approached. You spend the day managing the patient clinically, sharing the organs, coordinating the teams to come in. Inevitably, the OR is never at a sane hour. So by the time you get in the OR at 3am, you're fried and wondering if maybe a job in food service is the way to go.
Strong clinical skills are a definite requirement. Every donor is different. Some are hemodynamically unstable from the get go. Think a gun shot wound to the head or some other massive head trauma. They're in DIC, or DI. They're hypotensive from blood loss. Other donors are brain dead from anoxia, like a status post cardiac arrest. They may take a week to become brain dead and then you have all the problems of someone who's been immobile and on a vent for a week. Pneumonia, electrolyte imbalances, blood clots. Another challenge is the 180 degree turn in clinical objectives: from a head injury to an organ donor. With a neuro patient, you're trying to keep the ICP down, so you're minimizing fluids and maybe using 3% saline. You're clustering care and not moving the patient so much. After brain death, the patient becomes hypotensive from vasodilation and you're pouring fluids into them. To keep the Na low, or to lower it if it's already high, they're put on 1/2 NS. Suddenly you're asking for chest PT and frequent turning and suctioning. Inevitably, someone will ask, "why are we doing all this on a dead guy?" The best answer I've heard is that when you're taking care of an organ donor, you no longer have one patient, you have up to 8-one for every recipient who's going to benefit from these organs.
And that leads to the important skill:tact. You have to be a diplomat. Some hospitals do one donor a year, maybe. Some hospitals call you every week. Some now what they're doing, some don't have a clue. Some are very excited when they get a donor and are eager to work with you and some...well, not so much. In any event, you can't really go in their like gang busters and start telling everybody what to do. Well, you can. And some have. But it won't make you very popular and you'll make the next transplant coordinator's job that much harder the next time. Not that I'm bitter or anything, I'm just saying.
Add a large dose of compassion. And a good sense of humor. And don't take things personally. So, are you ready to see new places, experience new things and meet new people? And then take their organs? This job's for you.


Susan Palwick said...

Terrific post!

Quite a few years ago, now, a 25-year-old friend of mine had an asthma attack and wound up braindead on a vent. Her younger sister, her only surviving relative, decided to donate her organs "so maybe somebody else won't have to go through what I'm going through."

I've often thought about the donation process from the viewpoint of families, but never from the viewpoint of the transplant coordinator. Thank you for the insight. (And I hope you're submitting this to Grand Rounds next week!)

TC said...

Thanks. I'm always amazed at the courage and compassion people show when they decide to donate.

Robin said...

Yeah, good one. Nice closing line, btw. Gave me a chuckle.

Love Monkey said...

Great post if a bit bloggeresque. I like pictures, pictures are gud.

Hey, how about a post about your first AND exciting 48hours of triage.

I would like to go see the palio this year, how about you?

TC said...

Yeah, the triage was great until SOMEONE said, "it sure is QUIET so far." Then, all hell broke loose.

Mother Jones RN said...

I love your post. You have a great sense of humor about your work.

Anonymous said...

How does she do it, folks?

babe said...

i worked in a neuro unit for 30 years. and i always enjoyed taking care of the donor patients for the technical challenge and that little extra frisson that your work would care beyond this one patient. and everyone realized the amount of work involved. those patients were always 1:1, and occationally 2:1. or as we said - the dead are more work than the living!