Friday, August 31, 2007

Today in Donation History

Just found out that today is the 39th anniversary of the first multi-organ multiple transplant. You can go here to Wired! for the story. The 5 teams, involving 60 surgeons, nurses and assorted personel(we're gonna need a bigger OR) was coordinated by Dr. DeBakey. Yes, that Dr. DeBakey, as in "pass me the DeBakey." Here's a look at his remarkable career. Another interesting bio is here. The man invented a continuous flow rolling pump in med school, in between studying I guess, that later was instrumental in developing the heart/lung machine. That was just the first in a long line of medical inventions. Dr. DeBakey, by the way, is still on faculty at Baylor.

The surgery, which took place on August 31, 1968, recovered a heart, one lung and kidneys that were transplanted into 4 people at one hospital.

Random musings

Out of the five different patients I took care of these past few weeks, only 1 is probably going to have a normal life span. Two may very well be dead before the year is out. I thought I was leaving the dead and dying and going to work with the living and recovering. Ah, well.







Maybe it's the reason why I've been exploring my spiritual side. (Do we only have a spiritual side? Who was it that said we're not human beings trying to be spiritual, we're spiritual beings trying to be human? 50 points and an organ donor card for the first person to tell me). Anyway, I know Kim talked about this somewhere on her blog, eons ago, but I stumbled across St. John of God this week. Not literally, because as a saint he's in heaven and I think his bones are probably in a church somewhere. St. J of G is the patron saint of nurses, firefighters and bookbinders, if you believe in that sort of thing. He could also be called the patron saint of aimlessly wandering through life until you finally get your s*#t together. That's a little too long to fit on the medallion, but it suits me. I can't say I'm really down with the whole patron saint thing. I keep recalling my best friend and daughter of a Methodist minister in high school who was constantly chiding my Catholic self for worshipping idols. She also used to wear orange on St. Patrick's day. It's amazing she lived to see graduation, but I digress. Anyway, it's nice to find a saint that wasn't gruesomly tortured to death or did fantastic miracles, like levitate or have the stigmata.







Anyhoo, there's nothing wrong with being pierced by arrows or having your breasts sliced off, but old John seems like a more down to earth kind of saint. So I got one of these. Actually, I got the last St. John medallion they had. Like most of my religious leanings, it falls under "can't hurt, might help". Actually, that's a little flippant, even for me, but like poetry and masturbation, I think religious beliefs are something you save for when you're in private. If you want to know what I truly believe, it will require some wine and a long night of talking.



St. John of God



On a lighter note, we finally made it to the beach this week, LM, Pooter and I. We're trying to pull together last minute plans for the 16 year old's B-day bash, so we went on a scouting mission to Ocean County. First of all, what's up with the Seaside Bridge(or whatever it's called)? One side is high enough for boats to pass under, the other side is a draw bridge. Wouldn't it make sense to make BOTH sides high enough for boats to go under? Or do they just like to stop traffic every 5 minutes in the height of Summer? The world may never know. We did find out that Island Beach State Park allows camp fires on the beach and you can stay til midnight as long as someone has a fishing pole. I know this may astound some of my readers in more enlightened areas, but NJ has some really odd beach rules. Like the idea that you have to pay to go on the beach. I was in college before I realized that many parts of the country think this is sacrilege. So, most beaches are swim between the buoys, no campfire, no driving, no dogs allowed kind of places.



Pooter loves the beach. She stood in the surf, tried to catch a few seagulls, which she calls ducks, and did her darndest to dig to China. We came with about 10 pounds of sand attached to us, each. I have also now lost enough weight that for the first time in several summers, my abdomen saw sunlight. Granted, my belly looks more like this:







And less like this:







But one of the great things about being on the far side of 30 is that you really, truly, no longer give a shit.



If only I had that attitude when I had my 19 year old body, I may have conquered the world. Both the world and myself are probably better off for me being young and stupid and now older and (mostly) wiser.



We also found the best bakery, Park Bakery, in Seaside Park. Have you ever had those little Italian cookies, that look like this:






Right? Everybody has. I worked in a bakery when I was in high school and we bought them from a larger bakery. Most small bakeries do that, they don't make them. Hence, they are usually dry, crumbly things. My grandmother used to bake her own, mmmm. Well, Park Bakery makes their own and they are amazing. I had no idea these cookies could taste so good(sorry, Grandma). So the ride home was spent sunburnt and tired, happily munching cookies. I love summer.

Tuesday, August 28, 2007

Why I <3 Surgery

I've always loved being in the OR. My mom was an OR nurse. When I was growing up we'd watch the shows where they show you the surgery in progress. Totally gory. I loved it. In nursing school we got 2 whole days of OR experience. One in the PACU and one where we observed an operation(unlike my mom's 1950's nursing curriculum, where she was basically prepared to RUN an OR after her orientation there). Much to my dismay, the surgery I got to observe was an arthroscopy of a knee. Big Woop. One of my fellow students, a big fella, got to see the resection of a bowel and promptly passed out. Wuss.



My plan was to work in the OR after I graduated, but in 1996 hospital's were still in denial about the nursing shortage. Even the hospital my mother worked at wouldn't hire me without a year's experience. While I looked for work, I enrolled in an OR certificate course. The first time I scrubbed in, the doctor asked me if I was a righty or a lefty. I told him righty, and he grabbed my left hand and stuck it in this guys abdomen up to my wrist. "That," He told me, "is his pancreas. Don't squeeze." So I didn't. Probably my most memorable operation at the time was a splenectomy on a guy who had idiopathic polycythemia. It started out as a laparoscopic procedure. Just like Jaws, it quickly became a matter of "We're gonna need a bigger hole." They had made an incision to remove the spleen, then they made it bigger. Then they made it bigger. This spleen was bigger than most babies. Seriously, I think it weighted 10 pounds.



Five months after passing my boards I still didn't have a job, so I took the first thing that came my way-nights on a cardiac telemetry unit. Part of my orientation was to take the critical care class and part of taking the critical care class was a ride along with the paramedics. Two minutes into the ride, we got called out to a local quarry where a woman had been electrocuted. It was the first time I ever did CPR. After that, I was hooked on emergency and critical care. We had to supply a nurse every shift to cover codes and I used to beg to be that nurse. A year later I was in the ER.



Cut ahead several years. I had worked almost three years in the ER of a level one trauma center and I wanted a change, so I transferred to the OR. It was still interesting. They put me into a specialty rotation-pediatric orthopedics. Since all things pediatric go together despite the best of logic, I was also trained to do general pediatric and pedi urology. Three completely different specialties. You'd never see an orthopod cross over and do an appendectomy once in a while, right? Whatever, I liked working with kids, even if they were only awake for a short time and I liked ortho. Hammers and screwsdrivers and stuff. Much better than working in vascular with needles so small they make you weep when you drop one and much, much better than, God help me, doing eyes.



The head of our pediatric orthopedics service was(and still is)the captain of the ship. Back when God was a child he had been in the Air Force and he still had a way of making you want to stand at attention and snap your heels together. Frequently, and with no prior experience as a Southerner, I called him Sir. If he saw an unfamiliar face in his OR, he was on the phone to the front desk. If he thought anesthesia was asleep at the switch, he'd yell at them to pay more attention to the blood pressure. I'm pretty sure he is the only surgeon I've ever worked with who even knew the patient had a blood pressure. He loved those kids and he could put in CD rods quicker and more assuredly than I could get dressed in the morning. He also didn't give a fart about anyone else. If you weren't paying attention during the case he'd rip you a new one. If you did your job with competence and alacrity, perfection even, he'd allow you to be in the room the following week. One time we had a kid go into spinal shock. Like a precision machine we finished the case while anesthesia worked to bring up her pressure and the tech gave units of blood from the cell saver. Every time one of the surgeons put a hand out, I put the right instrument into it without them having to say a word. Finally, the crisis was past and they started to close at a more normal pace. I was about 2 seconds too slow in giving him his monocryl and said, "Hey, do you think you could pay attention to the case?" Afterwards, I confronted him. I told him that I had busted my hump to keep up with his furious pace for two hours and he had to bust my (proverbial) nuts over the closing suture? He had no idea what I was talking about.



I probably wouldn't invite him out for a drink, but his group has operated on my daughter.


Some surgeons were pretty aweful. Some threw things. Some really did think that white light emanated from their rectums instead of waste products. But some were also down to earth and very personable. One guy, Chuck, was the hardest working guy in surgery. He had privileges in like, five hospitals and said he'd have to work until he was 80 to pay off his wife's credit card bills. The docs would get lunch every day in their lounge. Every Friday brownies were included and every nurse knew it. Chuck would bring the tray of brownies into the nurses' lounge and we'd all be like, "I don't know HOW these got in here." It takes a smart man to know that if you give the wife the credit cards and the nurses chocolate, all will be well.

The other great thing about the OR I worked in was the people. It was a really amazing group of people who all, mostly, got along and helped each other out and that makes for a great job no matter what you're doing.

But in the end, I missed emergency/critical care too much. Which is why I liked being a TC-you get to incorporate the patient care, teaching, family support and the occasional OR into one groovy job. I wouldn't mind going for first assist when I get my master's, but I'm not sure how I'd incorporate that into an NP position. Well, we'll see.

Friday, August 17, 2007

Warning:Objects in the mirror may appear sexier than they really are



This is NOT what I look like at work.(although I think I've taken care of the chick on the right in the ER-tough night of partying, has a terrible headache and, oh yeah, can she get a rapid pregnancy test too? Yeah, I've taken care of that one).


Anyway, 12 hours on your feet is a bee-otch. How does Christina do it? In high heels and a garter belt, for goodness sakes. Remember, I've spent the past three years clicking through the hospital halls, giving orders and looking pretty. Now I'm back in sensible shoes and covered in body fluids. Literally. My first day back I had a post op who was nauseous. Guess who forgot how to duck in the last 3 years? Ewwww. Sweet kid. He asked if he got any on me and I just told him, "no honey, you totally missed me." The upshot of all this is that it gives me an excuse to shop for some new, cute scrubs. Dickies seems to be an especial favorite of the PICU set. I'm also on the lookout for some Curious George tops. I wanted this one, but I think it might not be appropriate for the little 'uns. The Little Pooter loves her some Curious George, but I draw the line at Thomas the Train. That show explains a lot about the British psyche, is all I'm sayin.


The past 2 days I've taken care of the sickest baby on the unit. His prognosis isn't good, but if he can make it to 10kg, he might be eligible for a kidney transplant. That might not sound like much. Heck, some of us can probably put on 10kg in a good weekend. But I have a sinking feeling that I'll vote Republican before this kiddie gains 7 more kilos. Not to mention the problems with his lungs, heart and brain.
Speaking of kids and kidneys, one of my sister's students is back on the waiting list for a kidney. She's 16 and her first kidney transplant failed, so she's back on dialysis. Please keep her in your thoughts and prayers that she gets a kidney soon. Here's a brief overview on dialysis, hemo and peritoneal. For a primer on dialysis complications, complete with nausea-inducing pictures, go here. Suffice it to say, being on dialysis is no picnic. Maybe working in the ER for so long gave me a jaundiced view(sorry about the mixed metaphore). Folks who have been on dialysis for a while do NOT look healthy. Their skin is dull, their hair is brittle. Long term dialysis can lead to osteoporosis, anemia, cardiovascular disease and arrhythmias. AV fistulas require special care and can get infected or clotted. Some people just seem to clot frequently and they come in often for AV revisions, but you only have so many sites for a fistula and so much vein to work with. And let's not forget the "routine" problems:you can't travel, you have to closely monitor what you eat and drink and you're hooked up to a machine 3-4 hours at a time, 3x a week. Every Mon-Wed-Fri or Tue-Thur-Sat, without fail, every week, until your kidney comes in. Having coded many people who were undergoing or just finished a dialysis treatmens, it is so heartbreaking to think that they died waiting to be free of that machine.
On a similiar note, my 8th grade science teacher, Mr. P, had an insulin pump for his diabetes. He named it Natalie. Natalie was a girl who liked him when he was a young man and he couldn't stand her but he could never seem to avoid her, either. He hated that pump, hence the name. He died from complications due to his diabetes in my freshman year-I think he was in his 40's, maybe 50. I think if I had to be hooked up to a machine to help me live, I'd name it something a lot ruder than Natalie.
Anyway, I was hoping to have more facts and figures on pediatric kidney transplantation, but google is not my friend this week. In fact, it's making my head ache, which is partly the reason I haven't posted in a bit. I really need to find a good, medical search engine that's free. Help a sister out and let me know if you all have any suggestions. That, plus the New Jersey weather has led me to a state of humidity-induced lethargy that requires lot of bedrest and frequent infusions of iced coffee.

Wednesday, August 15, 2007

Monday, August 13, 2007

Some stuff for Monday

Well, I don't know about you all, (or as they say in Pittsburgh, "Yens") but I could get used to not working weekends. It's only going to be for a few more weeks, alas, while I finish orientation. Meanwhile, while weeding through my stacks and stacks of emails I came across some stories on donation.

Starting off, this woman is celebrating her 22nd year with a donor kidney. While she reflects on all the good things that have happened in that time, it's also bittersweet thinking about the life that was lost.

Losing my religion: At first I wasn't going to even give this one any "cred", but I decided to link to it because this woman is becoming a thorn in my side(sorry, Jesus). She has a religious blog and uses her credentials as a paramedic to discourse on organ donation and other subjects. Seriously, this is why I don't go to church more often. On a lighter note, I came across what may be the funniest t-shirt I've seen in a while. Just don't let Father see.

I wish we would hear more about donor families. It is my sincere belief that donation doesn't just help the recipients, it helps the grieving families, too. Wondering what "presumed consent" is? Check back in a few days, I'm working up a post on it.

Wisconsin: It's more than just cheese! Wisconsin has the highest organ donor conversion rate in the country-83%. Twenty points higher than the national average. If memory serves, it was the Wisconsin governor's friendship with Tommy Thompson that brought about the HRSA breakthrough collaborative.

Over at Revive Hope, there's a call for people whose lives have been changed through organ donation. (BTW, cute baby picture, Steve. I notice the mouth is wiiiiide open. Hmmm.) Well, what are you waiting for? Get writing!

All right, enough for today, I still have to write my NJO post before the baby wakes up.

Thursday, August 09, 2007

9-5

****Check out Change of Shift over at Emergiblog!******



I have been so behind on everything this week-my articles, my posting, checking my emails. I'm in orientation again, so I'm at the hospital 8 hours a day, 5 days a week for 2 weeks. Which may be fine for mere mortals, but there's a reason I went into nursing and it wasn't for the sexy scrubs. I like working like a dog for many hours and then enjoying several days off during the week. I like having the early morning hours before the family wakes up to get things done. Well, maybe next week.

Also, I'm the newbie again. Not really, I mean I know more people at the hospital I work at than probably the CEO does. I went to get my employee physical a few weeks ago and I was informed by the NP that it was the 4th time I've had a new employee physical there. I like it there, but not enough to stay and collect some seniority, apparently, which is another reason I became a nurse-you can easily move between jobs. My experience is enriched for it, my retirement plan-not so much.

It's a little hard for me, not being the expert transplant coordinator, walking onto the unit with my white lab coat and my donor bag. Now I'm just another staff nurse grunt. I suppose I'll manage as long as I can keep out of the way of my own ego. I will say it is a fine walk to work, about 1.5 miles one way but I've been getting rides home with hubbie. Today I walked home, up a major hill. Next week I should be done working on my bike and I can ride in. My bicycle-don't get excited PJ, I have to pedal. I've been sanding the rust off the chrome and next I have to put naval jelly on the chain. It's a really cool, blue 1960's Schwinn I picked up at a garage sale last month. I can't wait to ride it. It's no 1964 Impala, but it'll do. Either way my legs are getting a workout.

So next week, more writing. Now, I'm going to put my feet up.

Monday, August 06, 2007

New tunes, new "Work Friendly" version

Here's some new music and it's not automatic. You have to click on it to hear it, so all you slackers at work should be safe while you read. I had to make a few artistic compromises. I wanted Lauryn Hill's "Every Ghetto, Every City" cause I love the line, "I was just a little girl, skinny legs and press in curls. My mother always thought I'd be a star." But I COULDN'T find it on projectplaylist. Same with Santana's "Without Love", but I did find a live version of "Oye como va" with Tito Puente-how cool is that? And of course a little P-Funk. I saw them live in Newark Symphony Hall many moons ago. I was one of 5 white people in the place. Best concert I ever saw. Enjoy.

Sorry for the lack of a post...

Last week was a whirlwind as I finished up at the old job. Loose ends to tie up, a project I had to turn over (still looking for someone to take over the ICG monitor, you know you want to!). Thursday night my peeps and I went for drinks and snacks. I imbibed way too much and wound up getting a ride home on my friend's motorcycle, much to the consternation of my husband. He was alright once he realized who it was that drove me home. How I managed to stay on is another story. Now he's using the incident to leverage me into letting him get a bike, as if I "let" him do, or not do, anything. And no, PJ, he not interested in seeing the pictures of your smashed up knee, K thnx.

Late Friday night, eldest daughter informed us that she wanted to come home for the weekend. She's been working as a camp counselor up near the Kittatiny Ridge and needed a ride home. Bonus, she's had the last Harry Potter book up there with her, so I allowed her to come home AS LONG AS SHE HAD THE BOOK. No, seriously, I was glad to see her. So guess what I've been doing this weekend? I had no idea Dumbledore was gay! Ooops, hope I didn't spoil it for anyone.

I completely missed National Minority Organ Donor Awareness Day, August 1st. I was going to write a post and, well, you know how it is when you're only allowed out drinking one night a year. Anyway, today the waiting list has over 96,000 people on it. Over half, I believe 52%, are minorities. Unless you live in a hole in the ground, you know that high blood pressure and diabetes are epidemic in minority communities. According to the US Renal Data System, African Americans are 289% more likely to need dialysis or a kidney transplant than a white person. In 2006, minority donation rates increased slightly, with African Americans making up 15.5% of deceased donors and latinos were 13.7%.

OrganDonor.gov has a nice site that not only tells you how to sign up to be an organ donor, but also how to avoid needing an organ. I recently read in the Institute of Medicine's 2006 report on Organ Donation that 1 in 5 people, sometime in their life, will either need or know someone who will need an organ transplant. Every day I hear some news report about the growing obesity epidemic. As hard as it is to get the waiting list to come down, we should remember that there are things we can do to keep some people from needing a transplant. I may not have a preventative for biliary atresia, but I can keep my weight and blood pressure down and educate my patients on why it's important for them to do the same. Every little bit helps, right?

Anyway, I've got 2 more chapters of Harry Potter to finish.....