There are no coincidences

So LAST Sunday I spoke in church about organ donation. Pastor Seth said about 3 minutes. Hah! Somehow I managed to stop speaking before anyone started yawning. Seriously, a lot of people told me I did a good job speaking and that they were going to put "organ donor" on their driver's licenses and so on. Which is nice, because I never look a positive affirmation in the mouth.

What really floored me is that one woman, who I've sat near and chatted with on occasion, came over during coffee hour and told me that her son was an organ donor last year, in the very same PICU where I used to work. We probably talked for half an hour, at least. She told me how hard it is, but how sharing his organs has given her some meaning, a way to cope better with having her only child die. I can't even imagine-I think about it and it makes me want to ground my kids for life so nothing bad will happen to them.

For me, as a coordinator, it was nice to hear that donating has helped her and I told her so. I've only ever seen families when their grief is still raw and fresh, so it was a blessing for me to hear her say that donating his organs is helping her heal. I've said it before and I'll say it again, donation is a solace in a time of mourning.

This past week I met a friend for coffee who is now the hospital services manager of the hospital where that very same PICU resides. She's having resistance, of which I am familiar, to donation. Not that the staff is against organ donation, theoretically. It's just that PICU people tend to be very possessive of their little ones and don't take kindly to OPO staff "hovering around". I told her I'd be available to talk to them, if she wanted.

So now I'm in church again today and the woman who's a donor mom and I sit together. While talking I mention the above to her. She got quiet. I didn't want to ask for her help, because she already told me that she doesn't think she's ready to talk publicly about it. But I can see she's thinking. After services, she tells me that if I ever need anyone to talk to the PICU staff, I can call her. I told her I'd take her up on it.

Because no matter how good I can gab, she's the one they're going to listen to.

Giving

My friend Ali works on a hospital ship docked at a port in Liberia. Recently, while visiting families out in the countryside, she joked to one woman that her baby was "so fine, I'm going to take him back to America." The woman untied the little one from her hip, handed her to Ali and walked into the bush without saying a word. When it was time for them to leave and she went to hand back the baby, the woman was sobbing.

Think for a moment what it could possibly be like to live in a time and place so hard that you would hand over your child to a stranger, like tossing a letter in a bottle out on the open sea. Was she thinking, as she handed over the child, that America was the promised land she'd never get to, but that her baby might have a better life there? Was she thinking that there would be one less mouth to feed? I don't know, I hope I never know.

It has made me think, as we enter the consumer frenzy we call the holidays, even more about what my values are and what my husband and I want to teach our daughter. The first Christmas she was here, all 2 1/2 months old, my husband announced that we would not pretend Santa Claus was real. Right from the get, he said, she would know he was make believe. I was appalled. No Santa? But, he's magical! Like fairies! Although the point may be moot (kids seem to have no dilemma with the paradox of make-believe being more real than reality), I think I'm starting to agree with him. I think I'm tired of the fairy tale Christmas.

I've long felt this way about weddings. Why would anyone spend tens of thousands of dollars, borrow it even, to live for one day in a way that is far above their lifestyle? Because it's the happiest day of your life? Well, if that's true, you marriage is going to be one long downhill of disappointment. But I digress. I don't feel a need to emulate the weddings of the British Royal Family and less and less I'm feeling a need to have a Currier & Ives Christmas. Especially when I remember that the reasons those Victorian Christmases were so lovely is at least in part because they had a lot of servants. Who worked on Christmas and didn't get to see their own families 'til the next day.

Bah humbug. So now I try and figure out what this season of peace and joy is supposed to mean to me. I spoke with hubby and said maybe we could take all the money we were going to spend on presents and send a big donation to a charity we believe in, like Habitat for Humanity or Heifer International. Wouldn't that be better than buying Aunt Carol another pair of slippers? But he likes buying and giving gifts for people. He loves it, in fact. It makes him act like a little boy and he tends to start buying early, like around Labor Day. He, once again, has the right point-it's about giving, stupid. While I ponder the moral quagmire, he's trying to figure out what he can get that will make someone else happy. So I'm starting with a small change. When the Pooter asks what Christmas is all about, we tell her it's about GIVING presents.

So, this year I'm trying to focus on what I can give. Not iPods and digital cameras, but what I can give of my time, my effort, my love. And if you want to know what to get me, I'd like every able-bodied adult to send $25 to a worthwhile, African charity AND spend 10 hours writing to your congressmen and senators why we should help the beleaguered continent. So no mother will have to choose between a life of poverty and handing her infant over to strangers. That's what I want for Christmas.

I'll probably get another sweater.

National Donor Sabbath

This weekend marks the National Donor Sabbath, created to bring the topic of organ donation into houses of worship. One of the biggest misconceptions people have is that organ donation goes against their religion. In fact, all major religions support organ donation. Want to see what your religion has to say? Go here. It's okay, I'll wait. Unfortunately, most people don't think about organ donation until they're in a devastating situation. And that's the worst time to make a decision. Quite possibly, there's someone in your neighborhood, in your schools, your congregations, your work place, who need an organ and you may have no idea. Or maybe you think, I'm going out with everything I came in with-let someone else donate. Well, less than 1% of people die in a way that their organs can be donated. As Rabbi Hillel said, "And if I am only for myself, then what am I? If not now, when?"

So, if organ donation has touched your life, get up and say something in church this weekend.

I'll be speaking.

The not so best phone call

We had wine with dinner, tonight, which is a very, very civilized way to end the week, even if all you're having is pepperoni pizza. ("Pepperoni?" My husband said, "You haven't ordered a pepperoni pizza in all the time I've known you." Well, that's my prerogative). Today started with a nasty gram from the boss: we all come in too late, leave too early and take too many frivolous breaks. For those (read: almost all) of us who come early, stay late and work through lunch 4 out of 5 days a week-we were pissed. Pissed enough to renew my BLS and see if the hospital down the street is hiring. Then by lunch time we were all friends again. Mostly.

Worst of all is that I had to write the "You better _____ by _____ or else" letters. Even though I deal with Post Transplant patients, we are all expected to pitch in with maintaining the wait list. Once you get on the wait list, for a kidney or panc, it may be years before you get an organ. In that time, the patients, depending on their health and needs, need to continue getting annual cardiac clearance, send routing labs in and come into clinic to be re-evaluated. Someone has to actually go through the list, figure out who needs what and when so that, when the time comes to transplant them, we don't suddenly realize that they need a pacemaker, ilio-femoral bypass or that their insurance has run out. So, driven by threats via email from teh boss, I had to scour a few charts and see why folks aren't keeping all their records up to date.

So here's the deal: folks get referred to us from their doctors when they need a transplant. Hopefully, they aren't on dialysis yet, maybe it's just looming large in their future. So they come in, meet with all sorts of professionals-surgeons, nephrologists, the financial coordinator, the social worker and last and most decidely least, the transplant coordinator. Then, once a week, we sit down as a group and decide who is eligible for an organ and who isn't. That's probably a whole 'nother post.

Once they're on the list, depending on age, health status and circumstances, they have to come in once a year or every other year for a re-eval. Annual retesting is also required, mostly cardiac testing. Folks who are on dialysis 3 times a week are getting reminded often when they need stuff and monthly blood samples are sent in, but the pancs are a different story-more on their own, so to speak. And, let me say, that the majority of people get things done in a timely fashion. For those that don't, we call doctor's offices for results, call the patient and remind them of what needs to be done and so on. I've been calling one woman for 5 months to get a stress test done or we can't call her in for a pancreas, should one become available. Remember, diabetes causes major heart problems. Another guy said he was going for a stress test in July. In August, his mother answered the phone and said he wasn't available. Now his numbers(all 3) have changed and I don't know how to get a hold of him, so I Fed-Ex'd a letter to his house, not sure if he still lives there.

I don't want to write the letter. You have 30 days to contact us or you're out. But, realistically, it does not speak well to his ability to take care of a donated organ (not that I'd be able to reach him I can't call him). The follow up is intense. We should have a slogan, "You get a new kidney, but your ass is ours!" Seriously, it's been 6 months and some of these people are like family, already.

ed note: started Atkins Monday, so that's the last pizza I'll see for a while. Pray for me.

It's still exciting to be on call....

Despite the sleep deprivation. I no longer take broken people off helicopters or spend days in the ICU trying to mend them, but being on call when you get a kidney offer is still pretty exciting. Or maybe I just need to get out more.

So, Thursday night into Friday, I get a call around midnight for a kidney offer. The surgeon says we'll take it as long as the biopsy and anatomy are good. For you non-medical types, that means that when they recover the organs, they'll write down if there's any noticeable injuries or disease that might effect its function, along with the size of the kidney and the veins, arteries and ureter. Then they take a chunk (a little chunk) and send it to a lab to be looked at through a microscope by a pathologist, again to see how good the function is. If neither suck, we'll take it. The OR is scheduled for the a.m., so we won't know 'til then. Now I have to call our potential recipient and make him NPO (don't eat or drink).

Then I realize that I've left my on-call book, with the wait list that includes everyone's phone numbers, in my office. So after I tell the hubby, I head on out to the hospital, fortunately only 5 minutes away by car(no, I did NOT ride the bike). Anyway, on my way to the office, I get another offer, this one for a teenager. So I grab the book, leave the office and get another phone call. This time to tell me that the intended teenager recipient does not have a blood sample on file and will need to come in ASAP to give one so that cross matches can be run. They run a blood sample of the recipient against the blood sample from the donor to see if there is any cross reaction to certain antibodies. Folks that are on dialysis have a sample sent every month automatically from their center, but this kid's no on dialysis yet. Plus, there's a special form that needs to be filled out and sent with the specimen to the local OPO and it's only-you guessed it-in my office. Well, maybe there was a reason I had to come in, because I don't routinely have this paper on me(although it's probably not a bad idea). Even if I did, though, this family doesn't have a fax machine, so I'd only have to meet them here anyway.

So what I do instead is head up to the transplant unit, make all my phone calls. I wake up to sleepy and now very excited families and tell them that they may be getting a kidney, not to eat or drink anything from now on except meds with sips of water and I'll call back when I know anything. With the second family I make arrangements to have them come in a few hours from now to give a blood sample. Then I head down to the lab, explain my plight to the one of the techs and he takes all my papers, along with instructions and leaves it on the desk of the person who does those tests. I have written at the top: "Patient S______ is coming in to have a specimen drawn for (the OPO). There is an available kidney for them and it must be sent to (the OPO) ASAP. Thanks." With my name and number at the bottom. Then I head for home.

Except I can't sleep. And I don't feel like blogging. So I watch some Anthony Bourdain and read a little and then toss and turn until 6:15 when, if I don't get out of bed this instant, I'll have to wait for The Teen to get out of the shower and she takes slightly less than forever in there. So I haul my carcass out of bed, get washed and dressed in my most-comfortable-but-still-appropriate-for-work outfit and, this time, bike to work. On my way in I get a phone call from the teenage recipient's dad, saying the lab can't find the paperwork. I say to have them look on So-and-So's desk. They come back on and say they have it. Sometimes, just sometime's, things work out the way you need them to. I get to my office, have a quick coffee and it's time for rounds.

Well, it's been a week.

Last night I was remembering with longing those heady days before the baby came, when I had scads of time to do whatever, whenever I wanted. Then I remember that I was the one who wanted a baby so bad. Then I also remember that when I had all that free time, I didn't really DO anything-I didn't write the Great American Novel or go back to school or even clean out the basement, so stop whining already.

Needless to say, I'm not getting on the internets so much, and when I do, mostly I just surf the news sites. Then I have to take an aspirin and lie down. You really shouldn't read the news-it's not worth it.

Work's been, well, it's a living. I'm vaguely happy that I get to totter around in my heels and long, white lab coat. I have a signed prescription pad in my pocket that I get to whip out when someone needs a test or a medication. Then I wonder when did I ever become so shallow that a lab coat and a little authority can make my day? That worked well 'til Friday, when we all got a nasty-gram from the boss for things that weren't our fault, that made me want to march in there and toss down my resignation and THEN I got a stern talking to from the chief surgeon about things that were my fault and it took all the wind out of my sails, which is probably just as well. Until I renew my BLS/ACLS and get a new car, there's no point in job shopping.

Aside from the soap opera, it's a pretty swell gig. I have a bunch of patients who I really like that have just reached their 90 day appointment and so I won't be seeing them until December. During the first 90 days after transplant the patients come in 2x a week for the first month, then 1x a week, then every other week, plus many, many phone calls, so you get pretty attached to some people. Then, like little, baby birds, they fly off back to their regular, hopefully improved, lives.

I feel like I've been seeing all these weird articles about transplantation, but I haven't had the wherewithal to come on and share them. First up, if you haven't already read about, is a story from April of this year. Appears a guy committed suicide, his wife donated his organs and then, years later, meets the heart recipient, ends up marrying him and then HE commits suicide. There's been bunches of stories circulating about cellular memory, as if the second guy somehow "caught" the suicide bug from him. If you read the story from the South Carolina paper, I think you'll agree that it was in fact 2 guys who had the bad luck to hook up with this woman. Anyway, if you want a bit of "As the World Turns" meets "King of the Hill" with a little bit of "Heartland" (remember that show?) thrown in, then read this.

Yes, Virginia, there's a new post coming...

Recently, a commenter named Virginia asked if nursing was a good profession to go into.

Hell, yeah!

As long as you can get RN with an associate's degree, it remains a great bargain, as far as college goes. Two (well, more realistically three) years of school for $50,000 a year? At least in my neck of the woods. That's not too shabby. While I can see both sides of the argument for RN's having a minimum of a Bachelor's, for the time being it remains that you can make a pretty good living with not so much school.

Nursing school changed me. I learned how to prioritize, I learned how to focus my thinking. It gave me a lot of confidence. I never realized how smart I was until I went to nursing school. It also brought me out of my shell. I am pretty introverted. (Seriously, Steve, I am). In clinicals, you just have to hitch up your britches and march into the room, introduce yourself to the patient and get on with it. I learned how to make mistakes and learn from them-the first time I logrolled a real person, I pulled out their JP drain. The first time I made a medication error, I walked into my bosses office with my head down and we had a good long talk about how to avoid that in the future. I learned that I didn't know what I didn't know and that NOBODY, especially in medicine, knows everything and if someone thinks they do, don't let that person take care of you or your family. I learned that it's ok to ask questions and that the learning never ends.

I went to nursing school with someone who wanted only to go into research. She quit after the first few weeks of clinical-she just couldn't take wiping butts. It's a shame, really, because if you can make it through two years of clinicals and one year of med-surg nursing, you can really go anywhere. Get a few more years experience, some additional education and certifications and really, where can't a nurse go? There's nurse legal consultants and nurse educators and nurse lobbyists and if you really like school, you can even become Dr. Nurse. You can go into pediatrics, delivering babies, oncology, school nursing, travel nursing, dialysis, emergency room, ICU's, home health care, public health and if you get tired of patient care and don't want to look at another human being, there's infomatics.

Become a nurse and you'll always have a job. Those baby boomers aren't getting any younger. I've been reading these articles about how to recession/depression proof your job and they always have healthcare at the top of their lists of desirable positions. (My poor daughter is going into fashion, but I told her people will always need clothes, too).

You get to do really cool things as a nurse that most people just watch on TV: I've taken people off a helicopter while it was still running, I've had my hands in someone's abdomen up to the wrist ("That's his pancreas. Don't squeeze."). I've held someone's hand as they watched their mom die. I've put band-aids on boo-boos. I've handed out a lot of tissues. And yes, I have wiped a LOT of butts.

Nursing is flexible. You can work full time, part time, per diem, just weekends.

You can go to work in your pajamas. Or scrubs, which is almost the same thing.

Oh, yeah, and you get to help people in a really rewarding way and make a difference in their lives.

And one last thing. If you run into anyone who pooh-poohs this and says, "Nursing sucks! Don't be a nurse!" Please tell that person to get the heck out of the field, because their sorry ass attitude isn't helping anyone.

Well, for those of you that go to Falling Down Is Also a Gift, you know that Anni is back on the liver list and pretty sick. Stop by and offer some words of encouragement and don't forget to keep Anni and her family in your prayers.

The pharmacist is your friend

Have you ever watched "It's a Wonderful Life"? Of course you have. I'm a big Jimmy Stewart fan, myself and I've probably watched it dozens of times. I have my own copy, still in the original black and white, no thanks to Ted Turner. Cry every time, too, cause I'm a big mush. One of the big turning points in Ole George Bailey's life is when he keeps Mr. Gower from poisoning a patient because he's drunk and distraught over his son's untimely death. "It's poison, I'm telling you, it's poison! Please don't hit me again!"

What does that have to do with this post? Nothin'. I just like the movie. Plus, I've been talking to a LOT of pharmacists lately. I used to work in an ER with a dedicated pharmacy, which was oh, so handy and the PICU had a pharmacy too. Nowadays, I'm on the phone just about everyday with a pharmacy because someone needs a prior authorization or a refill on their prograf or something. And oy! The prior authorizations! What a pain in my tuchis! (spelling? You know what I mean). I don't understand why, if the insurance is going to give me the epogen anyway, I have to go through the trouble of calling some 800-number and explaining WHY we're giving the patient epogen. Do they think we just hand it out like party favors? Anyhow.....

I haven't yet met a pharmacist I don't like (Although one seriously tries my patience, no pun intended). But I do have to say that I'm starting to have a special place in my heart for the local, independant druggist. I'm sure that there are very good, capable and compassionate folk in the local big-chain drugstore. (Like Drugmonkey!) My goodness, though, is it refreshing to call Joe's Pharmacy instead. For instance, most of the time when I call in to a pharmacy, I'm greeted with the usual recording, "Thank you for calling Big Drugs. If you're calling from a doctor's office, blah, blah, press 8. If you'd like to call in a new prescription, press 2. If you'd like to talk to a person, hang up and find someone in your office, because we're all too busy to talk to you. Have a nice day."

When you call up Joe's, though, you get a human on the line, right away. 9 out of 10 times it's Joe, himself. I start in with my schpeil. "This is TC, from Dr. Kidney's office, I'm calling in a prescription for Doris Dontfeelsogood, her date of birth is..." At this point, Joe cuts me off, "Oh, I know Doris, what is it that you need? Ok, with 5 refills. Yes, I know your office number. Thank you." And there you have it. One time, our doctor gave a prescription for a med to the patient, and then changed his mind and I had to call the pharmacy and the patient to make sure the patient took the new med. And the patient only spoke Spanish. They said, "I'll just bring this new prescription over right now and make sure I get back the other one so they're not confused." I'm not making it up-they brought the new med to the person's house. Do you know what that says? It says, "Screw you, CVS and your fancy, new drive-through, we do house calls."

So there you have it-support your local Mom & Pop drugstore, they're a dying breed. As an added bonus, if it's an especially old establishment, take a look around and you may find neat stuff, like Bay Rum or castor oil soap wrapped in silver paper or greeting cards from 1978. And to show you that I put my money where my mouth is, our family uses the little pharmacy in our town, even though the cashier is a little loopy and always follows the baby around the store so she won't break anything.

Just tell 'em Clarence sent you.

Universal Theory

The family's asleep. (Except for The Teen-she only sleeps during the day). I'm heady with the excitement of web-surfing without feeling guilty or being interrupted for the 88th time. I hardly know where to begin. I lie. Let's begin with my new favorite site: Pioneer Woman. She's my new heroine. Wife, Mom, Cowgirl-what's not to love? Mostly, I envy her ability to pull all areas of her life into one, cool, nifty, link-filled blog. For those in the know (all 3 of you), I have three blogs: this 'ere one, Laughing-Baby, (which is pretty much just my articles for the George St. Coop), and P is for Pooter, my baby blog. Which prompted Robin, from Nova Scotia, to say, "How many blogs do you HAVE, for cryin' out loud?" or something like that.

Anyhoo, I've been thinking for some time about tidying up my baggage, er, I mean bloggage. But I really like the whole donorcycle motif, ya' know? Also, I do get annoyed from time to time with Blogger's inability to say, space properly or upload a picture. So if any of you have mad web skillz, I'd love to talk with you about having my own site, with cool links and funky graphics that aren't stolen from Google images, etc. and that would be easy to maintain and (fingers crossed) maybe turned into a real, money making proposition. Make me an offer, I'm easy. (Shut up, all of you and get your minds out of the gutter.)

Guess what happens when you get a new kidney...

YOU HAVE TO PEE!!

No, seriously. I have plenty of folks complaining about how often they have to go to the bathroom, now what with the new kidney and all. One guy is downright annoying about. I feel like telling him, "Good thing you didn't get a lung transplant, or else you'd be complaining about having to breathe."

In other news, my partner and I have a good system going. He talks to all the difficult patients and I talk to the crazy ones. (In all fairness, I should stress that 90% of our patients fall into neither category). But, also, crazy does love me. I really do seem to have a way with anyone mentally ill, drunk or anyone with more issues than the National Geographic. I could've been a social worker, but I'm not dysfunctional enough. Ba dum bump. Thank you, I'll be here all week. Eat the chicken.

Just so you don't think I'm completely snarky, a patient today told me that I have "sha-fi". Don't ask me how to spell it. Or even if I'm pronouncing it correctly. In his religion, it means I'm a healer. He told me he was blessed to have such people take care of him. The truth is, I'm blessed to do what I do.

One summer apon a time, I used to do agency shifts in this little, rinky-dink, lousy ER near the neighborhood I grew up in. I don't think the equipment had been replaced since my mother worked there in the early 60's. So one night, I went out to the waiting room to discharge this homeless guy who had come in with some minor complaint. We used to get a fair share of homeless patients. I was a little apprehensive. I wasn't sure if maybe he had a psych history or rotten smelling feet or some other issue that would make me want to keep my distance. I shouldn't have worried. With a dignity that I've seldom seen on anyone, rich or poor, we discussed his care. When the discharge instructions were finished, I told him to come back if things got worse and to take care of himself. He looked straight at me and said, "I will and I shall." For a second it was like looking into the eyes of God. Then he shook my hand and left. If Jesus ever returns, you'll find him in an ER waiting room. I will and I shall. It echoes still in my mind.

I have a patient currently who is mentally ill. When she was still in hospital she became very paranoid, telling me that the nurses were keeping her in bed and wouldn't let her go to the bathroom, among other things. (Not true, I checked). Her discharge instructions included several interruptions by her boyfriend to argue with her, when he wasn't looking at me like I was a total waste of his time. I thought, "Hoo, boy, this one's going to have trouble with the follow up." I mean, our clinic schedule isn't rocket science, but it does take getting used to and there is a big onus on the patient to be responsible for frequent medication changes and repeat blood work and keeping track of their daily blood pressure, temperature and fluid intake and output. Trust me, it challenges those firing on all cylinders, as it were. I might even have projected that this one would be screaming at me on the phone every time her creatinine jumped or she had to adjust her prograf.

Instead, I find her to be one of our more pleasant patients. She keeps track, so far, of everything she's supposed to and shows up when she has to. If I think back now to how she was in the hospital, I think of how stressful it must have been to be helpless in a hospital bed, just recovering from major surgery, with lots of noise and little sleep or privacy. Now, she's taking all her meds, she's cut back to 2 cigarettes a day, one in the morning and one at night-which I think is a major accomplishment for her. Have we changed her whole life? I don't think so-she's still dating Mr. Douchebag and she still has whatever issues she had before the transplant. But she's doing well for her. Optimizing the patient's potential, or some such nursing theory stuff like that.

Just for the record, I don't really believe that Jesus is coming back to take the faithful up in a big rapture (although if he does, I am SO upgrading my car). But if you look for it, the Almighty Big-Whatever shows up from time to time in endless, little ways. The question is, how will you react to it?

This video is awesome!

I found out about this from my friend Steve's site-Revive Hope. And I just had to pass it on:

Make your own, home dialysis machine

A baby dying from kidney failure saved when her doctor designed and built her a dialysis machine from scratch in his garage.

That's not a headline you read everyday. Before I opened the link, I was supposing the story came out of Africa, or maybe the Australian Outback. Then I read that it happened in England. ENGLAND. I don't know much about the NHS, but I can't fathom a baby going into kidney failure and the family being told, "So sorry, but she's going to die."

I do know that hemodialysis is hard on the hemodynamics of a 6 pound baby. We had a baby born with kidney failure in the PICU, so he was started on peritoneal dialysis, which is also no picnic on a 6 pounder-their BP can still drop after they drain and although the machine can be reprogramed, it still alarms 80 times a shift because the dwell volumes are so low.

Anyway, back to the BBC. So this doc makes a hemodialysis machine, I suppose out of stuff he had lying around the garage. Goodness knows what I could make from the crap in my basement. A heart-lung machine, probably. How they got the hospital to use it is another wonder-I can't even use a different brand thermometer without a committee vote and a bioengineering seal of approval. And now the baby is a toddler and looking amazingly cute. Dr. McGuyver strikes again.

(Hmmm, when I think about it, the baby probably couldn't have PD because she had already had bowel surgery, so I guess HD was the only option.)


BTW, for all you facebook folks, (you know who you are), I'm on it, but I only visit once in a while, so I'm sorry if I don't return your flowers and zombie hugs and whatnot, but I barely have enough time these days to check my emails and put out the occassional post. So, you can keep sending me quizzes "What are your favorite felonies?" "What smell are you?" but it's unlikely that I'll answer.

Good news everyone!

Remember I mentioned a while back about the Astellas Rose Bowl contest? Well, my friend Steve is one of the winners. Check out his winning essay at Revive Hope. I'm so proud. I can't wait til the parade, so I can point at the TV and shriek, "I know him! I know him!" and generally have my family look at me like I'm nuts, which may be true.

The dust is still settling at work after our recent inspection. I'm just trying to sit at my desk and schmooze with the patients and do my little job and go home like a good girl, for now. In the words of a trusted advisor, "KEEP YOUR MOUTH SHUT!" Hard for me, but I try. I am definitely the Queen of TMI. "Oh, did you not want to know that about me? Sorry, K THNX."

Other than that the summr is winding on. We will have no more vacation days til we straighten out the mess-glad I had that week off. K THNX.

I'm in a little funk today, the past week has brought up some old friends I haven't seen in a while and I ponder getting in touch with them. Well, one, anyway-my BFF from when the teenager was a wee girl. Haven't spoken to her in like 15 years at least. Well, we'll see.

Possibly adding to my pensive state is this video. If you haven't heard of Randy Pausch from under your rock, I highly advice you to take and hour and sixteen minutes and watch it. To that end, I started thinking about my childhood dreams......

1. To be Quincy. You know, the medical examiner? No, I did not want to be a crusty, old guy like Jack Klugman, but I did want to cut open dead bodies and solve crimes with a trusty sidekick, like Sam. I'm still bitter that nurses don't take Gross Anatomy.
   
2. I wanted to be an actress. Did well up until high school. Had the lead in Guys & Dolls, Dracula (the female lead, I was Lucy, not Dracula), and Bye, Bye Birdie and I was in West Side Story, too. But I was not really confident enough in college to pursue it, so most of my singing is saved for the Pooter.
3. To play the violin. I love the violin. But I play the clarinet. Because that's what we had in my house, my brother's used clarinet. My mother kept telling me that when I got good at it, she'd let me take violin lessons. I made it to first chair and still didn't get violin lessons. But it's not too late. And I am trying to learn piano, so I can accompany my singing. See #2.
   
4. To write a book.
   
5. To run a marathon.
   
6. To travel and live in far flung, exotic places.
   

Some, like the book, I'm still working on. What are your childhood dreams? Have any come true?

Well, it's a little easier to write a post thanks to my husband. My laptop went on the fritz about a month ago. Wouldn't start up at all, just gave me an error message on a blue screen. Apparently, my cute, little laptop didn't come with enough memory to run a diagnostic and fix whatever problem it had, so my husband put in a few more gigabytes of memory. And erased my computer. Which was necessary, but still. Fortunately, the great American novel is still in my head and so wasn't effected.

Work is going ok-I still like the job. I have people thanking me for being their coordinator, which is nice. I have people asking me if they can switch over to me from the other coordinator (we split the alphabet) which is nicer. I can't help it if I'm nice and return phone calls mostly on time. Doggonit, I'm nice and people like me.

I did have one downer moment today. I received a call from an OPO last night, their donor family wanted an update on the recipient who was transplanted a few years ago. I'm only allowed to give basic info, like-they're still alive and the kidney's ok. So I called the person up and asked if they wanted to give any more info to the family. Apparently, they're having a hard time on the medications, they're not feeling well, they've developed side effects and probably "wouldn't recommend anyone to get a kidney." So no, they don't want to get in touch with the donor family. But they're thankful.

I can't imagine that it's worse than dialysis, but then I haven't gone through either. My biggest surgery was getting my appendix out and I balk at taking more than one fish oil tablet a day. One the other hand, I spoke with a person who'd been a living donor today, and she was so excited because for the first time in a long time her whole family was together, including her recipient. No surgery works out exactly the same for everyone and I guess transplant is no different. I like to hear the stories that people are going about enjoying their lives. It doesn't work out that way for everyone. Some have complications and I think for some it just wasn't what they were expecting.

I read somewhere that people given a chronic disease diagnosis usually find it easy to stick with their regimen for one year, then the compliance issues begin. I don't know if that's true, but I'd love to hear from you folks. I know it's hard also for kids to stay the course when they become teenagers. First, because hormones throw everything into turmoil and then add to that rebellion mixed with a bit of "it won't happen to me". I'd love to work with teenagers who need/have transplants.

On a side note, to all you F&F out there-Poot is asleep at this moment and I get to spend some quality alone time!! So I'm off to surf the innernets before she realizes I'm no longer sleeping next to her.

So that's how it is...

I can write whole, big, informative posts and get nary of comment. But post one cute baby picture and y'all tripping over each other to comment. That's fine. I can take it. God knows, she's much cuter than I am.

And Ali, I hate to tell you, that picture was taken almost a year ago! The curls are longer, the dimples are deeper and she's prone to answer any request to stop doing what she's doing by saying,

"But Mama, I just doo-in!"

If you want to know what melts my icy heart, it's a cherubic little voice calling me Mama. It's been about 12 years since I last heard that. The other night I looked over and her and the teenager were snuggled on the futon eating noodles together. That just about did it, too.

p.s. Ali, I'm glad your cousin got her lungs! I'll keep her in my prayers as well as the brave family that made the decision that saved her life.

What gets me through my day...

This is the picture on my desktop. Now you know why I can't wait to get home. Squee!

Oh, God, it's hot!

I'm sweating, for no reason what so ever. It's not like I'm doing anything active. Just typin'.

Some weeks ago our main air conditioner died. Our landlord sent some guy over to look at it and, I don't know, make sure it's dead, I guess. He came on a day we told him we wouldn't be home. That's the last we've heard of him. At least we've got the AC in the bedroom. I feel like jumping into a vat of Pellegrino. Even my mouse is sweaty. Blech.

The good news is that I'm on vacation this week, so I can be as sweaty as I want to be and just lie around the house and moan about how hot it is. But work has air conditioning, you say. Yeah, and it also has WORK. Since I didn't win the Megamillions Friday night, I guess I'm going back Monday.

This has been my first vacation since maternity leave and since that involved something called "labor", I don't really consider it a vacation. It's been a nice week. The lil Pooter and I went to the zoo last Tuesday. Despite the fact that most of the animals were sleeping, it was tons of fun. They had a little train that went through the woods and along a lake. Everytime the horn went off, she grabbed my arm tight and put her head into my shoulder, but she was grinning from ear to ear. The carousel was another big hit, as were the monkeys. Another day we went to the farm and fed some piglets. I think Pooter loved this even more than the zoo, especially since they were up close and touchable. They had a ball in the pen, so we'd throw it and they'd chase after it. Someday, I might be called upon to explain where bacon comes from, but for the time being it was a blast. The big hightlight was when the enourmous mama pig pee'd on one of the piglets who didn't get out of the way fast enough. Pooter laughed until she squeaked.

We also inflated our kiddie pool and put it under our screened in tent for a ghetto fabulous resorty effect. This way mama can sit in the shade with a cool drink while the Poot splashes about.

Thursday was the big excursion. All four family members: Papa Bear, Mama Bear, Cranky Teenager Bear and little Baby Bear, all went to the Shore. As in "Down the Shore". My husband is from the shore area and he calls it "the beach", as in, "We're going to the beach, you Bennies." He won't say Down the Shore. Benny, if you're interested, stands for Bergen, Essex, Newark and New York. Some places call them Shoobies. In other words, loud, obnoxious persons with questionable driving habits who take over your town from May to September. Known to wear bermuda shorts with black socks and sandals. Since I myself once lived blocks from the beach, I don't think I should fall into that category but hubby begs to differ. Just because I never lit things on fire and then used a shotgun to put it out. And then blamed the whole thing on a black dog. Or something.

Anyhoo, Pooter also like the beach. Especially the SAND. Crashing waves, not so much, but the sand was a big hit. So big, that she brought several quarts of the stuff back in and upon her person that continue to be deposited on our bed and belongings no matter how many times we wash her. Her and Daddy made a big sand castle while Teen and I played in the waves. To insure we went against the BENNY grain, we arrived late and stayed til dusk, long after the lifeguards had gone and got to see a few people surfing in the full moon high tide. Then we had dinner at Wegmans and drove home. Pooter managed to fight sleep all the way home but was asleep minutes after her head hit the pillow. Just enough time to let me know how much fun the beach was.

And all week long I got to sleep without an alarm clock and be with my family every second of the day. I've got to figure out a way to make money without actually working. Legally, and without changing my name to Bush. Otherwise, it's back to work I go.

The best call I ever made

I've been putting off posting in every way I can think of. Of course, my laptop is on the fritz, so that helps. It's so much harder to get on the family computer, what with the Counter Strike and the poker playing. At least the poker pays dividends. Then, when I do finally get a turn on the computer, I find endless, diverting stories on reddit or else I go shopping.

Mostly, though, I just haven't felt like putting myself out there. Work has been very stressful the last few weeks for reasons I don't think would be prudent to put on the internets. Let's just say I feel like an ant that some mean kid's been holding a magnifying glass over. And it rhymes with "EMS". Oops. Said too much.

Anyway, I am almost at the end of my 90 day probationary period. I have 10 more days to go back to the PICU, scot-free, no questions asked, according to our policy. And don't think I haven't thought about it. I'm used to a steep learning curve-I worked in a level I trauma center, for Christ's sake. But I am rather weary of asking people what I have to do in a given situation, being given vague instruction, asked for clarity, been told not to worry about it, and then being called on the carpet-sometimes from the same person I asked advice from-for messing it up. When I was younger, I'd just say to myself, "suck it up, buttercup" but I am too old for this crap. Then I start kicking myself, because at almost 40, I should be an expert, not a beginner again. I wanted an interesting life, and I've certainly got one, so there's no sense pouting about what I do and don't have.

"But what about the good bits?" I hear you ask. Well, I genuinely like the patients. About 98% of them, anyway. Over the 4th I was on call and we were pretty busy. I called a couple people for back up offers-meaning, someone was ahead of them on the list, but if it fell through for any reason, they'd get the kidney. So I called to make sure they were all healthy and available and whatnot. I mean, healthy aside from the kidney failure. You know what I mean-like I called one woman on her cell phone and she answered from her hospital bed. Not exactly up for major surgery. Anyway, I call this one guy for a backup offer and he gets all up in my grill. "What do you mean someone's ahead of me? I thought I was at the top of the list? What's going on?" I try and explain about how the list is really a pool and when certain tissue types match, a list is generated, but, if there's a perfect match somewhere in the country, they get first priority. I didn't get into paybacks and all that, please, I barely understand all that myself. Let's just say, thanks to the wonders of dialysis and insulin, that kidney and pancreas sharing is more complicated than with other organs. Remind me sometime, I'll explain in more detail.

Anyway, I calm this guy down, "listen, it's gonna happen, you're up there. I know it's frustrating to get called and then nothing happens, but hang in there and it's gonna happen."

A little while later I get another backup offer and I call another guy and he's pleased as punch, "a kidney, are you sure?" That offer turns into a primary offer and I call him back to tell him to not eat or drink and come into the hospital in a few hours. He can't believe it. Imagine, 3 1/2 years earlier you do all this stuff to get on the waiting list and then-you wait. Who knows when the call is gonna come? 3 1/2 years is a long time to hold your breath. So there he is, going about his daily business, doing whatever with the missus and BANG! Drop everything, pack your toothpaste and jammies-you're going to the hospital for a new kidney! And I get to be the person who tells him it's Christmas, your birthday and the 4th of July all rolled into one. It definitely makes up for the 4 people who I had to call back over the weekend and say, "sorry, not this time, but soon, I know it."


(As for Mr. In-my-grill, he got his kidney a few days later. The message-don't give up before the miracle happens.)

The new job is busy

And, lo and behold, I really like it. I forgot that I like working with grown-up-people-patients too. Some are exceptionally nice, some are downright loony tunes. Some are exceptionally nice and loony tunes. Most are just normal folks, which may be why it surprises me how much I like working with them. I guess what I'm trying to say is that the last time I had adult patients was in the ER and that's not always a place to catch people at their best, she says diplomatically.

The people never cease to amaze me. I've met people who would wake up and be at dialysis at 5am(the am stands for Areya Mad!) 3 times a week and then go and work a full time job. And I whinged and moaned because I had to do a bowel prep once (seriously, by 9am I was like "how many more hours of clear liquids?" AND you can't eat red jello! Why do they even MAKE other flavors?!) I'm also the one who, after all my talk of natural childbirth, crawled out of the elevator and said, "Get the anesthesiologist, I want my epidural NOW!!!"

All this means that if I'm ever your patient, please just point to something shiny and hit me over the head with a large rock while my back is turned-because I am just that much of a pain in the ass when I'm sick.

And sick I've been. The third week of work the plague struck everyone and the office sounded like a consumption ward. I called out 2 whole days because of fever and general malaise and because I didn't think it was cool to cough on all the people on immunosuppresion. Then I was out for a day when Pooter had her surgery. Then, the VERY NEXT DAY, I woke up with-yes, that's right-fever and all-over ickyness and called out again. The next week I got a stern talking-to. Me. Whose husband yells that I go into work when I can't talk from laryngitis and I'm coughing up a lung. Who gives him a hard time if I have to stay home with a sick baby(that's why they make tylenol). I'm a rotten mother, but I show up for work, dammit. Now I'm working with people who never call out and eat lunch at their desk. Sigh.

Another reason for the long delay since my last post, beside being plague-ridden, is that I'm a little leary blogging about the J-O-B and I'm not sure what I'm going to do about it. If I thought the OPO would give me hard time, this place would definitely put the keebosh on it, so I'm wondering what my next move's going to be. And I would lerv to talk about work. There are some real characters, staff and patients alike. I really like everyone. Well, I really want to like everyone, and isn't it the thought that counts? Today, someone brought me 3 Twizzlers and left them on my desk. Isn't that nice?

I'm splitting up the post patients with another coordinator-and we do about 100 transplants a year, and the program's been around for a while, so it's like-a gazillion patients. 1/2 a gazillion for him and half a gazillion for me. Once I lose the water wings, we're going to split the alphabet. Hubby informs me that he read somewhere(probably reddit) that if you split the alphabet by last names, the first half is unfairly burdened. I suppose that's true. If I really wanted to (and had the time), I could go into the chart room and start counting, but I s'pose I'll just take my chances. So far, it does seem like A-M has more crazies, and if you see yourself or your family members in that statement, don't come complaining to me-I didn't pick your last name. For example, I know a guy whose last name is pronounced "Co" as in Codependant or Co-defendant, but it's written like a part of a man's anatomy that rhymes with rock. And he gets pissed off when people mispronounce it. For the love of Pete, I know it's your proud family name and all, but just change the spelling already. From now on I'm going to say his name is Rick-the "P" is silent.

But I digress. Mondays and Thursdays we have clinic from 8-12 noon. Folks sign in at the clinic, go down a floor to the lab to get their blood work done, then return to clinic, where they go over their medications with the TC (moi) and see one of the docs. First come, first served-somedays we see a few, but most days are nonstop patients for 4 hours. One TC starts the clinic, the other rounds with docs until about 8:30. At noon, I run for a bite to eat and return to my little office where we write down all the labs onto one overview sheet for the docs to review, then transcribe each person's labs into their chart, because our brand new fancy computer system cannot print out lab trends. Then, around 1:30 the prograf levels come back and we start scribbling again until the doc comes in. Chart by chart, we review the labs and meds and write down in each chart what changes need to be made. THEN, we call everybody with their changes, book biopsies and call in prescriptions until it's time to go home.

The other thing that amazes me is the time committment this takes for the patient. For the first three months following transplant, they come in for clinic and/or labs 2x a week for several weeks, then once a week and then finally every other week. And that's the minimum. If anything's out of whack, or they look like they're going into rejection, it's more frequent. Each visit takes at least 2-3 hours and some of them come from pretty far away. Most of them don't ever complain-"it beats going to dialysis" I've heard more than once, and that's the truth, I'm sure. By the end of 3 months we're like old friends. I've seen some of these people more than my own parents in the last couple of months.

The other days are filled up with filing, patient phone calls, reviewing blood work and tests sent in from outside facilities, the weekly staff meeting. It's a far cry from the office days at the OPO, where I'd arrive at a leisurely 10am, take an hour lunch and be out by 3 or 4pm. But then again, I don't have to jump up in the middle of the night and drive to Pennsyltucky any more, either. I like the 9-5, I like having weekends off and regardless of what my husband thinks, I come home at a reasonable hour and spend some time with my family before going to bed, which is nice, too.

Lucky

Well, it's about 4:30am and I can't get back to bed. Late last night, after we got the baby to bed, I started coming down with yet another head cold. I try and think back to any infectious people I might have touched in the last 24 hours, but I can't. And, of course, yesterday I toughed it out and went to work when I just felt like staying home in bed and came home to baby crankasaurus, whose mouth is sore and my husband has no sympathy ("but my temp is 99.8!") And I got banished to the futon because a. I'm snoring and b. I'm on call and have 2 phones under my pillow threatening to go off at any time. Then I felt all good and sorry for myself and had a big 'ol pity party, population 1.

Fortunately, call's been-well, I don't really want to say-I still have 4 hours to go. And while I want each and every patient to get a kidney, if you could just keep those offers to yourself for 4 more hours, I'd be real appreciative.

As for the pity party, all it takes is a visit to Revive Hope and think about my friend Steve turning blue and coughing up a lung, or go over to Falling Down is Also a Gift and pray for little Anni who looks like she'll need that next liver transplant sooner, not later, or even over to 'Ole PJ with his gimpy leg to realize that I've got nothing to complain about.

Last night, after we got our little post-op patient settled in bed, my husband hugged me and said, "We're so lucky. Like 'win the lottery' lucky." And that is very, very true.

My friend Steve wrote a touching post about paramedics and remembers the team from the University of Michigan who lost their lives last year in the service of organ donation.

They were:

Dr. David Ashburn
Richard Chenault II
Rick Lapensee
Dr. Martin Spoor
Dennis Hoyes
& Bill Serra.

You can see their bios on the Umich site here…

If you think being a patient is bad...

try being a patient's mom. Or dad. Pooter had surgery on her teeth today. 2 1/2 hour surgery. Let me tell you, it is no fun at all to kiss your little one goodbye and send them off into the depths of the OR.

I'm also ashamed to say that Poot has bottle mouth caries. Or booby mouth caries, as the case may be. The dentist says the breastfeeding is to blame, although it would be more realistic to say that my practice of breastfeeding her to sleep is to blame, not breastfeeding in general. That's a habit that I never should have started. They start off wailing little wee ones and you think, "It's all right if I nurse her to sleep tonight." and the next thing you know you're paying more for dental work than I've spent on some of the cars I've owned. God forbid she should need braces-I've used up her dental allotment for the next decade, at least.

I've also got a good whopping dose of mommy guilt. Everything I had learned up til now made me think that breastfeeders were practically immune to cavities. Now research I've found says that while breastmilk alone is protective of teeth, breastmilk combined with sugars can be worse than either alone. If you're interested, I'll be posting an article on that over at Laughing Baby. It doesn't matter. I still feel like the worst mother ever. I called the dentist's office this afternoon to see if sucking would damage the caps and they said, "stop breastfeeding your toddler this instant, you freak." or words to that effect.

The other thing which I was unprepared for, but have since found out is common, is how rapid the progression is. We just saw the dentist 6 weeks ago and in that time it got a lot worse. We knew we had to have the work done in same day surgery because it was so extensive, but what was supposed to be a one hour case took more than twice that time. I was just glad that it was done in the hospital I work at-it has a children's hospital, pediatric anesthesiologists and, worse comes to worse, a great PICU (natch). I certainly didn't want to give her sedation in his office-I would have had everyone opening their wallet and showing me their PALS cards before they began.

Last week we went in to tour the pediatric same day area with a child life specialist. Pooter thought it was great fun-she was climbing on the stretchers and playing with everything she could get her hands on. This morning we arrived and she was right at home, driving the Little Tykes cars around and generally have a grand time. We got weighed and our vital signs taken-she even let them take her temperature in her ear which she never lets US do. I knew the anesthesiologist, so that was a great relief. Then they gave her a little liquid versed and before you know it, she was getting a little wobbly driving the car around and slurring her words. Before you could say, "Pull over, ma'am" she was snuggling into me and I settled her down onto the stretcher.

Daddy went in with her. He was a wreck the night before, but I knew I'd be ok until the moment came to say goodbye, so he went into the OR until she went to sleep and I headed upstairs to PICU to get hugs and mommy support from my friend Colleen. Then we met up and went to get some breakfast. After she had been in their about an hour, my husband said, "Ok, this has been fun, but I want my daughter back now." I agreed-I don't think she's been out of both our sights for 3 hours since-I don't know, I think we went on a date in 2005. At about that time my pastor came in to visit and we sat and chatted for a bit and so that passed another 1/2 hour talking about nothing, for which I was very grateful.

We got her back around 11:30. Recovery wasn't too bad-she was a little disoriented and crying, but consolable for about 20 minutes, then she woke up and drank 4 apple juices and announced, "I want to go home". So we did. They took out the IV and gave us an ice pop for the road and we went home and snuggled on the futon and watched Nemo and ate some pudding. Around dinner time she was feeling more herself and so we went in town to get some take out Thai and while we waited we went into the toy store and got her a present for being a brave little monkey.

As she was falling asleep, I asked her how her day was:
"We went to the doctor with daddy."
"That's right, we were at the hospital."
"Yeah, the obspittle."
"Was it fun?" I ask skeptically.
"Yeah, it was fun! I want to go to the obspittle 'gain." I'm grateful that she's not traumatically scarred by the experience. "Ok, we'll go to the hospital again." And I kiss her little head goodnight.

Yeah, I know I haven't posted in a bit. The little one is having surgery tomorrow-nothing major, but you know, anesthesia and all that. Please keep her in your thoughts. Thanks.

Contest for Recipients

Astellas Pharma-who need no free advertisement from me, but I thought you might be interested-have a yearly contest to help promote themselves and their website Transplant Experiences. They're looking for essays from transplant recipients and the winner gets to ride on their float in the 2009 Tournament of Roses parade.

If you go to the above site, there's a link called "The Ride of a Lifetime" that will give you all the info and includes winning essays from previous years to inspire you. The essay must be submitted by June 13, 2008 11:59 pm EDT, so if you're interested, get crackin' and good luck.

Starting Over

I'm a newcomer, again. On a new job, with new people, not sure of what I'm doing or even where I'm supposed to be half the time. While my sense of adventure is still intact, it is a little bit tedious to be a newcomer at my age. I keep thinking that I should really be more settled by now. I tell myself that the many job changes (7 in 11 years? Eeks!) has enriched me with invaluable experience. As for enriching my retirement account, not so much. (Right now my retirement plan is to be nice to my children, so they'll take care of me when I'm old. That, and staying in shape, because I'll probably have to work 'til I'm 80).

Also strange is the transition to a desk job. I mean, occassionally as a procurement TC I'd be a desk jockey, but most of the work was in the field. When we all would get together in the office, it was usually riotous and no one could get any work done anyway. My new coworkers are "office people" though. There's a total of 5 of us, plus my boss. Three would (and do) gladly work for 8 hours straight at that desk making phone calls and sending faxes with the occassional potty break. They eat at their desk. The guy who's training me told me that he doesn't eat lunch. Yeah, ok. I can understand that there are days on the unit, when you have an unstable, vented patient who might not live to see the next shift and so you skip lunch. But in an office? Seriously, the phone calls can wait half an hour. Besides, sitting in that little office all day, you start rebreathing your own CO2 and the next thing you know, you're a little loopy-which I think has already happened to one of them.

The first 2 weeks I mostly watched people work, which I can't stand. I'm a doer, not a watcher. This week I managed to cut my chops on some actual work which involves calling people and telling them what to do, where to go and what meds to take. Twice a week, in the mornings, we have clinic. The newly transplanted come twice a week for several weeks, then they come twice a week alternating lab and clinic visits. Then they come every other week, with just a lab visit on the off weeks-all for the first three months when the risk of rejection is highest. Then we see them every three months for the first year, as long as everything's going ok. Then every six months and then once a year. After the first three months, their primary care gets turned back over to their nephrologist.

The patient's clinic day goes like this: they take all their meds in the morning except for their anti-rejection meds. We do a trough level every visit. They come into clinic, sign in and then go to the lab on another floor for bloodwork. Then they come back to clinic, take the anti-rejection pill and wait to be seen. When they first come in, the TC(me) goes over their meds to make sure they're taking the right things. Note to God, please don't ever let me become chronically ill, because I can't even remember to take my daily vitamin. How anybody manages to stuff so many pills down their gullet is a wonder to me. Basically, everybody is on the following: Prograf, cellcept, prednisone, multi-vitamin, iron, potassium and magnesium supplements, blood pressure pills and, of course, something to protect the ol' stomach from taking so many pills, like nexium or prevacid. This doesn't include the drugs for whatever other problems they have-insulin, water pills, more blood pressure pills, pills for gout, whatever. I'm trying to get used to all these "old people" drugs (no offense, but kids are usually on meds for breathing and reflux, period).

Clinic ends at noon and then we write down all the lab results in columns by patient for the docs to review, write them again in everyone's individual chart and together with the surgeon go over the labs for everyone who's been in the clinic and a few who have their labs faxed to us from outside labs. Then we write down the changes they want to make and THEN we spend the afternoon (and the following day) calling folks and telling them to increase their prograf or decrease their magnesium, etc. Anyone who looks like they're going into rejection gets scheduled for a biopsy and possibly comes to the hospital for 3 days for high dose steroids. It's not rocket science, but it's a lot to stay on top of. One good thing is that the docs are all super and my boss is pretty laid back as long as the work gets done.

You want me to take WHAT with a sip of water?

In other news, our recent bout with the plague of the week is dissapating. Everyone in the house is on antibiotics, except for the teenager, who's never home long enough to catch our germs. Possibly, if she did come in contact with one of our germs, she'd kill it with a withering glance.

Also, my friend and former coworker is working on a Mercy ship in Africa for a year and has a blog. Besides, being a better writer than me, she's also an amazing photographer and altogether more awesome human being than I could ever hope to be, plus she's muy modest, so she'll probably be pissed that I'm even mentioning it, but you should read her blog. It'll blow you away.

That's it for now. I'm off to enjoy me weekend, now that I have weekends to enjoy.

Well, I started checking some of my links and found that Moreena's wasn't working, because I never updated it. Whenever I haven't been to her blog in a while and then I go there, she usually has something up that makes me cry. Then I wonder how come she hasn't written a freakin' book yet, because her writing talent makes me gnash my teeth in jealousy.

Then I watched the video and cried some more. A whole lot more. It's worth reading, but don't say I didn't warn you.

So long and thanks for all the fish

Three weeks ago this Friday was my last day in PICU. Possibly my last day as a bedside nurse, ever. Mmmm, well, maybe. There's something to be said for taking care of the immediate needs of another human being. A long time ago, my friend John dated these two women (not at the same time). They could have been twins: they were both tall, blonde and bitchy. Well, there's something to be said for his taste in women but he was a fun guy to hang out with. Anyway, fast forward to 1997 and I run into girlfriend #1. She asks what I'm doing and I tell her I've become a nurse. She sneers and makes a remark about how co-dependant that is. (Remember co-dependancy? Or as I like to call, As Crazy as You Want Me to Be). I was brandy-new to nursing, at the time, so I just mumbled something about her not understanding and made my get-away, before I caught whatever it was she had. Another year goes by and I run into girlfriend #2. She also asks what I'm doing and again I say I'm a nurse. She ALSO says that that's soooo co-dependant. Now, I could have said that nursing is about caring, not co-dependancy. That it's about advocating for the sick, helping people when they're vulnerable, and healing folks who are wounded in their hearts, minds and bodies. It's about education and research and community outreach and technology and putting it all together in a multi-disciplinary, holistic package. But I didn't say any of those things.

Instead, I smiled and said, "How interesting, that's just what C-- said to me."

She just turned on her heel and walked away.

 

Without a doubt, some people think nurses are co-dependant. I know one or two doctors who think we're overpaid babysitters. (Oh, is the nurse talking? How cute).

 

For the past few weeks I've been doing another kind of nursing. So far I've mostly been making phone calls, or watching people make phone calls. I've done med reviews and taken histories and started to learn about the process of getting people on the waiting list for a kidney and then what to do with them after they get one. I will eventually wind up on the post-transplant side with another coordinator. People are constantly saying, "Oh, you're going to be working with him? Good luck." Love Monkey thinks this is a bad sign but I'm taking it as a challenge. I'll let you know how that all works out. For now, I'm not sure how much I'm going to be talking about my actual coworkers or patients because I've come to find out how non-anonymous the internet is and I've already been bitten in the butt making that mistake. I will say that the worst part of my week was telling someone that they're not a candidate for a transplant due to other health problems. Not fun. Think of taking away someone's puppy on Christmas and then telling them Santa's not real. It was worse.

And do I have to say that I'm sick again? Toddler germs. Just when I thought I'd caught every germ in the Mid-Atlantic states, I find a new one. Oh, well.

End of the Week Update:

My last 2 days at worked sucked. Wed I was in a terrible mood and I had to take care of 2 depressing cases. One kid will never leave the hospital and the other is neurologically devastated and will be on a vent forever. I kept thinking that his case sounded familiar but I didn't work in the PICU when he was initially injured. At 3pm, the evening secretary came in and enlightened me-I had assessed him for organ donation a year and a half ago when he came in. Unfortunately or fortunately, depending on your point of view, he still has a little bit of brain stem left-just enough to give him clonus every so often.

Yesterday was worse and I had to stay late to catch up. My day was going swimmingly until I had to take a 2 hour road trip to specials AND got an admission, a fresh post-op, at the same time. And I pissed off the fellow, who's already pretty pissy if you ask me. Ah, well. I did get my starting date, finally, for the new job, April 28th. Then I guess I can start bitching to the anonymous innernets about that job.

Anyhoo, now that I've vented-thanks innernets!- We've got two carnivals this week:

Grand Rounds was Tuesday at Women's Health News. Next week it's at Dr. Val.

Also, this week, Change of Shift was up at Nurse Sean's.

Enjoy the reading...I'll be back at work all weekend.

Legacy

I want to tell you a story. You may think you know the people involved, especially if you’ve been in health care for any period of time. Lately, I’ve been thinking about a lot of stories from my years as a nurse, mostly because I’ve been working with an awesome and funny agency nurse who keeps egging me on. Narcissist that I am, I happily oblige her. This, however, is one person’s story in particular.

It’s the story of an average girl, from an average family. By all accounts she was funny, even irreverent, smart, sassy and full of energy. She was opinionated. She had a lot of friends. If you were to look into her future, you might see college and a career, a family, some kids. Maybe she had something really big coming down the pike-like she’d write a famous novel or develop a cure for a major illness. At 17 years old, on the verge of womanhood, I’m sure she thought about her future a lot.

I’m not sure any of us understand why sometimes children die. I like to think that the children who come into our lives only to be taken away too soon come with a purpose. They teach us to love, they teach us to make every day count and most of all they teach us that to be human is an impermanent state, as fleeting as butterflies. Or perhaps that’s just my rational mind searching for meaning to a meaningless tragedy. In any event, on this day eight years ago, this 17 year old girl died.

I will never meet Kari. At best, I can get an idea of who she was and who she might have become through the people who knew her. Yet, this 17 year old, who died eight years ago today, has touched my life. She’s touched a lot of lives, people that she never knew in places she could never imagine. Think about it-if you died today, do you think that your life would have meaning to anyone beyond your circle of family and friends? So many of the things we do, as human beings, are done to insure that something- some part of us, will live on after we die: great works of art are created, books are written, children are born. You can take the poorest among us or the most powerful and all want to be remembered, to leave behind a legacy.

If Kari had lived her life exactly as she did, she would have left behind a legacy of love and happiness and that would have been enough. But Kari did one thing more. She had already told her parents that if she died, she wanted to be an organ donor. Sure, her parents probably thought, never thinking that they’d actually have to honor that request. But they did. When Kari died, someone had to approach that family and ask them, in the midst of their grief, to donate her organs and they, in the midst of their grief, said yes.

You would think that that would be an easy and straightforward decision. But her parents didn’t have to say yes. There’s also a possibility that her parents wouldn’t have been asked. The road to requesting organ donation is more complicated than most may realize. The hospital may not have called in the referral to the organ procurement organization. They may have said to the family-there’s nothing more to be done, let’s just pull the plug and let her go. The nurses may have thought-what’s the use, this patient is dead or going to die, and not been vigilant in maintaining her organ function. Instead, in those hours as Kari became brain dead, calls were made, support was provided, information was given and a whole host of people, some of whom will never realize it, made the organ donation happen. From many, to one, back to many, Kari’s donation became like a stone thrown in a lake, the ripples carrying the legacy of her life farther and farther from its original impact.

I know about Kari because her lungs now live in my friend Steve. I know I talk a lot about the fact that people shouldn’t have to be proven “worthy” in order to receive a transplant, but if there’s a person out there who’s more worthy of those lungs, I’ve yet to find him. In eight years Steve has become the head cheerleader of the “Keep Kari’s Memory Alive” team. I always knew he was filled with gratitude. Although he’s very vocal about how much his transplant has transformed his life, it was his unspoken actions that showed me the depth of his devotion: on his key ring is a little sandal with one word on it-Kari.

I don’t know how many people Steve has touched in his life, but if you walk the streets of Chicago with him, you’d think he was the mayor. Someone once told me that gratitude is an action word and watching him in action is a lesson in how to live life. When I get to feeling sorry for myself, I write to Steve and soon I’m wondering what the hell I’m moping around about. And Steve is one person. Kari donated several of her organs-each one touching a life, each life touching the people around them, and those around them until, until what? I don’t know, but if you want to know what love to the infinity squared looks like, think of Kari. That’s a legacy any of us would be proud to leave behind.

*photo by Howard Thompson

Starting the new job....someday soon?

Well, I'm not sure when I'm starting the new job. It might be as soon as next Monday, but certainly no later than the end of the month. By hospital policy, I have to give my old job 4 weeks notice from the day I put in for a transfer. My old boss can ask for a couple more weeks saying it's a hardship and they need more time to replace me. Now the new boss and the old boss are "debating" it out with administration to see who needs me more. In my younger days it would have been thrilling to have two guys fight over me (hah, never happened), but this may be more satisfying.

Last Friday I did attent an education day for the transplant department and I got all excited about starting the new job. So excited that I went shopping. Because in this job, I get to wear CLOTHES! (As opposed to scrubs, you know what I mean). With summer coming up, new shoes may be in my future, also. No, seriously, Love Monkey, I got rid of TONS of shoes last year and I have hardly any in my closet. I desperately need some summer sandals.

In tranplant news, this blog is allegedly about transplantation, my friend PJ has a coupla posts on recent organ donation cases. I'll leave it to him to fill you in this week on actual blog content, while I go back to thinking about shoes.

Oh, yeah, I had another blog I wanted to link to: my friend Ramona at Suture for a Living had a post on the first full face transplant in France recently. Last year at the AOPO conference I went to a lecture on face transplant. Full of graphic color photos, I'm just glad it wasn't a "lunch and learn." I used to think that I would draw the line on donating my face, but when you see what type of deformities these people have, well, I'd want to be able to give them a somewhat normal life if I could. Face transplants would be for people who have severe burns or deformites or trauma to the face, things like missing lips and noses. I think I remember hearing about one woman who hadn't seen her own grandchildren in years because they were so afraid of her. Interesting topic, they're looking for the right opportunity to do it here, but as you can imagine, people aren't exactly lining up to donate their face. It's hard enough to get people to donate the non-visible parts of them.

Anyways, I'll let you know when I start the new job.

There are no coincidences. Today I had a busy day at work. One little guy was very emotionally needy and the other little guy was very physically needy. I called my husband at 6pm and said, don't bother picking me up at 7:30, I'll call you when I'm done.

I finally finished charting around 8p, called him to pick me up and went down to the lobby to wait. I started reading a paper that someone had left. Halfway through, I got up and went to wait outside. He called back and said he was just leaving the house. I sighed and went back inside and picked up another section of the paper. I read the comics, my horoscope("stay in bed today") and a couple other things before I got to the obituaries. I always read the obituaries, because, well, you never know. And I saw that a little precious baby I had taken care of a few times had died yesterday.

I knew from the first time I took care of her that she was going to die. At six months old, she was diagnosed with a disease that would rapidly waste away her muscles until eventually she would stop breathing. I think it was on that admission that her parents decided that when the time came, they wouldn't intubate her but would just put her on comfort care and let her go.

Now, I would think of her time and again, knowing that eventually by the end of her first year on earth she'd be gone. But I like read the newspaper, I don't know, maybe once a month. Today I just happened to be late, then my husband happened to be later and somebody happened to leave a paper lying around for me to pick up. I'm sure I would have heard the news eventually, but I'm glad that I got to read about it right away and while I'm sad for her and her parents, I'm glad that her suffering is over. No more chest PT, little girl, no more coughalator.

What a baby, she was, too. A tiny little thing with a smile that could light up the room. I don't know why children are born into this world just to die, but it's a blessing to take care of them, every one.

Oh, the Peep-manity!

Remember when I said the Pooter didn't eat any Peeps. Well, she proved me wrong:

The Great Peep Massacre of '08

She bit the heads off of every Peep she could get her little hands on. Like the Easter Bunny meets Ozzy Osbourne. It was terrible. Then we let her loose on daycare. After I brushed her teeth 3 times.

She's still smart as hell, though.

Evidence of The Pooter's exceptional intelligence

Pooter and I woke up this morning to find her big sister still in bed. Apparently there was a delayed opening today. Spring holiday isn't until Passover week, which makes Teenager happy, as the weather will be warmer. Anyway, first thing Pooter did was steal some Peeps from Teen's room and run gleefully down the hall.

I expecter to find her stuffing her mouth full of Peeps and thought, "What the hell, Easter only comes once a year." We like to practice a laid-back style of parenting here at Chez TC. Instead, she had them arranged on the rug like action figures and was playing with them. I knew she was a super genius. Even the l'il Pooter knows that Peeps aren't a REAL food.

So I worked on Easter, which was not too bad. Pooter doesn't know her days of the week yet, so we can do Easter baskets and dye eggs any day of the week, it's all the same to her. And it gives me a reason to avoid my extended family. Plus, working on a holiday guarantees that someone will bring in food, especially if you work with Filipinos. Unfortunately, I didn't get any ponsit or turon (spelling?) but somebody did make some kicking stuffed shells and there were enough cookies to stretch around the unit 3 times.

We had one little kid who was really too well to be in the PICU, so once he was up and bouncing around we made him an Easter basket out of an old gauze box and colored tape and filled it up with the candy we had at the nurses' station. He was a super sweet kid, very smart but a little too respectful, as in every time a family member raised their voice, he flinched. Not surprisingly he had an open DYFS file. That's when I start wishing I'd win the lottery so I could take home every stray kid I can get my hands on and love them to pieces. And another reason to miss the PICU. The law of Hospital Karma says that in the next few weeks I'm bound to have plenty of experiences that will tug at my heart strings and make me regret my decision to leave. That's the same law that guarantees that the last shift before you leave a place will be hellish. Sorry, coworkers, you've been warned.

Sorry the blogging has been so splotchy. I'm hoping that will change with the new job and I'll have more time. I'm only writing today because I have a deadline for my monthly newsletter article that I'm in deep denial about. One more threatening email from the editor and I'll get right on it. But first I gotta eat some more Peeps.

** And if you didn't get enough Peeps yesterday, here's a little Peeps poem from The Original What's for Lunch blog.

The Kids are All Right

Well, all right, enough suspense. The news is:I'm back in the transplant game. I was waiting to break the news to my boss and officially decide before I said anything to anyone. I'm taking a job as a kidney/pancreas transplant coordinator starting next month.

It was a toss up. The new job is Monday thru Friday, flexible hours as long as I show up for clinic and meetings. Call is from home-I only have to take calls, I don't have to go anywhere in the middle of the night. No weekends or holidays.

The flip side is that I'm giving up bedside nursing, which I do like and I'm giving up taking care of the little ones, which I love. I'm also giving up doctors who role their eyes at the nurses suggestions, giving up working every other weekend and giving up getting a talking to when I'm 5 minutes late. No more 12 hours shifts. I can come home and do something more than gobble down dinner and go to bed with the baby. Pay's the same, benefits are comparable, one more week of vacation. The group of TC's in the office all seem pretty cool and they seem to get along with one another and the boss. I'll be doing post transplant, following up with the patients after they're transplanted, going over their meds and educating them on everything they need to know about their transplant. I'll be in clinic twice a week. It's new-very different from the organ recovery biz. I think I'm going to like it. Wish me luck.

But first, a word from our sponsors!

This is NOT the big news. It's more like some housekeeping tasks.

Let's start off with a commercial:

Up til now I've been a bit like Madonna. Like a virgin. Not actually a virgin, you understand, just like one. But NO MORE! I've tossed aside my amateur standing and have officially become a Professional Blogger. According to the fine print in my Adsense contract, I'm not even supposed to hint that they exist on this site, so I won't. However, just below all that you may have noticed an ad for scrubshopper.com. In the interest of full disclosure, I haven't shopped there yet, but I'm going to. Good news for you, Lucky Reader, is that Scrub Shopper is giving donorcycle readers a 10% discount! To get the 10% discount enter promotional code SSBLOG10. Thanks, Scrub Shopper!

Let's see, what else. Like so many people I know, I'm going back to school. Over at the Nursing Online Education Database is a new article, 101 Little Known Nursing Scholarships for Nurses.

What else? I haven't kept up with Grand Rounds or Change of Shift in ages, sorry. That could all change soon cause there is BIG. NEWS. COMING. Ohhh. I can't wait. What could it be. I'm not pregnant, I didn't win the lottery and I didn't run into Brad Pitt. Nor am I having Brad Pitt's baby after winning the lottery, but I can dream, can't I?