Sunday, July 29, 2007

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.


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.


Anonymous said...

Congrats on your new job! Can't wait to hear your stories from there...

Sharon from NY said...

Congrats on the new position, I hope it's terrific for you. One question... any way to fix the music so I can choose to hear it or not? I often sneak a look at work and the music kinda gives away what I'm doing!! I just grab for the volume control and shut it off, but then I forget to turn it back on..... ah well, I like your blog too much to give it up over this!

A Colleague in AZ said...

I will miss you. You are the only one I know who can put what we as coordinators all feel into a great story for everyone to read. You have shined a light on donation to many, and the ripple effect is probably unmeasurable.

The hours are so very long and hard to make up with just a days sleep afterwards, and your family suffers along with you. It's definitely not the work we do that makes us leave this job. I wish you the very best in your endeavors!

DKA said...

It has been so rewarding and comforting to read your stories. I am still in orientation as a coordinator. I attempted to start my own blog. I had a link to it from my MySpace page and mgt. got wind of it and asked me to pull it. That damn MySpace!!!
I will forward stories, questions, etc to you. Thanks for taking the time to share.

Just Me said...

Good luck with the job in the PICU! Some days it feels like I work in a PICU, so the sharing stories thing still works :o) I really enjoyed this post...a rewarding story was good one to "end" on. The "liver only" post got to me this week too because over the weekend I had two kids who "only" got livers (partial ones from adult donors). They are both SO precious it would be hard now to imagine not getting "just a liver" for them. Thanks for all your work in getting those donors! Welcome to 12-hour shifts :o)