Guess what I got for Christmas??

No, it wasn't coal.

When I left the OPO, sadly I also had to leave my laptop. 14" IBM Thinkpad, mostly indestructible. It was basic black, addressed all my needs, wasn't too heavy. It didn't have a disc drive, cause they didn't want us installing programs, I'm sure, but other than that, I loved it and vowed to never have a desktop again.



Husband told me he was going to me a gift that would change my life. Several things came to mind-a trip to India to spend a week with the Dalai Lama? Hmmm, too expensive and he's probably busy. A winning lottery ticket? A chance to meet Johnnie Depp? (that wouldn't change my life, but it would totally rock!) No, none of those.



He got me my own laptop. This is me, typing away on my brandy new acer, with CD/DVD burner and a webcam. Maybe I could do podcasts!? After I lose 20 pounds and get a makeover, of course.

This past week at work was a doozy. I worked Sat, Sun and Mon with the same sick, intubated kid. Nobody was really sure what was wrong with him, but originally they thought he had croup. Last week, I took care of him and he was doing something really weird-for a couple of hours his CVP would be high-19 to 22 and his urine output would drop. Then, without any intervention, his CVP would return to normal and his UO would increase. I told the intensivist on that day and then never heard anything else about it. I was wondering if he had a coarctation of the aorta, but his pressure was low, not high, and I really thought someone would have picked up on it(he's an older child). Turns out, he has a collateral artery wrapped around his aorta and it's not respiratory at all. Always go with your gut.

So New Year's Eve I was asleep by 10pm. Then the next 2 days I was off and basically did NOT ONE THING. So much for time management, but it's been a long time since I've taken a nap without a kid attached and I'm not apologizing for it.

On the organ front, I've been reading about this girl, Nataline Sarkisyan, who was denied a liver transplant by CIGNA. I was pretty appalled but hadn't written about it because I didn't really have time to delve into it. And if there's one thing we pride ourselves (myself) on here at donorcycle, it's avoiding easy answers and half-truths. So today in my emailbox was a surprisingly in depth article on the case from Maggie Mahar at Health Beat. I did think at the time that it was surprising that doctors would transplant an organ into a person with cancer. Except in certain cases, cancer patients don't usually get transplanted because the immunosuppression drugs already put a person at risk for cancer and there's a high risk of coming out of remission with the same or another cancer. But I thought, well, maybe Nataline was cured by the bone marrow transplant from her brother. Now, reading the article, it says that her doctors gave her 6 months to live WITH the transplant.

Of course, if it was our own child we'd take those odds, but here's the thing-there aren't enough livers to go around. So who should get it? The 17 year old who will probably die anyway, or someone else who will live another 5,10, 20 years? It's a hard choice and I'm trying to come up with an analogy but I can't think of anything that involves such a restricted resource with such emotional appeal. Then, too, the hospital asked the family for $75,000 if insurance wasn't going to pay. I guess some have argued that the hospital could have eaten the cost. I'm not sure if that figure was for the surgery and hospitalization. I do know, that for self paying recipients, the hospital wants to see if they have the resources to pay for the first year of anti-rejection meds, which runs around $50-60,000. Again, this sounds really harsh, but the meds are needed or else the organ will be useless. It's the same reason why people are counseled to see if they are up to all the follow up treatment that comes with receiving an organ. Again, I'm not really sure why that gave that dollar amount to the family, who couldn't come up with the money of course, and the doctors are no longer talking.

I don't know where the answer lies. I'm reasonably sure that if the docs at UCLA felt the transplant was worth it, then CIGNA should have covered it. On the flip side, Maher points out that CIGNA approves 90% of all tranplants. And I do agree with her on this point, by reconsidering their position when it was essentially too late, CIGNA now looks like a horse's ass(My words, not hers).

The one thing I am sure of is that this sort of thing happens because organs are scarce. If you could get one just as easily as you could go the pharmacy for a presciption, no one would have to make these choices. I do hope, if nothing else comes out of this, that all those who fought for Nataline will sign their organ donor cards.

Well, it's Christmas Eve

And we're all sick, except for the dog. I think we must have the most virulent head cold ever seen...it's now over a week and my head still feels 2 sizes to big. Tomorrow I have to work, which is making me feel very Grinch-like. We are all making tons of food, so hopefully it'll be a slow day, no one will die and I'll get to pig out. I've given my teenager the option of waiting til I get home to open presents, or getting up with me at 5am to open them. She just huffed.

Just like in Hooville, Christmas come whether there's presents and a tree or not, so I'm diligently buying presents at the last minute. We were going to have Christmas morning THIS morning, but last night we made the discovery that we didn't have wrapping paper. We do have a tree and it's up but still a little bare. There's lights and garland, but so far no ornaments and the dog keeps eating the candy canes off the tree. Pooter has added to her reportoir with some Christmas words: Woo-woof(Rudolph), Santa Claus, candy cane and sssssssssnowman (the S-N combo is still a trial for her). We have watched the original Burl Ives "Rudolph" a record 823 times over the last week. Every time I watch it I can't help thinking that in real life, Rudolph, the dental elf and Cornelius would all run away to the East Village, where the elf and Cornelius would finally proclaim their love for one another (he is a total BEAR, after all) and Rudy would be panhandling on St. Mark's Place.

In other news, this happy article was posted in a local paper. I've had the pleasure of working with Dr. Laskow and it's true, he is a class act.

Last week I was the primary nurse for an organ donor. My good friend "Hector" got to come out an be the TC and boss me around with 8 gazillion orders and, as usual, the OR was delayed until almost midnight. But this time I got to go home at 7:30pm. His poor orientee was like, "I have to stay HOW long?" I assured her that in no time, she'll be able to stay awake 30 hours straight on 5 hours sleep and then drive home. It's funny that my first job was 8 hour overnights and I could barely stay awake through it. The down side is that if I get woken up in the middle of the night, say by someone snoring(ahem), I'm awake for the duration. I might as well just get up and get a cup of coffee cause they'll be no more sleep for me.

Having a 17 year old donor was sad. I didn't know her at all, having been off the first few days of her admission. When I saw the OPO staff on the unit, at first I was afraid it was for a girl I've been taking care of, on and off, since Thanksgiving. I'm now on a first name basis with mom, dad, younger sister, best friend and several teachers from school. She's been touch and go for weeks and if she doesn't make it I'll be really upset, but I haven't given up hope yet. That's the thing about critical care, some patients are there for so long, you really get attached. We did have one Christmas miracle-a little bugger who's been in the ICU or in subacute care since he was born 10 months ago finally went home. Mom carried him around the unit so we could all say good bye to him.

Well, as you can see, I still have stuff to talk about, so I guess I'll still be blogging for now.

Merry Christmas.

SurgExperiences

Check out SurgExperiences over at Buckeye Surgeon. Now I have to get back to Christmas shopping.

If You Give a Surgeon a Scalpel

(with apologies to Laurie Numeroff)

If you give a surgeon a scalpel, he’s going to want a pick-up.
But wait! He’ll remember that he always operates better with some music.
“Nurse! Can you put on the radio please?”
“Certainly, Doctor. Do you want Rock?”
“No.”
“Classical?”
“No.”
“Country?”
“No.”
“Easy Listening?”
“Oh, God, no.”

Then he’ll remember that he has a Frank Sinatra CD in his car. He’ll want you to page the tech and ask him to run down and get it.
While you’re waiting, he’ll hum a few bars and show off a few dance moves to the scrub nurse. “Yes sir! I used to really cut the rug in my day.” He’ll say.

While he’s dancing, he’ll remember that he’s parked illegally. He’ll have you page the tech and see if he can move his car while he’s down there.
Suddenly, the resident will comment that he’s hungry. A spirited discussion will ensue on where’s the best place for lunch.
“Chinese?”
“No.”
“Thai?”
“No.”
“Italian?”
“No, I had pizza yesterday. Sandwiches?”

The surgeon will remember that a great, new Mediterranean place opened up. You’ll page the tech again while he talks about the great hummus and baba ghanoush. “Wait! I want brownies, too! Tell him to get brownies!”
To fill in the time, he’ll tell a story about the time he vacationed in Greece and lost the keys to the rental car on the beach and they had to walk 10 miles back to their hotel room and his wife didn’t speak to him for 3 days.

Finally, the tech comes back with 5 Frank Sinatra CD’s, the keys to his car, now washed and polished, one pint each of hummus and baba ghanoush, 6 gyros, a 2 liter bottle of soda(it was a special), extra pita, two types of brownies and baklava.
“Hmmm. Now what was I going to do?”
The anesthesiologist looks out from behind his paper and coughs, “Ahem”.
“Oh, yes. I was going to ask for a scalpel.”

To all my favorite surgeons and everyone else:

Happy Holidays and all the best in 2008!!

As most of you know, I quit the TC business in August to spend more time with my family. I'm not really sure where I want to go with this blog. I certainly haven't been spending the time on it that it needs. So I'm taking a hiatus until after the New Year to see where, if anywhere, it's going to go. Thanks,

Susan

Dah Na Na Na Nah Nah Na Na

It's my birthday! Enjoy the tunes.