This one's just for Roy at CORE

Aaaah, Roy. No more will your warm, friendly voice get me through the long, lonely nights of organ sharing. Sigh.

Full Circle

This weekend I ended up where I began. In the SICU where I got my first consent on my own. Saturday, I got what is probably going to be my last organ donation request for a while. The mom, who had already let go of her daughter and was preparing for her death, said yes. Because she thought it was what her daughter would have wanted.

This weekend was my last call for a while, maybe a long while. I'm taking a full time position in PICU, taking care of the wee ones again and working 12 hour shifts, which, as you all know, is only half a shift for me. Don't worry, the blog isn't going anywhere. I'll still be bringing you quality blogging the latest info on organ donation, and tunes. Don't forget the tunes.


I've been offered a per diem position, which I may take 'cause God knows one job has never been enough for me. Not to mention that little "mommy thing" I do on my days off. I'll also be working at a transplant center, seeing donation from the other side as it were. PICU gets the occasional kidney transplant and we also see a lot of cardiac and liver kids, but so far they get sent out to NY or CHOP for transplants. I'm going to ride my bike to work-how nice is that? I'm going to get reacquainted with the family. I'm going back to school. 3 twelve hour shifts and the blackberry is getting tossed down the toilet(only kidding, IT guy).


I am interested in hearing from other TC's....people from all walks of life seem to read this blog, but WHERE are the TC's. Busy working, of course. Who has time to surf when you keep a schedule like this? So, if you have a good TC story, please email it to me at the address above. Please keep it all HIPAA happy, thanks.

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So, there I was at 0315 Sunday morning. I was awakened at 0615 Saturday morning evaluate this patient. I got consent around 1800. Two and 1/2 years ago I asked another mom for consent all by myself for the first time. I was nervous as hell. I was waiting for a TC who spoke Spanish to arrive and help me out. Before she could get there, the surgeon told the family, "You can donate or we're taking her off the vent." I nearly crapped my pants. I did the consent and med/soc with a family member to translate. Between my Triage Spanish and her Spanglish we got it figured out. Why did they consent? Because they had a cousin who needed a kidney. Similiar family dynamics today, except I can't go into details because they'd be too telling. I will say that for the first time in 3 years I had a real ethical and moral dilemma. We convened the hospital ethics committee but I was still funky weird about it. Then I spoke with the hospital priest, who is awesome. Sometimes, the right person you need to talk to comes along at the right time.

The weird thing about getting consent is that it's such an emotional roller coaster for the requestor(at least for me). I'm always nervous. I want to find the right words to comfort the family. I want to phrase the request in a way that is most likely to have them say "yes". I usually wind up crying with them. It doesn't take much to make me cry. As Frank McCourt says, "My bladder is near my eye". If that isn't picturesque, I don't know what is. Then, when they say yes, there's such a relief. When I first started I used to take it very personally. Sometimes, if they said no, I'd be mad. Not visibly, I'm not an ass. But inside, I'd want to say, "Don't you know what a good thing this is?" Or I'd wonder what I could have said differently. If you look back to my earliest posts, I'd really take a bat to myself, imagining how many people died because I screwed up the request. Well, you can either get over yourself at that point or become a little nuts. I chose to get over myself. Now, before I ask, I say a little prayer for God to put the right words in my mouth and to help the person make the right decision for them.

Long ago I read somewhere that if a doctor or nurse assumes total responsibility for the successes, then they have to take full blame for the failures too. What I'm trying to say is, I'm only an instrument.

Anyway, it's after 3am, my circadian rhythm is at an ebb and my scrubs could stand by themselves, I've been wearing them so long. Dinner was a bag of Cheetos and a peach Snapple. Ymmmm. Oh, yeah, and a donut for dessert. Also, my partner in crime came out to help me and brought me an enormous iced decaf. I know what you're thinking. Decaf? At 3am? Trust me on this: if you give up caffeine that little 5 mg in the decaf really perks you up.

The OR isn't going to be until morning, so I'll get relieved at 0700. Immediately following consent, it's very exciting. I mean, it's sad, because you're dealing with the family but you're also like, "Yes! I got consent!" Then, there are a million things to do right after you get consent. Phone calls to make, paperwork to fill out and fax. Orders to write, huddling with the staff to go over the best treatments to maximize organ perfusion and function. It's like you've been sitting on your butt a lot of the day waiting for things to happen and then you spring into action mode. That was me at 1800. Now my butt is dragging and my teeth feel fuzzy and I left my little toiletry bag back home. Uck.

I spent a lot of the night working on lung recruitment. She had some atelectasis on the right, maybe aspirated. The nurses were amazingly helpful. I'm lucky to be on this unit, they practically don't even need me. So we got respiratory treatments on board, started Solucortef, Gave albumin and lasix. A repeat CXR, repeat ABG's. We did the "30 second PEEP", putting the PEEP up to 30 for 30 seconds, then down to it's original setting for 30 seconds, then repeat the whole thing 2 or 3 times. Do another O2 challenge and repeat the ABG. Both lungs wound up being recovered, along with heart, liver, panc and kidneys. I know what I said last week, and I stand by it, but it feels good to know you made a difference to seven people and all the people they'll touch in their lives. Feels good.

My coworker left around 5 and I spent the last 2 hours trying to figure out how to get everyone to the OR at the same time, with help from triage and inhouse. Ever try coordinating 4 surgeons, their assists, their perfusionists and all the people who are driving or flying them to the hospital. It's a little like trying to rustle cats. Thankfully, I only got a few minor scratches. Have you ever had one of those mornings where you literally want to kiss the calzuros of the incoming nurse? It was that kind of night.

Hopefully, this will be it for the call period. My sister is making Thanksgiving today. No, really. My neice and her fiance and my nephew and his wife are going to South Korea for a year to teach the heathens Korean children English. And they're going to be away for a year, so we're celebrating Thanksgiving early. Two years ago they left in March so we had St. Patrick's Day early. You gotta have priorities and my family's usually center around food. So hopefully, I can go home and sleep, then wake up and stuff myself silly.

See ya. It's been a fun 3 years and I'll miss you all.

p.s. Thanksgiving was REALLY good! We should do that about once a month.

Adults only!

Guess what, bored internets folk. You can get your blog rated. No surprise here:

Mingle² - Online Dating

This rating was determined based on the presence of the following words:

death (6x) dead (5x) whore (1x)

Just don't call me a Death Whore. Thanks.

Change of Shift

Monkey Girl has done an outstanding job at Musings of a Highly Trained Monkey. Check it out.

p.s. be sure to check out this one, it's a keeper. Seeking Words of Balm by Ambulance Driver.

This is why we do it...

There's a saying my friends and I have when we go backpacking. You're out in the wooks for three or four days without showering, living on gorp and couscous. By the time you hit a trail center you're a little ripe. People are looking at you funny and trying not to get to close. Like being out for 24 hours in a row, when you start to smell ripe and look a little weird from lack of sleep and eating out of snack machines. So we ask ourselves, "Why do we do it?" The answer, of course, is because it feels so good when it's done.


I've written a couple times in the past few weeks about trying to get consent and recover organs from less than marginal donors. "Extended criteria" is what we call them in my business. Now, extended criteria means(if I don't get it exactly right, I'm sure I'll be corrected) a donor who:is older than 50 with a history of hypertension or stroke, someone with a history of Hep B or C, or someone who's admission creatinine is >1.5. Apparently, NJ is the extended donor capital of the world, or something. When we go onsite, though, sometimes we are evaluating people who are far worse than just having hepatitis or a high creatinine.

Often I will get a doctor or nurse who tells me a patient is not eligible to be a donor because of x,y, or z. Sometimes it's something simple like pneumonia. As long as they're getting antibiotic treatment, they may be a lung donor, but they could donate other organs. People with brain tumors can donate-depends on the type of tumor and whether or not it's been resected. Bacterial meningitis also is not an absolute rule out. If they've been treated and have negative cultures, we'll pursue it.

There's not many absolute rule outs besides most cancers and HIV. Although some programs are recovering from HIV+ donors to transplant into HIV+ recipients, but I believe that's still considered experimental and would need a consent for research. Recently, we had a family consent but there was a strong suspicion of viral encephalopathy, maybe West Nile Virus. We wound up walking away. WNV is lethal to recipients.

Back to last weekend. I can't go into details but we had couple of referrals that just made you go, "ick." Several times I, as triage, had to listen to some bitching about why we were going onsite. (you know who you are!) I can't go into details, but the patient was what we would call a "train wreck." The family wanted everything done, even though it appeared she had been brain dead for a long time. Neurology wouldn't do brain death. Everything pointed to this being a no consent and, at best, we were looking at "liver only." Maybe. So why are we putting all these resources into it? Hanging out at that hospital, sending labs, supporting the family, etc. This isn't going to go anywhere, right?

Yesterday, the patient became a liver donor. The family consented, we were able to offer them the opportunity to donate and, AND, someone's life was saved. Someone got another chance at life. That's why we do it.

Let there be music...

And it was good. I finally did it. I finally managed to to master Project Playlist and get some tunes up. All it took was a large glass of wine, some chocolate and Kahlil Gibran. The baby helped too. She's too young for both the wine and the Gibran, but she says the chocolate is dee-licious. Today has been one frustrating day, but all my cares have melted away. Right now the music comes up automatically, I may change it to where you have to choose it. Let me know what you think.

I'm on call this weekend, the last call for a while. It's bound to be a doozy.

Among the hills, when you sit in the cool shade of the white poplars, sharing the peace and serenity of distant fields and meadows-then let your heart say in silence, "God rests in reason."

And when the storm comes, and the mighty wind shakes the forest, and thunder and lightning proclaim the majesty of the sky,-then let your heart say in awe, "God moves in passion."

And since you are a breath in God's sphere, and a leaf in God's forest, you too should rest in reason and move in passion.

Kahlil Gibran, The Prophet

Lover's Wish by Patricia Donegan

When I'm dead

steal my bones

cut them up

into Chinese carvings

a mountain, a sage

a heart, a leaf

to hang like stars

in the sky.

When I'm dead

make from my bones

a whistle for a child

a necklace to fondle at night

the dagger geishas use

behind silken screens

an incense burner

a comb for your hair

tangled on the pillow

a netsuke, smooth, soft

as mother's breast,

most of all make

a small clown face

that laughs a millennium.

When I'm dead

make art of my bones

bleach & dry them in the sun

pure white

startling as stars

turned round in your hand

like a porcelain cup,

then after holding my bones

my skull, arms, pelvis & feet

take my thigh bone

gently

make a flower vase.

(I've been wanting to post this for a while, it's so beautiful. There's a passage from Kahlil Gibran I like also, but it's pretty long. Maybe some other time-TC)

How was your weekend? Mine sucked.

This was my last weekend of doing triage for the time being. True to form, it was a lousy weekend. We got a million referrals and all of them crappy. Necrotizing pneumonia. An ancient nursing home patient who, it appears, had been brain dead for a week. Strange penile infections. Almost, let me think, 25% of the referrals were already in kidney failure. I ran my poor team ragged, sending them hither and yon around the state. I found myself saying, a lot, "I know it's not a great referral, just go take a look." Oh, and we were down a person Saturday and Sunday.

Friday started out ok. I only sent out one person for a few hours. Friday into Saturday, I get woken up at 0130. I went back to sleep at 0700 for 2 hours. Saturday, I went to bed at Midnight and had, really, the most delicious sleep. For 4 hours. Up all day, back to bed Sunday at Midnight. Woke up at 0400 again, tried to sleep for an hour, no luck. I was up and stayed up until 0930 Monday morning. Blessedly, I gave report at 0700, stayed up for another 2 hours catching up on my charting while the baby watched A LOT of television. BTW, has anyone else noticed that TellyTubbies and Boohbah are really indoctrination films from our alien overlords? No? Well, maybe it was the lack of sleep catching up with me.

Baby and I went back to sleep at 0930 Monday morning and slept til 1430. Nice. I feel human again. Also, it's a dreary day and raining steadily, so perfect for sleeping and snuggling a warm baby. I highly recommend it.

We had a couple situations where it was pretty iffy if the person was medically suitable for donation, for various medical reasons. The hospitals basically weren't doing any more care for the patients due to their grim prognosis and I had to ask coordinators to approach the family. That way, if they said yes, we could push the hospital for more management. Nobody was really comfortable with this. I said to the one coordinator, be up front with them. Don't paint this rosy picture that their going to save 7 lives when we'll be lucky if they can donate a liver. Just tell them it's a possibility and see if they're interested. They weren't. It gets very frustrating. You have to tell yourself, it's not a liver, it's someone's life. It's worth a shot. But you can see why we get called vultures.

Calling all geeks. I am looking to embed a playlist on the blog. Any advice, either on a good playlist to use, a good place to find tunes(it has to be extensive, I like classical as well as top 40) and how the hell do I embed it?

And Tuesday...Grand Rounds is up at Laurie's blog, A Chronic Dose. Check it out. Now if you'll excuse me, I have to go pull an NJO blog post out of my butt before tomorrow.

Talk amongst yourselves

I'm taking a break, people. Talk to you on Monday. Or Tuesday.

Say what you will, I guess it worked

An update on the Netherlands DonorShow hoax. They're reporting that in the last month, 12,000 people in the Netherlands have signed up to be organ donors.

Do You Deserve an Organ?

**Today, I'm blogging for organ donation, which is sponsored by Blog Catalogue. Want more info, visit UNOS or OrganDonor.gov. Also visit the British Organ Donor Society. The Blog Catalogue site will let you know who else is participating. **

Do You Deserve an Organ?

Occasionally, I come across commenters who say they don't believe in organ donation. Curious, I think, because unlike Tinkerbell one doesn't need to close their eyes and clap their hands to know that organ donation saves lives. Also, on occasion, such comments make me irate.



I've been going to Ask Sister Mary Martha, because a Google alert showed she had a post on organ donation. Sister states correctly that the Catholic Church is in favor of donation. She argues that people's fear of donating is a lack of faith. However, many of her commenters think otherwise. Can people really not believe in brain death? I ran into similiar opinions at this site. I won't go into my whole argument again, you can read my comments at her blog or read this. Through the marvels of modern medicine, we can keep a body going long after nature would have called it quits. Yet for some people, "pulling the plug" at this point is against God's will. Unfortunately, I don't have a cozy enough relationship with the Big Guy to pretend to know his will. I speculate that keeping a body going, not alive-just going, is man's will, not God's. At least Sister's readers aren't hypocrites. Most of them said they wouldn't accept an organ either.



What about that? What about people who wouldn't donate, but would accept an organ if they needed one. You might think that once a person has had an organ transplant, they would agree to donate. You'd be wrong. I have asked families of patients who, following their transplant, developed complications and became brain dead. Some have said no. If I get past my annoyance, I can understand, I think, their response. Perhaps they're mad that the transplant didn't work. You don't know what kind of relationship they had with the doctor or the hospital. This is not a time for people to be logical or selfless and it's hard to analyze why a person makes the decision they do in the small window of time we have with them.



Should someone who's against donation get an organ? Organs and organ donors are rare, I think we can all agree on that. Less than 1% of all deaths are brain deaths and medically suitable to be donors. In NJ, there are currently over 3000 people on the waiting list. Last year we had about 300 potential organ donors. A little more than 2/3 consented. That's why the waiting list keeps growing. Into this mix are people, patients and institutions who are trying to come up with solutions, sometimes controversial ones.

Dave Undis from LifeSharers wrote an op/ed piece in the Baltimore Sun last week in which he says that organ donors are "getting the shaft".

registered organ donors who need transplants are treated no better than
people who have declined to donate their organs when they die. As a result,
every year, thousands of registered organ donors die waiting for transplants
when the organs that could have saved their lives are given to nondonors.

He's very persuasive. Why should people who won't donate receive an organ?His argument takes a creative leap, however. More accurately would be to say that every year organs go to people whose beliefs regarding donation are unknown. There are many requirements for getting onto a transplant list. Your feelings about being a donor yourself is not one of them. He goes on to say,

But shouldn't organs be given first to the people who need them the most? Not if these people aren't willing to donate their own organs. If people are unwilling to save their neighbors' lives, should we really elevate their needs above everyone else's?

In other words, if you join LifeSharers, you agree to donate your organs, if you are brain dead and medically suitable, to other LifeSharers members. That in itself is a big "if", given the small likelihood that you will be a donor. This falls under the "direct donation" stipulation, that families are able to direct who will get the organs and bypass the national list. If you see a cute kid on TV or know someone at church who needs an organ, you can direct an organ to them, as long as it's a medical match and the recipient's surgeon ok's it. What Mr. Undis is saying is that, even if a person on the waiting list is a status 1A, they shouldn't receive an organ if they won't agree to be a donor. But what if that person has never heard of LifeSharers? How would you know what their wishes are? If I'm a LifeSharers member and I become an organ donor, my organs will go to other LifeSharers members, even if there are people ahead of them on the waiting list. Even if some of those people(the status 1A's) will die if not transplanted immediately. Tough Nooggies, is his response.


LifeSharers is at least free. MatchingDonors has a fee of several hundred dollars to be listed for a living donor transplant. Go to his site and you'll see requests, "help my dad lead a nrml life" or "desperately need kidney, blood type A+". What's wrong with this? It brings to mind, my mind at least, women who go to a sperm bank looking for the perfect donor. Ooh! Pick this one-he's Norwegian and he speaks three languages! And he's a doctor!" There's nothing wrong with paired kidney exchange programs when there is oversight. The two biggest problems with these online programs are 1. they are not accessible to all and 2. they aren't accountable to anyone. The day people can advertise for a kidney donor is the day that money will exchange hands and the day that some people will be considered "not worthy" of an organ.

It's easy to say that people who won't donate shouldn't receive an organ. I have said it myself. Then a respected colleague and friend reminded me that putting restrictions on who can get a certain treatment could lead to restrictions for other illnesses. A person who had unsafe sex wouldn't get HIV treatment, for example. If nothing else, your insurance company would love to find some more reasons to deny your claims. Fat people receive treatment for heart blockages, smokers get help for their COPD and alcoholics sometimes get new livers. If you don't think that's fair, ask yourself if you've always gotten what you've deserved. I haven't, and that's a good thing.

Grand Rounds...

is up at Vitum Medicinus. And I won a special award! Not special like Kim's award, but it'll do. Check it out.

Also, new posts everyday at the NJO Blog. Kim wrote a good piece yesterday about the history of nurse practitioners. My new Penlight post is finally up. Friday, Labor Nurse put up some links from a NY Times article that I can't wait to read in my free(?) time. Terri is taking a little break, but she's still writing at Nurse Ratched's Place. Over the weekend I saw part of "One Flew Over the Cuckoo's Nest". Not only did I never realize what a great actress Louise Fletcher is, her Nurse Ratched was a PATIENT ADVOCATE! After Jack steals the boat and takes the boys fishing, she petitions the medical board to keep him in the hospital rather than return to prison. Imagine that.

Oh, and if you'd like to see what TC really looks like, there's a new picture up with my bio on the NJO blog. Try not to be blinded by my beauty.

Got Hope?

Carnival of Hope is up at Rickety Contrivances of Doing Good. Deadline for next month is August 9th, hopefully I'll make it in time to submit something. I keep meaning to and I keep forgetting. Check it out, Susan's blog is one of my favorites.



This week we had a case where nothing was recovered. The patient had various infectious diseases, but his family really wanted to donate. We went to the OR thinking we were going to recover liver and kidneys. Then, literally as we were pulling in the door, I got word that no one wanted the kidneys. God, there are so many people waiting for kidneys, I couldn't believe it. Plus, kidneys can be put on pumps for a few days to improve their function AND they can get shipped just about anywhere. Once, I had a box o' kidney go to Hawaii. I offered to take it there personally, but my boss didn't go for it.



So, the liver team proceeded with the case but, unfortunately, the liver turned out to be severely cirrhotic. Case aborted. I was with another coordinator, the one who had gotten consent, so she told the family. I can only imagine it must be heart breaking, when organ donation is the only silver lining in a horrible situation and then it doesn't happen.



It happens. I always tell families that it's a possibility. You open the donor up and find a large tumor or a necrotic bowel. I've had a couple experiences, both with little babies, where they had a rare blood type and there was no one their size on the list. In those cases, the lists are usually small to begin with and I went through them quickly. I think it's especially heart breaking when something goes wrong with pediatric donors. Losing a child is the loss of hope, and organ donation can be the only hope they have left-that a part of their child will live on. It's so hard to have to tell these families that the donation can't happen.



Sometimes, you find out a patient is HIV+. Legally, as part of the consent, we tell the patient's doctor, the funeral home and the legal next of kin. Imagine calling an elderly widow and telling her that the donation didn't happen because her husband was HIV+. Or a husband that his dead wife had hepatitis B or C. At that point we've already done the medical/social history with them, so we know if they didn't know about it. Again, it's a possibility I try to prepare people for, but at that point, most people are just going, "yeah, yeah, ok" They have a lot more on their minds at that point than theoretical possibilities.



With DCD, there's always a chance that the patient won't expire in the 60 minute window. This is something we discuss with the hospital staff beforehand. The patient would then go to a predetermined spot-back to the ICU or a medical floor. There, end of life care will continue as before until the patient dies. I always think with DCD that you are really asking the family to take a journey of faith with you. The act of dying is so personal and private, but these families are so commited to organ donation that they're willing to open that moment up to you, so that someone else can live.



Saying yes to donation is an act of faith. It's a seed of hope for a tree you might not ever see bloom. Sometimes even I question why we're putting so much effort into a marginal donor, or a "liver only". Except that it isn't just about the liver or the kidneys, it's about John, the 48 year old who's been on dialysis for 4 years or Amy, the 17 year old who won't live to graduate high school without a new liver. I'm constantly amazed by the families who could understandably think only of their own grief, but instead think of the good that can be done for others.



Don't forget Wednesday the 18th is Blogging for Donation day! Hmmm, what to write about?

Meetings, meetings and more meetings

My brain is fried, I've been in meetings since 9am. Now, it's about time to relax and enjoy Change of Shift over at NursingJobs.org. Be sure to check out the NJO blog, too.

Got Internets?

I recently joined MyBlogLog. I have to tell you, I'm like an idiot savant when it comes to the internet, or as we say in my house, "teh interwebs. " I just kind of surf around until I see something bright and shiny and then try and figure out how it works. Usually without reading any sort of instructions or FAQs and such. FAQs are for wimps. Then, after many hours of scratching my head and mumbling under my breath, sometimes cursing. Well, oftentimes cursing. So, I do what every person over the age of 30 does when they need internet help. I ask my kid. Not the 16 year old, of course-she's already obsolete. I go straight to the baby. At 21 months, she's almost past her computer prime but she can still handle a mouse with the best of them. Except that sometimes she puts it up to her ear and says, "Her-ro?"

Anyhoo, I just started reading some of my fascinating stats on MyBlogLog (which for some reason I keep wanting to call MyBlogLand, I may have been watching too much Heartland). And I noticed that someone got to my blog by going to Google(no, I'm not posting a link for it. If I can find Google, so can you) and typed in "If I put organ donor on my license will they kill me?"

Excellent question! The answer is that in many hospitals they'll just kill you, whether you're an organ donor or not. The trick to living a long, healthy life is to really stay out of hospitals altogether.

I'm just kidding. There are many good hospitals out there. But let us look at what happens when you come into the hospital. For the sake of this post we'll say that upon arrival you are unconscious, possibly intubated and your family is still en route to the hospital. I assume(ass-u-me) that people who arrive under their own steam for say, a twisted ankle or an elective hemorrhoidectomy, aren't worried about inadvertant organ retrieval.

"I'm sorry, Mr. Smith, but these are the worst hemorrhoids I've ever seen. I'm afraid there's nothing left to do but hope someone else can benefit from the gift of your heart."

"My heart! But, but, I'm still using it!"

"Tut, tut. Doctor knows best. Now lie still, this won't hurt me a bit."**

So, there you are, lying on a stretcher in extremis, your loved ones confined to the waiting room and the doctors and nurses start trying to save your life. Now, here's the first thing: no one is looking at your wallet. Except the plastic surgeon, but I digress. No, they're looking at you. And probably doing a few things to you, too, none of which will be pleasant, but hey-you're unconscious, so you won't mind a few probing fingers in your orifices or comments about your "Snuggle Bear" tattoo.

Here's the second thing. What's good for you is good for your organs. In other words, the things they would have to do to save your organs for transplantation are many of the same things they would do to save your sorry butt. I have been in some situations where the patient came in with a large bleed and the doctor just tries and talks the family into extubating the patient and letting them die. If you are that critical, and possibly fatally injured, wouldn't you rather go through the process to make sure you're brain dead. One time, I walked into an ER and they basically had this accident victim written off, so they weren't treating him. I asked them to start pressors so they could keep him going until I could ask his family. Lo and behold, when his blood pressure came up, he started having purposeful movement. I believe he was discharged to rehab many weeks later. If we are thinking that you could possibly be a donor, we want what's best for you and your body. That includes the best medical care possible and if that medical care makes you better, we're happy for you. We don't walk away, heads shaking, saying, "Rats, he coulda been a donor."

So don't worry about checking off your license. But you may want to rethink that tattoo.

**This is an excellant thing to say just prior to starting an IV. Also, if the patient asks if you've ever done this before say, "Well, there was this one time, but my lawyer advises me not to talk about it."

p.s. I also now know that many of you are enjoying the "Name Your Girl Parts" link. Naughtly readers!

I hate traffic. I got called to help out with a DCD this evening. I typed the name of the hospital into Mapquest, may it rot in hell. Many miles later I realized it had given me the directions to the wrong hospital. Several frantic phonecalls that involved much cursing got me to the right place. Now, I don't know if you realize this, but New Jersians have a favorite past time. Every afternoon, around 4ish, every licensed driver gets behind the wheel of their car, drives to the nearest highway and parks their care for 3-4 hours. Literally, there is never a time when there is no traffic on the highways in New Jersey. Drive the Parkway at 4am on a Sunday morning, there will be traffic. In Montana, you can drive a day and half without seeing another car. Here, you can't drive a minute and a half.

Anyway, Grand Rounds is up at Aetiology. And don't forget to check out the NJO Blog, with some of the best nursing writing on teh internets.

About 8 million years ago, Keith at Digital Doorway nominated me for the Thinking Blogger award. I was supposed to name 5 blogs I love that make me think, to keep it going. The problem was not that I couldn't think of 5 blogs that make me think, the problem is that many of the blogs that fit that description are like me, slightly to the left of Abby Hoffman(STEAL THIS BLOG!) I have tried to keep this blog apolitical, because, holy cow, do people get crazy about politics and I'd like to keep us all on the topic at hand, organ donation, and not have to worry about comments like, "your stupid and I'm right, nyah, nyah!"

Also, a lot of the blogs I like have already been nominated-like emergiblog. But, I must do something-it's an honor that someone thinks my blog makes them think(name your girlie parts, et al) and also I'd like to pass it on. Keep the karma rolling, as it were.

So here goes.

If you're unfamiliar with the Thinking Blogger award-here's the site that started it all. The Thinking Blog-how appropriate.

Here's my 5 blogs that make me think. Possibly, some of them don't even know I'm a reader, some of them may eschew such an award, I don't know, but they all make me think and that's really the only criteria, I believe.

1. Patrick Hughes' Bad News Hughes. Listen, it ain't called Good News Hughes and there's a reason for that. It's rude, irreverant and sometimes a wee bit gross( or a lot gross, actually. He has a whole post where he talks about his balls, for God's sake). It is also the funniest shit I have EVER read. It reminds me of "A Girl Named Zippy", only ruder and grosser. I'll try to explain for those of you who may be from a gentle, civilized background. When your life growing up is a train wreck, there are really only two things you can do, slit your wrists or say screw it all and laugh about it. Patrick Hughes not only proudly lays claim to his crazy, dysfunctional family and all the consequences thereof, he makes you wish you could be a part of it all. Somewhere in it all you start to understand why "Those People" do what they do and why it's a good thing we're not all Normal, Thank God.

2. Now for something completely different. Pop Occulture, Tim Boucher's online journal is like Soul-if you have to ask what it is, you don't have it.

3. A shout out to one of my nursing peeps. Why Nurse Ratched has been overlooked so far for this award, I'll never know. And yes, I love that she named her blog, about psychiatric nursing but so much more, after the evil nurse from One Flew Over the Cuckoo's Nest. Hey, I named my blog donorcycle, didn't I. Irreverence is always rewarded in my world.

4. The Wait and the Wonder. If you haven't been to Moreena's blog run, don't walk, over there right now. I'll wait. There, aren't you glad you did? She writes very tenderly and very well about her experience as a mom of two amazing kids, one of whom is waiting for a liver transplant. It's a lot more than just a mommy blog. Moreena brings a wonderful insight into every day living. She's an inspiration to me and a joy to read.

5. Last, but not least, Mama Midwife Madness. Because my first desire, in nursing school was to be a midwife, but somehow I wound up in critical care. Because some days I still think I'm going to chuck it all and go catch babies. Because I'm a strong advocate of keeping pregnancy, childbirth and the postpartum period natural and woman centered. I like Louisa's blog because she's funny, doesn't take herself too seriously and yet manages to talk about some very serious subjects in a thoughtful way.

So, if you've been nominated, here's the "rules" from the Thinking Blog.

The participation rules are simple:
1. If, and only if, you get tagged, write a post with links to 5 blogs that make you think,

2. Link to this post so that people can easily find the exact origin of the meme,

3. Optional: Proudly display the 'Thinking Blogger Award' with a link to the post that you wrote (here is an alternative silver version if gold doesn't fit your blog).

So, there's my picks. Thank You Keith.

I've been called worse

I know this is probably not appropriate for this, ahem, proper blog but I couldn't resist.

Your Girl Parts Are Named:

Easy Bake Oven

Girl Parts Name Generator

Alas, I don't think they'll be any more buns in this oven.

I can't take it

Here's an article on the lawsuit brought on by a mom in California who says that a transplant surgeon misrepresented himself and took a dying patient off life support to do a DCD donation without her consent, then kept ordering the nurse to up the pain meds to make him die quicker. I don't know what the truth is, I do know he's being investigated by the Centers for Medicare and Medicaid-the agency that oversees hospital compliance in many areas in order to be reimbursed by medicare and medicaid. They also put out the regulations regarding organ donation and survey the OPO's to make sure they are following best practices as put forth by Health and Human Services Organ Donation Breakthrough Collaborative.

Anyway, regardless of what you think this doctor did or didn't do-read the comments. I can't believe, in regards to organ donation or anything else for that matter, that people are so ignorant. I read things like this and I think that if you don't believe in organ donation, you shouldn't get an organ. It's that simple. It's like members of PETA, who can believe whatever they want, but don't come to the hospital and expect to get any treatments that involved animal experiments. That may leave you with only bandaids and ice packs, but I wouldn't want your principles to be compromised just because your dying.

Am I alone in thinking it's a miracle that ANYONE gets an organ?

BTW, I got a great reader comment in the last post and I posted a rather lengthy reply. Just thought you might be interested and also I'd be interested in other points of view on the same.

Blogging for Organ Donation

Tell all your friends, yes, even your imaginary, internet friends, that JULY 18th is Blogging for Organ Donation day. This is being sponsored by BlogCatalog with the hopes of raising organ donation awareness and getting folks to sign up to be organ donors. What can YOU do?

1. Link to organdonor.gov and/or UNOS. (In the effort of full disclosure, you can also link to matching donors dot com. I will not, as I do not support their efforts). If you live outside the US, link to your country's organ donation site, if you have one. The British Organ Donor Society (BODY-the Y is really an psi, you clever Brits!) has a site with links to organ & tissue donation websites around the world.

2. On July 18th, On Wednesday, July 18, write a blog post asking all your readers to sign up as organ donors. Your blog post should:

• Have the title “BlogCatalog Community Organ Donation Awareness Campaign” (or some variation)

• Explain the importance of organ donation and how it is a gift of life.

• Link to one (or all three) of the sites above or the most suitable site for your country.

• And add a link to our BlogCatalog Community Organ Donation Awareness Campaign page so we can give you and your blog credit for being part of it. (you have to sign up in order to do this.)

If you have any questions, email tony@blogcatalog.com

The TC as patient

I went to the ER last night. As a patient, not a worker. Three weeks ago, in an episode that had NOTHING to do with a drunken limbo contest, (seriously) I hurt my back. Huge knots under my left scapula. Over a few days, it improved. Then Friday, I must have slept the wrong way, because it came back. Back rubs, hot showers and ibuprofen didn't really touch it, but it was bearable. Then, last night, I was nursing the baby, I rolled a little one way and AAAHHRRRGGGGHHHH!!!!!

Now, please believe me when I tell you that I try not to go to the ER unless my eyeballs are on fire. Especially the one up the road, where I used to work. It's a great ER but also a level I trauma center and if they get a trauma, me and my little back problem will be laying on that stretcher for a loooong time.

Anyway, I get there, still in spasm and am greeted by my long time buddy Aldair, a CCT from Haiti. "Cherie! Ca Va? Q'est ca fait-tu ici?" From there I was greeted by a succession of old co-workers as Aldair wheelchaired me back. "No, I can walk." "Non, non. Ah push you."

Which brings me to my second reason for the avoiding the ER. I do not want to look like a wimp in front of my friends. "You came here for back pain! At 2 in the morning?" I repeat my tale of woe to the triage nurse, the doctor, the PA and the RN who gives me my flexoril. "But it hurt, really bad. Spasming and pain!" Yeah, total wimp.

I climb onto the stretcher, broken, of course(the stretcher, not me-I'm only slightly bent). Aldair brings me TWO pillows and TWO blankets. Now, if you've ever spent a night in the ER, you know this is the equivalent of a gracious host saying, "Please, pick one of daughters to sleep with." I mean, it's unheard of. I tell my husband this later and, with eyebrows raised, he says, "Whoa. You rate."

So when the doc, who I do not know, comes in, he asks me what I want for pain. Oh, God. What to say? I know, from past experience what works and what doesn't. Flexoril, not so much, but I know the ER doesn't stock Soma, so I ask for and receive a flexoril. He asks if I want a valium. Do I? Is this a test? I don't think I've ever had a valium. So I decline, because I don't want him to think a. I'm pushy and b. I'm looking for drugs.

As predicted, the flexoril doesn't do much and I can't even sleep because my back still hurts. He checks on me in a little while and asks me if I want something else. I do, but again I don't know what to ask for. When I had my wisdom teeth pulled, they gave me Tylenol #3. It was 4 hours of waking nightmares that I'd rather not repeat. I've had darvocet in the past and it didn't really do anything. Do I run down the list of narcs I don't like and sound like a drug seeker? Do I say, have you got anything that'll take the pain away without making me see the walls breathe? He suggests percocet and I take it.

Quickly I'm fast asleep, still in pain but too high to care. I've been awake since 7am the previous day and it's now about 4am. I guess I doze for about an hour when the wake me to see if I'm better. Some things never change. "You don't have to go home, but you can't stay here." I take my prescriptions, get a cab home and sleep for a few more lovely hours.

Next time, I'm passing on the limbo.