I told you so

Well, word is out. Dumbledore is gay. In case you've forgotten, you heard it here first. That's right, I called it. Now pay up, suckas. Actually, I didn't bet anyone, but if you'd like to lose retroactively and send me some cash, I'd be ok with that. If you've got the time and would like to know where the "gay-ness" shows up in the books, the LA Times will tell you all about it.

Well, I've been spending a lot of my internet time on Facebook. What little free time I have, that is. I've now discovered zombie hugs, tattoos and quizes about my sex life. Hoo, boy, and if you think I don't have a lot of time for the internet...Anyhoo. Now, I know I'm a grownup and all, but seriously, my niece and nephew and their respective sig others are all teaching this year in South Korea and you know the kids today, they're all on Facebook. Even my teenager, who just discovered that I'm on it, much to her mortification. Want your kid to spend less time on teh interwebs, join Facebook. It's much less cooler when your MOM uses it. Tee Hee.

This week, I've actually had a little time to peruse the weekly Grand Rounds. My friend Susan over at Improbable Optimisms has the first spot with a great read on hope. Check it out.

And under the "Better late, if ever" category: The latest Change of Shift over at Kim's.

Meanwhile, Love Monkey and I spent a night at Atlantic City this week. With teh baby, of course. All paid for by his poker habit. Gotta love the comps. It was nice, we spent some time at the beach, but it's no Vegas. In fact, it's a lot like Keansburg with shiny skyscrapers. Ah well. And could someone please tell me why you can't get a decent, cheap meal in A.C.? I mean, you can mortgage your house and go to Ruth's Chris Steak House, but want breakfast for less than $12? Forget it. In Vegas you can get a steak for $1.99, but in AC, 2 eggs, toast and some freezer burned sausages will set you back 8 bucks. Other than the eating, though, we had a good time.

In organ donation news (oh, yeah, this blog is about organ donation), Scientists in the UK are doing studies on giving CO2 after transplant surgery to dilate vessels and improve blood flow to the organs. Now, the funny thing is, the picture in this article is the SAME picture the BBC uses for EVERY organ donation article. I'm thinking, if you're the BBC, you could spare a photographer once in a while to go and get a new shot of something else related to organ donation. Or maybe the Brits are just very frugal. Anyway, I'm off to work, where there's no internet. Very sad.

Ray of Hope

From ESPN, this is the story of the North Carolina mascot who was struck by a car last year and became a donor. Buy more Kleenex and pass this on to everyone you know. If you didn't believe that love conquers death, you do now.

Tuesday!

Holy Crap! I'm up early enough to read Grand Rounds! Version 4.4 is up at NY Emergency Medicine.

Memorial Day

October must be the month for memorial services. I had my pick of two this past weekend, one for the children's hospital and one for The Sharing Network. I picked the later, because I was hoping to see some of the families I've worked with in the past year. And the free food, of course. Then I notice some other folks had their memorial services this past weekend, also.

Sunday, after the service, I had this fine post practically writing itself in my head. Now, in my younger days, I could carry a half-finished poem around in my head for a week and work on it, finally writing it down in almost completed form when I got around to it. Ha! Like I really knew what busy was when I was 20. Anyway, the baby was up sick all night and I had work at 7am Monday and by Monday night it was gone, gone, gone-appropriate lead-in lyrics and all. I'll miss my brain when it's gone.

Anyway, I'm glad I went and I did, in fact, see one of my donor moms. She had driven all the way from Pennsyltucky with her sister and they were glad to see me too. The staff always does a nice job on the service. We(they? See, still doing it) offer folks the option of making a quilt square in honor of their loved one and then my old boss' wife and her friends sew them up into big quilts that hang in the office and get shown at events and donor drives and stuff. I brought one to my daughter's Career Day one year.

They also did a photo tribute at one point. It was amazing to see pictures of all the donors alive and smiling. Especially because I tend to remember them as I first saw them-intubated in an ICU. If you work in a hospital you probably know the feeling. You take care of this patient for so many days that you can forget they're a person. I remember one donor, whose family showed me a picture of her, in better days. "She's beautiful!" I said, because it's hard to visualize what a person really looks like when they're lying flat in bed, with their hair matted down and their face all puffy and their body bruised and there's five miles of tubes and wires coming out of every available body part.

It's nice, even if your patient is just sick, and not an organ donor, to see their picture. It makes them real, you know? Then they're more than just the splenic lac in 18 or whatever. It certainly is easier to do this in PICU, because kids are, well, kids and you'd have to be a cold-hearted snake to not fall in love with them, but it's still nice to see pictures of them taped up in the room.

I don't like to think that people who work with the donors forget their "human-ness" often. I mean, you spend an awful lot of time with the families, crying with them, talking about their loved ones. But it can be tempting, when sleep is a dim memory and you've been sitting around a hospital for too many days to count, waiting for something, anything to happen, to just think of the donor and not the person. How many organs can be recovered, what time can we get to the OR. It's in the language-"I got consent". No, you didn't GET anything. The family GAVE you consent. Maybe it's just me, or maybe I shouldn't blog at 5am when I can't sleep. The people in the business are some of the most caring, compassionate people I've ever met and they don't take donors for granted. As long as you can still see the forest for the trees, is all.

Anyway, I also got to see my peeps, who were (mostly) glad to see me. The highlight may have been the 4 year old kidney recipient and his parents who were on hand to thank the donor families. It's nice to see the living, kicking, cranky, I-want-to-play-I-don't-care-why-these-people-are-here-to-see-me results of your work once in a while. Also, I got to see my friend Pammy-cakes invite the Imam back to her house for drinks. That certainly was worth the price of admission right there.

Well, I've gotten my verbal catharsis and I still can't sleep. Time to clean.

Also for Wednesday

Team Annika needs your help! Moreena, from The Wait and the Wonder is in charge of the American Liver Foundation walk in her area. Help her meet her goal, so she won't have to do anything desperate AND you'll help find a cure for liver disease. Send in what you'd normally spend on beer and wine in a week and it'll be good for everyone's liver!

Meanwhile, over at Nurse Ratched's, there's Grand Rounds with an armed forces theme.

Better Send Flowers

I went to the wake of a friend's father last night. I'm always at a loss for what to say at funerals. I didn't really know anyone there, other then my friend, so I just people watched for a while. Then, I checked out the flowers. He was holding wooden rosary beads. A rosary made out of those tiny roses is nice too, but do you any idea how much that costs? The flowers made me think of my great-uncle's wake. Similiar families, although my friend's "out-Italians" my family by a magnitude of 10. Anyway, when Uncle Micky died, my siblings and I decided to pool our resources and send flowers. Then my sister suggests, since flowers die, wouldn't it be nice if we sent a plant arrangement instead? I left the details to her and ponied up my money.

The thing about my uncle, he was a terrible alcoholic. Later, as an adult, I heard some stories, but as a kid I only knew that he was perpetually cranky and I was a little afraid of him. A year before he died, he went into our community hospital with some ailment and wound up coding, being resuscitated, coding again, another resuscitation and then getting a million complications, including infections. When my aunt didn't make him a DNR, we thought she was crazy. I mean, the man had abused his body for decades, we didn't think he'd survive another code. Just to prove how stubborn he could be, he not only recovered, he made it home. My aunt recalls that the next year with him was a really good year. He certainly was nicer and funnier than I'd ever seen. Goes to show, you can play the odds in medicine but you never really know what's going to happen.

My aunt and uncle have four sons. They're my family's version of the Marx Brothers. Remember them? I think their names were Groucho, Harpo, Marco and, uh, Squiggy. Anyway, these four had an act they could take on the road. They're still the funniest guys I know. Nothing is sacred with them. If you take yourself too seriously, they'll skewer you, but they're hysterical. Anyway, we're at the wake and I look around for our "plant arrangement" amidst the enormous and lavish flower pieces. Then I see this, I don't know, some sort of tropical vine in the corner with a big bow on it. One of my cousins spots me. "Hey, thanks for the vine. I thought it was one of the funeral home's plants, then I realized you guys sent it." His brothers join in for the kill. I think there are jokes about jungles and Tarzan, I'm not really paying attention as I scan the room for my sister. She spent 75 bucks on that?

We do, all, eventually have a good laugh. We try and imagine what Uncle Micky would have said about it, which leads to reminiscing about him. Cranky, and alcoholic, that he was, he was a character and soon his sons have us laughing. Which is, if the person was old and lived a good, long life, a fine way to go about waking someone. I hope I'm enough of a character that I have folks cracking up at my funeral. If you know the person, this is always a good thing to talk about with the family-remembering them, remembering the good times you had.

What not to say? Well, I would caution you to never, ever say "I understand" unless you have been through something very similiar. My friend's dad was home with hospice care for the weeks before he died. My grandmother also died pretty quickly and was at my mom's home under hospice care. My mom and I took turns staying up at night with her. It was hard on everyone, hard to watch her dying, but worth it, knowing she died surrounded by her family.

I wouldn't offer platitudes, either. "Well, he's in a better place" or "God must have needed him more than we did" or whatever people try to come up with to rationalize the person's death. The best bet is sincerity. Say you're sorry for their loss. I like to say to people at funerals that I'm there if they need me, but I think there's too much going on at that moment. If you know of something you can do in the days around the funeral, then make a concrete offer. Can you take their kids for a while so they can make arrangements? Drop off food, run some errands for them. One nice thing to do, after the funeral is over and everyone stops dropping by is to not forget them. Like send them a card and some flowers on the next holiday or on the anniversary of their loved one's death to let them know that someone else remembers, too. Not everyone grieves, right away, either. My sister in law lost her younger brother a few years ago and I remember, almost a year later, she broke down at a family picnic crying. She just needed someone to listen to her.

Meanwhile, my aunt still has that plant. She told me it takes up most of her sewing room, it's grown so big. I'm haunted with the thought that everytime she waters the thing, she thinks about her husband's death, but she seems to have a good sense of humor about it. A trait she has passed on to her children, evidentally. I think she's even going to name it.

But in the future, I'm going to stick with flowers.

My Big Day Off

It's Friday. I've worked 8 hours of overtime last week and 4 this week, the l'il Pooter's still sick and my house looks like who done it and ran. Then working all weekend. While I'm figuring out what to do with my big day off, I'll probably read the latest Change of Shift at Madness:Tales of an ER Nurse. I've been promised some writing time today, but you know I'll probably just clean. God forbid I need an ambulance for any reason, I'll have to tell them my house's been ransacked to save face.

When Everson Walls donated one of his kidneys to Ron Springs earlier this year, it made news. Now it's making legislation. Rep William Lacy Clay (D-MO) is sponsoring a bill named after both players. The Everson Walls and Ron Springs Gift for Life Act of 2007 (HR 3635) hopes to fund a national resource center and grants for organ transplant needs. Walls and Springs together have started a foundation to promote organ donation.

For your weekly carnival update, the new SurgExperiences is up at Suture for a Living, one of my new, favorite blogs. Also, Grand Rounds is up at Musings of a Distractible Mind(note the new blog address). Great Dr. Seuss theme this week, rhymes included!

Happy Reading.

A Tale of Two Jobs

Yes, I love the new job, as my aforewritten post shows. I love the babies, I love taking care of sick kids. I even love(well, maybe like a whole lot) taking care of stupid teenagers who ingest too much beer and fall off car roofs. No, really. I think it's because you can talk to teenagers in a way that you can't talk to other patients. "Dude! What the hell were you thinking?" and they just shrug and look sheepish. Plus, you can get away with the occassional curse word in front of teenagers, as long as their parents aren't around, like when you're hip deep in a dressing change and you drop your last piece of Telfa and now you have to stop everything and walk clear across the unit to get another one and so, without thinking, you mutter, "Mother-f*#ker!"

Sorry, but TC can curse like a sailor. In several languages, including Tagalog. It's a gift.





Anyway, I have had a series of patients in the last 4 shifts, mostly because I am low on the totem pole and so don't get continuity with my patients because some other, more senior, nurse, wants to take care of "her" baby. Whatever. The past couple of days we've had a potential organ donor on the unit and my former colleagues have been present. In was nice, in that I got to exchange some juicy gossip and catch up on the happenings around the office. It also shows me that, just like being Catholic, you never stop being a TC. I still say "us" and "we" when talking about the OPO. Actually, I instinctively typed "my" OPO. See what I mean.





So, even though it's probably good that I got out of that handbasket before it bursts into flames, I have to say-I MISS IT! I miss my old job. Or at least I miss the work, if you know what I mean. I miss the thrill of waiting by the phone and finally getting called out. I miss sitting around ICU's all day waiting for the doctors to finally start clinicals and listen to them whisper about you at the nurse's station. I miss the nervousness when it's finally time to ask the family and then the rush that comes when you know they're going to be a donor and you have 8 million things that need to be done all at once. I miss crying with the families and hugging them and listening to them talk about their loved ones. I miss knowing that you're getting one more person off the waiting list.





Also, I miss the free time I had, when waiting, to write as much as I pleased with no interuptions. I do have more free time now, but it's all spent at home and there are lots of distractions, including one who can crawl all over the desk and say, "Eat dat! Have dat! Want dat!" Right now, as we speak, I have a 2000 word essay in the works, that requires actual research and critical thinking as opposed to my usual snarky ramblings. My fingers are itching to type it, although I hear there's a cream for that now. In former days, I could pass the time in an ICU, tucked into an inconspicous corner, surfing and typing away on the best technology a non-profit could buy, while waiting for a doctor to decide if 96 degrees is too cold to start brain death and is it ethical to start pitressin on a patient who's peeing a gallon a minute if the organ donation people are in the same hospital.





Ahh, well. Maybe when the little distraction is older I'll go back.





Speaking of which:

I Cn Haz Cupcake!

** Sorry bout the run on sentences, I'm trying to finish before "The Big Comfy Couch" is over.

One more reason to be a nurse

If I were a better woman, I'd do my job without regard for accolades and thank you's.

But sometimes Thank You's are nice, too.

Sunday night reading

I've worked all weekend and my feet feel like they weigh 20lbs each. Riding the bike to work is really nice, but that last hill on the way home is a doozy. Tonight I walked the bike up it.

Anyway, I'm overdue for my monthly coop article, so tomorrow will be spent busily thinking up a topic and then writing on it. Better late, if ever, is my motto. In the mean time, if you haven't read it already, Change of Shift is up at Kim's. I have a new post in the works, so check back in a day or two.

LPS(longer post soon)

Well, we all survived the weekend.


And I have to say, Sixteen-odd years and two kids later, I finally feel like a "real" mom. Mainly because I managed(with ample help from Love Monkey) 8 teenagers and one baby for 2 days and there were no injuries, no fights, nobody got lost and everybody got fed(if burnt weenies and ice cream cake count).

The weekend turned out to be nice. Around 9am the rain stopped and the sun came out, even if it was a little windy. Even the old folks came out-Auntie and my mom and dad. I had the most awesome video on my phone of this parade snaking its way out to beach, led by Auntie, with her walker, going full steam ahead, followed by the Teenager holding a huge Jolly Roger flag and various kids carrying all our crap out to the beach and the grandparents bringing up the rear-my mom with her cane and dad carrying the beach chairs. I was even going to post the vid for your delight and edification. But I didn't press record. Because I am tekniklee challenged! Auugh!

We had a nice fire on the beach. We did some swimming until the park ranger yelled at us. We roasted weenies and marshmellows and generally had a great time, including Pooter, who chased every "duckie" (read:sea gull) she could find. It was so great that I want to do the same for my 40th next year, except maybe not in December, unless it's a beach party in Jamaica-hint, hint.

Monday and Tuesday were 12 hour days for me, which I was looking to with dread as I'm still kinda sick. I feel loads better but I have this bronchitic cough that makes me sound like the illegitimate spawn of Betty Davis and Harvey Fierstein. Just what you want in a nurse taking care of your small children. I sound like I have the consumption, but REALLY-I FEEL SWELL!

Anyway, miracle of miracles, our census was low Tuesday, so they let me go 3 hours early! Huzzah! Then, later that night, the Pooter got sick and was up all night miserable. She still a little fragile today, but several doses of motrin and tylenol and some soup have made her happier. So, longer, more relevant posts to come. I'm going back to sleep.

Weekend Report

I've spent the last three days desperately ill, the last two days working and now, at 9pm on a Friday night, I'm leaving for a weekend at the shore with a dozen teenagers.

Please pray to the deity of your choice that:

a. It doesn't rain, and

b. I don't kill anyone.

DT(dear teen) has just called to ask me to bring her hairdryer down. HAIRDRYER. At the beach.

Cough.

This just in....

Donorcycle's official fact checker and stats keeper has just informed me that 100-47 does indeed equal 53, not 63. Thanks, PJ, and keep up the good work. And for the record, you try writing with a toddler climbing all over you. Oh, wait, she was in daycare today....I'll have to come up with some better excuse.

Hollywood Healthcare

Recently, I watched a rerun of CSI. The Las Vegas one, of course, I'm no great fan of either David Caruso or Gary Sinise. But oh, that William Peterson. I just love nerdy guys. Which always gives my husband pause, as in, "hey, that must mean...". Sorry Honey.

Anyway, on this rerun, called "The Organ Grinder", a guy is found dead, yada, yada, bad guys, etc, etc but the guy was poisoned to death and it is IMPERATIVE that his organs be used in the investigation. Except that he was an organ donor. Aaagghhhh! How will we ever catch the criminal? In a scene that somehow manages to combine the trippiness or "Fear and Loathing in Las Vegas" with a graphic Jack the Ripper movie(take your pic), they show a flashback to the organ recovery(they may have said "harvest", I can't remember). "Eight organs in 2 hours," the coroner intones, with organs coming out in quick succession and tossed to waiting surgeons. Then cut to the cadaver, with incisions going up, down and sideways. "A Frankenstein" says Grissom. Oh, Grissom, you're so handsome, but you need to go back to your bugs, baby.

All right, gentle reader, where to begin? First of all, I have never, ever, NEV-AH(as we say in Jersey) seen an organ donor with anything other than ONE midline incision, from the top of the sternum to the pubis. If they're recovering heart valves and other tissue, they make a Y incision for the heart valves and then incisions along the extremities and pelvis to retrieve bones. Just organs, just one incision. And they don't rip out the organs, for goodness sakes. You know, these organs have to be used in a living person, right? Do I need to say they are handled with care? Not tossed around the OR like a live hand grenade. But you, as faithful donorcycle readers, already knew that.

Here's another thing. Many donors require autopsies. They are homocides, suicides, accident victims or sometimes they have just been in the hospital for less than 24 hours, requiring a call to the ME. In NJ, it is ILLEGAL for an ME to deny organ donation because of their investigation. In some cases, they may put limitations on it. For instance, say you were unfortunate enough to be shot in the left lung. The ME might then say that all organs could be recovered EXCEPT the left lung. Which we wouldn't want anyway, seeing as it had a big hole in it.

Here's the other thing. The medical examiner is welcome to COME TO THE HOSPITAL and see the deceased. Either up on the unit and/or in the OR. If they decline, we TC's have a special form, called "The ME operative report" that is filled out with all pertinent info, signed by the surgeon and then passed along to the ME's office, with pictures, blood, bile, urine specimens, copies of the chart and any radiology films, as well. We are a full service OPO, after all. We also call the ME prior to the recovery to set all this up. In this heartbreaking story, the grandparents' hope that their grandson's death would not be completely in vain is dashed by an ME's office that routinely denies organ donations in homicide investigations. A mom in Ohio had the same experience, when the coroner would not allow his organs to be recovered, even though his cause of death was obvious-a gun shot wound to the head. In such cases, it would be within the realm of common sense to deny cornea or eye donation-nothing above the neck. But really, do you need to see his kidneys to know how he died?

I hate to sound like a broken record, but donation is good for the donor's family as well as the recipient. Knowing that someone is going to live on with their loved one's organs is a balm for their wounds.

So where does this leave me with the guys in the crime lab? What would I say if I had an hour alone with Nick and Warrick? Nothing, of course, I'd be too busy staring into their eyes...my goodness, have you seen Gary Dourdan's eyes? Oh, yeah, organ donation-where was I?

You might think, savvy, innernet-reader that you are, that TV is just a harmless pasttime, a way to unwind after a hard day, to put your feet up and have a nice cold one. Well, that would be true for only 67% of you. Because in 2005, a Gallup poll showed that 43% of Americans got their health info from the TV. Out in Cali, a group of OPO's and transplant organizations has started a campaign called Donate Life Hollywood, They explain that if a show's plot contained such inaccuracies about HIV, there would be an uproar.

Dr. Susan Morgan, of Purdue University and author of "Entertainment (Mis)Education, has published two studies showing that the misperceptions of organ donation portrayed on TV keeps people from registering as donors.

It's true. If I think back to all the story lines I've seen on TV about organ donation, they always seem to involve some urban myth-selling organs, buying organs, mutilating bodies, etc. But never do I see them resolve the problems or clarify the myths. Maybe it's not compelling enough TV. Which may explain why I read a lot.

Now, if you'll excuse me, I have a producer to write to.

Rutgers sinks the Navy 41-24

If you watched ESPN tonight, you saw that Rutgers Stadium was a sea of red, with one teeny little corner of white midshipman. Sorry Navy, but RU swabbed the deck with you.

Of course, this is the reason, just here to my left (although she's a bit bigger, now). Pooter now has 2 Rutgers shirts, red for home and gray for away games. I promise she'll always be wearing the shirt for games, cause that's what makes them win, you know.

The odd thing about living so close to the stadium and watching it on TV is the slightly surreal moments. I was watching the game and heard a helicopter on TV. Seconds later I heard it above my house, then heard it heading for the hospital. Then, being the nurse I am, I wondered if it'll be anyone I'm taking care of tomorrow. Fortunately, my neighborhood is quiet, so there's no rowdy partying or beeping, but I'm sure College Ave is hopping right now. Hopefully the ER will be quiet too, but it's very possible that tomorrow morning will see a small crowd of patients sleeping off their ETOH. Well, time for me to go to bed.

Catching up

I haven't been doing much writing lately. I feel like I'm in the doldrums.* Maybe it's the heat. While I generally eschew central air conditioning, I wouldn't mind sitting in a cooler right about now. It could be worse I suppose. At least I'm not in California.

I didn't write my monthly article for the George St. Co-op, which I put up on my Laughing Baby site. At this blog, I've been doing my bestest to bring you light and breezy postings, devoid of actual content, if at all possible. I haven't sent anything to a blog carnival in ages, and, in case you haven't noticed, I'm not writing for the NJO blog anymore. It was all part of a grand plan to start a large project this month, now that I'm only working 36 hours a week instead of 176 (go get your calculators, I'll wait).

I've also been ignoring some of my favorite blogs and blog events. If I have the time I'm going to sit down and read this week's Grand Rounds and Change of Shift. Then, if the baby's not crying yet and the dog doesn't need walking, I'll read the Grand Rounds from the previous week at one of my favorite sites, Rickety Contrivances of Doing Good. I wish I had known, I would have liked to post something for that one-sorry Susan.

Anyway, my horoscope for this week says that if I get off my lazy ass and invest some time in a new project, I'll make loads of dough. Hey, ya never know. But the get off my lazy ass part is good advice from anyone.

*And if you make any analogies concerning hot air and this blog, you'd be right on the mark.

Horseshoe Kidney

Earlier this year I did a recovery from a donor and in the OR we discovered, unknown to everyone including her family, that she had a horseshoe kidney. According to this case study from Britain, such a kidney can be transplanted into a recipient with good results.

This is supported by data from Stroosma et al (2001). 13 In this article,
eight horseshoe kidneys transplanted en bloc and 26, which were split and
transplanted into 47 recipients, were compared with 110 transplants in a
control group. No significant differences were found either in the short- or
long-term post-transplant results. Furthermore, no difference was noted between
results from en bloc or spit horseshoe kidneys.
13,18

Last I heard, the recipient of our donor was doing well, also.

According to my mom, I had a great-aunt who had a horshoe kidney. She died young, but not from kidney disease. I think she had cancer. Apart from being a colorful character and a bit of a hellraiser, she had no other issues.

A horseshoe kidney is what happens when both kidneys become joined at one pole, usually the lower pole. This happens during fetal development, during the 5-12mm embryonic stage when the kidneys are still in the true pelvis and the renal capsule is not yet fully developed. Of kidney fusion anomalies, horseshoe is the most common. It has an occurence of 1 in 400 births worldwide and is not linked to genetics. There have been cases where one identical twin has a horseshoe kidney and the other does not. There is some thought that positioning of the fetus in utero can cause the anomaly, as the kidneys migrate up from the true pelvis into their normal dorsolumbar position. The cause, however, is not really known.

Many individuals with a horseshoe kidney go through life with no idea they have it. Symptoms include frequent UTIs, kidney stones, hydronephrosis, and ureteropelvic junction obstruction, due to the high insertion of the ureter. There is also a higher risk of trauma to the isthmus because it lies anteriorly to the spine. Treatment is usually reserved for when the patient becomes symptomatic; antibiotics for infections, and surgical or nonsurgical interventions for hydronephrosis or stones.

In about 1/3 of all cases, there are additional congenital abnormalities, often occuring along the midline of the body: hydrocephaly, VSD, cleft palate, spina bifida, anorectal malformation, malrotated bowel, club foot and polydactyly. People born with a horseshoe kidney are more likely to also have Wilm's tumor or renal cancer. Two sydromes are associated with horseshoe kidney, Turner Syndrome and Trisomy 18.

Two articles are included here and here for more info. I also found a link to some good pictures of kidney anatomy and abnormalities here, but be warned, it's not for the squeamish. You'll never look at pyelonephrosis the same way again.

I've also been looking at congenital heart defects, but GOOD LORD, it'd take me a week to write all that. Do you have any idea of how many different ways your heart plumbing can be screwed up? It's a wonder and a blessing that most babies are born happy and healthy.

I thought so....

You Are: 0% Dog, 100% Cat

You are are almost exactly like a cat.You're intelligent, independent, and set on getting your way.And there's no way you're going to fetch a paper for anyone!

Are You More Cat or Dog?

Thanks to RLBates for turning me onto this quiz. Her website, Suture for a Living, has a great post on another great surgeon and his role in transplant history, Dr. Joseph Murray. Check it out.

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.

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.

Change of Shift

Be sure to check out this week's Change of Shift at Nurse Ratched's Place.

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.

Reminders!

Don't forget that Grand Rounds is at Med Journal Watch. Also, I'm still writing at the NJO blog. I have a new post up, so check it out!

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.

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.

Grand Rounds Beach House!

Grand Rounds is at the beach this week. Dude, I am TOTALLY there.

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.....

This one's just for Roy at CORE

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

Full Circle

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

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


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


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

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

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

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

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

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

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

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

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

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

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

Adults only!

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

Mingle² - Online Dating

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

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

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

Change of Shift

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

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

This is why we do it...

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


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

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

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

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

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

Let there be music...

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

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

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

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

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

Kahlil Gibran, The Prophet

Lover's Wish by Patricia Donegan

When I'm dead

steal my bones

cut them up

into Chinese carvings

a mountain, a sage

a heart, a leaf

to hang like stars

in the sky.

When I'm dead

make from my bones

a whistle for a child

a necklace to fondle at night

the dagger geishas use

behind silken screens

an incense burner

a comb for your hair

tangled on the pillow

a netsuke, smooth, soft

as mother's breast,

most of all make

a small clown face

that laughs a millennium.

When I'm dead

make art of my bones

bleach & dry them in the sun

pure white

startling as stars

turned round in your hand

like a porcelain cup,

then after holding my bones

my skull, arms, pelvis & feet

take my thigh bone

gently

make a flower vase.

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

How was your weekend? Mine sucked.

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

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

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

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

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

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

Talk amongst yourselves

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

Say what you will, I guess it worked

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

Do You Deserve an Organ?

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

Do You Deserve an Organ?

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



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



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



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

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

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

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

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

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


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

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

Grand Rounds...

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

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

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

Got Hope?

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



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



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



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



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



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



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



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

Meetings, meetings and more meetings

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