Like a Pair of Comfortable Shoes

Wow.

Flying up and down EDSA in Manila.

Bouncing up and down in the back of the jeepney between Naga and Libmanan.

The green.  The warmth.

This is home.

With the all the problems and the romance and the tragedy.

This is all the Philippines and I’m in Love with every piece of it.

+++++

My brother, my parents, and I left Manila this morning.  We stayed in a beautiful hotel in Pasig City and I had our Titas Fely & Claire over for dinner last night.

When we were young, my parents arranged everything.  Now, I’m the one planning the itinerary.  It was nice to be able to set up my parents’ room.  All they had to bring was themselves and their appetite.  My brother and I took care of the rest.  It’s comforting to pay them back in a small way for everything they’ve given us.

We’re planning our trip to Singapore and if the winds blow in the right direction my brother and I will buy motorcycles here in our dad’s hometown.  He can rent them out and have his own little business.

The money will be modest but every little bit will help.  Really, it’s more to help our cousins and give my dad another project to manage because he likes that stuff.

Having Trouble Finding the Right Pace

Well, I’m in the Philippines.

This is going to be a quick trip — 15 days and three of them have already passed.

It’s warm here in the lower level of the Robinson’s SM.  My brother and I are  both adjusting to the time difference.  Wisely, he chose not to do anything today but minor, minor errands; relaxing by the pool; working out; etc. 

We’ll have dinner tonight with our parents here in the hotel. 

Then it’s off to Libmanan tomorrow morning.  It’ll be strange to see my dad’s hometown again.  In 2006, I lived here for three great months.

So many puzzle pieces jumbled in the air, floating.

It’s all going to come together one day, right?

First Breaths (Final)

(Note: This is the last entry of a series I started earlier today.)

When the case is completed, the lights are turned on, the anesthesiologist is waking up the patient, the staff is moving instruments back from the table and unplugging hoses and electric cords and the room becomes  a mess.  There are linens on the floor.  The garbage bags fill up with drapes and towels and bloody sponges used during the case. 

The surgeon is dictating a note over the phone and calling the patient’s family.  The circulating RN is calling the recovery room for a slot and the only one left with a gown on is the scrub nurse.  The reason for one person remaining gowned is this: if there is an emergency where they need to re-open the patient then that last remaining gowned individual is ready to go. 

The garbage on the floor and in the bags accumulates and the surgeon gets ready to put the kidney in the recipient who is ready to go in another operating room.  Today the other room is O.R. 20.

The patient looks like one who is waking up in the middle of the night from a deep sleep.  Only it isn’t night time and she isn’t surrounded by people with masks… and her stomach hurts.  She is barely audible and if she could have a conscious thought right now I bet she would wonder what made her choose to donate.

The anesthesiologist makes sure the patient can breathe on her own and has good hand-strength (i.e., no longer paralyzed).  I.V. lines are bundled and pieces of equipment that will go with her are placed on the cart.  The patient is asked to cross her arms while we log roll her onto a roller and finally we get her onto the cart.

As the O.R. door closes behind her, the room that was once a center of concentration, focus, and order is nothing but a box of junk with two tired souls dressed in blue.  In about 20 minutes the cleaning crew will do their thing to restore the room’s usefulness and it’ll be ready for another go… tomorrow.

First Breaths (Part 3)

(Note: This is Part 3 of a series I started earlier today)

11:59AM

O.R. 14 is quiet.  The lights are off except for the one on the swing-arm over the my friend\’s instrument table.  The reflection of the light off of the instruments make them seem heavenly, other-worldly.

Tones-of-voice are matter of fact, which is good.  The surgeon is describing his actions to the medical student who is holding the camera today.  If the surgeon is comfortable enough to talk about the surgery then that means all is going well.  I can tell by his voice that things have gone pretty smoothly since first incision.  If they had hit a rough patch earlier in the case then his tone would\’ve been different, tense. 

If something bad happens in a case you\’re always worried it can happen again.  It can affect how the whole day goes.

On the monitors you can see blood vessels.  The image of the laparoscopic stapler on the screen is as big the medical student\’s head though in real life it\’s no wider than the average thumb.  The surgeon is talking about how the staples he is applying will prevent any future bleeding from taking place.  These staples are saving the life of my patient. 

They haven\’t yet freed the kidney.  That\’ll happen in another couple of hours.  Right now they\’re sealing all the blood vessels they\’re going to cut.

My friends are very matter-of-fact.  In the operating room you\’re always thinking about the next few steps.  You want to make sure everything is where it should be and that you know where you can find things you need.  There\’s a lot of instrument sorting, giving, and receiving.  You\’re checking tips and untangling cords.  You\’re looking at the meds on your table and making sure the kidney, once out, has a place to go.

The real tension will rise in about 40 minues when they start cutting the blood vessels to free the kidney.  This is when a patient can (but shouldn\’t) bleed to death.

I left the operating room, quiet as it was, to examine the room my patient will be going to after she is strong enough to leave post-op recovery.  I didn\’t tell the family we got her a bigger room.  For that matter, I didn\’t ask the surgeon what meds he was going to prescribe upon discharge.

I don\’t want to assume everything will go fine because that\’s when disasters occur.

The family and the recipient are sitting in a little suite that looks like it was pulled right out of Ikea.  It\’s a living room mock-up that feels surprisingly warm despite the fact that it is embedded in the middle of all this activity.  They\’re watching TV though I can tell by the look on the mom\’s face that she wants this day to be over as soon as possible.  She\’s going through her quiet hell. 

They\’re glad to see me and comforted when I tell them, \”I just came from the operating room and everything is fine.\” 

I look at the mom when I say those words. 

I think I detected a little relief though it was brief.  I\’m in my surgical scrubs with a blue O.R. gown – quite a contrast to this, what is now occuring to me, as a strangely bizare living room setting we\’ve created for our patients. 

It\’s the opposite of the operating room.

I\’ll go back in about another hour or so.

First Breaths (Part 2)

(Note this piece is the 2nd in a series I started earlier today.)

8:13AM

The operating room is busier now.  All the niceties from the clinic and our offices have been left behind the double doors that secure the O.R. suites.  It’s all business now.

My patient has been guided onto the table and is about to experience general anesthesia where the person made to sleep using gases and medicines.  The anesthesiologists will put a tube down her airway and will control her breath for the duration of the surgery. 

The instruments have been released from their case.  There’s a lot of shiny things on top of all the blue paper.  My friends are counting them and the sponges to make sure nothing gets left behind in the patient.  Yes, it’s happened before and the effects have been catastrophic.

Television monitors will be brought in because of the technique we are using to remove the kidney.  Three small incisions no longer than one inch will be made that will allow the insertion of tubes that have a handle on one end and a fine surgical instrument on the other.  Gas is used to inflate the patients abdomen and all of this activity will be visible using  a camera that is designed to be inserted into one of these incisions.  Once the instruments are in place the monitors will be moved into position, the circulating RN will shut off the lights, and O.R. 14 will go dark.

I’ll check on them again in about three hours…

First Breaths, Last Breaths, and Everything in Between

I realized this morning that my work has taken me through the entire lifespan.  I’ve watched my patients take in their very first taste of air as well as expel their last lung-full of breath.  My patients’ ages have been measured in minutes and seconds as well as decades.  I’ve work with patients who weighed ounces and others who had enough pounds for several people.

It’s 7:15AM and I’ve been in the hospital now for over an hour.  I’m writing this to capture what happens on the day of surgery when someone donates a kidney to a person they love.

I left my patient (the donor) about 45 minutes ago in the pre-op holding area with her mother.  It is worth mentioning that the recipient is the donors father and the mother’s husband so the mom has two people to worry about for the rest of the day.

I tried talking with the mom to explain how the day would go but I realized my words couldn’t break through the thin veil of panic she felt for her family.  This fear is instinctual and reason alone cannot penetrate its effects.  The only way to loosen its grip is through touch & familiarity and that is what the other family members will provide for the next fourteen hours.

My friends are setting up O.R. 14.  My friends have trained for this case and have done this kind of work for years.  As they set up the trays of steel instruments and move around the room’s equipment, they catch up on life since they left each other last night.  They joke and gossip and talk about the upcoming weekend while struggling to recall the last.  They’re calm now but when things happen, they happen fast and my friends are the best I’ve ever seen.

This room has light beige colored tile on the walls and a black floor with speckles that I think were put in to help camouflage dirt.  It has three huge swing-arm mounted lights that I believe were designed to replicate the pure brightness of the sun.  Nothing about the operating room table looks inviting.  It’s narrow so the surgical staff can be as close to the patient as possible and we use a strap to hold the patient in place.

I can’t imagine any warmth being conveyed from that damn leather strap.

The table is sectioned and can be manipulated in many ways.  By the time the incision is made, the patient will be on her side and flexed in a way that I am incapable of describing but will allow the greatest exposure possible to the left kidney. 

Once the donor is draped,…

(to be continued because I have to go to the operating room now…)

Two Sisters Who Would Also Be Daughters & Donors

I really don’t like talking about work so this space is quickly becoming a repository of stories about what I do for a living.

Let me start out by saying that I love my job.  I’m the only one in the office on a rainy, Sunday afternoon and I don’t mind a bit because of the case I’m working on now…

There’s a man who needs a kidney and this man has two daughters who would both like to donate.  Obviously, we’re not going to use them both but through a strange turn of events we’re working them both up in parallel which is to say the first one to pass all the tests gets to be the donor.

Now I’m in an interesting position because each of these sisters to me is a separate case.  I cannot talk about the details of one sister to the other and vice versa; not to mention their dad who isn’t my patient at all.

We’re in the final stretch which is to say that the transplant has a high probability of taking place within the next two weeks.  There’s a strong push to get it done this week for reasons I can’t explain. 

So I’m talking with the one woman who is in the lead to be a donor and I explain to her that I’ll update her sister as much as I can without explaining any details of the lead sister’s case.  This juggling act is pretty humorous; especially when I get to the part where I say to each of them, “Now if you can explain this all to your dad because I can’t even talk to him at all since he’s no where close to being my patient.”

But I think the one thing that I find touching, rewarding, whatever you want to call it is that I’m the one steering this ship and if you can hear some of the things they tell me and the gratitude they express for my efforts… well, you’d see why coming in on a rainy, Sunday afternoon is no problem at all.

And I Carried Her In My Arms

A woman today was dying in our clinic.  There was a lot of blood and her breathing had changed and her eyes looked panicked and frightened because she didn’t know what was happening to her body. 

We grouped around her dressed in our lab coats and scrubs.  Those closest to her had their hands on her body doing what needed to be done.  Those on the outside of this circle waited for instructions from us in the middle.  Oddly enough I found myself going back and forth between the center of this group and the fringes.  This quick, deliberate movement reminded me of working in the operating room. 

I made one of the nurses laugh because she needed a new glove to protect her from the blood and I held one out for her using the O.R. technique.  Having never been offered a glove this way before, she was puzzled at first but then all I had to say was, “Just put your hand in and push down.”  In two seconds she was re-gloved and back to helping.  Quietly she laughed and said, “Just like the O.R., right?”  I smiled in response. 

We stopped the bleeding but still needed to transfer her from the waiting room chair to the cart.  Looking around our group of white coats it was easy to see that I was the one who was going to do the lift.  Someone held pressure on the site of the bleeding, someone held her head and neck, and I found myself digging my arms underneath her back and legs.  On “3″ I pushed up with my legs and realized that never in my entire career have I ever held a patient like this. 

Despite the chaos, it was a very tender moment. 

Getting her onto the cart was not easy because of all the people surrounding us and the cart initially was turned the wrong way.  Once she was lined up, I still had to lift her pretty high because the head of the cart was elevated.  As the minutes passed I wondered if this was going to work.

In a flash she was on the cart and I found myself backing away from the center feeling like I had done my part and it was time for the others to get her ready for the trip to the emergency room.  Someone called for a blanket and I found myself walking down the hall in search of one. 

So many of us were involved in this incident that I was surprised when more than a few people came up to me to express their appreciation for my being able to lift her from the chair to the cart.  It was nice to be complimented but I told each of the staffers who came up to me that we all did our part.

It’s been about ten hours now since this happened and I can still feel her weight and I can still see the blood & the look in her eye.  I remember all the white coats and being shoulder to shoulder with my co-workers.  My mind is still jumbled from earlier today and I hope a quiet night will settle me before the morning.

The End of the Second Week

Well, the last I heard, the transplanted kidney was working fine.

I ended my second week as living donor coordinator by visiting the operating room where I used to work and helping my friends remove a kidney from my patient. There was the a little O.R. drama during the surgery but overall it was a quieter case than I anticipated and my friends were glad I was there to help them out.

To be honest, I was just there to observe the surgery & take photos so initially I just planted myself on one of the chairs in the room to avoid getting in the way. But things came up (as they do) during the case and they really needed an extra set of hands to help push things forward. Choosing to remain seated and out of the way seemed kind of irresponsible when you consider that I spent two years in the O.R. and knew how to help.

In the end everything turned out ok and they joked about seeing me in action again. You know, they laughingly said things like “Just like getting back on a bicycle, right?”… and stuff like that.

Honestly, I forgot how much I respect the ability of my friends to perform highly technical work under crazy-stressful conditions. Sure, I can hang in there with the best of ‘em but they’re the ones who are there everyday getting it done.

I have to admit though, it was kind of fun… flying around the room again like the old days.

I’m also struck at how courageous my patient is to step up and donate a kidney. All throughout the process (especially, the day before when things got a little nutso), the dedication to the decision never waivered. It’s my job to move the case through the donation process while simultaneously making sure the person is constantly aware of the option to back out and not once did the patient consider cancelling.

The recipient of the kidney has been through a lot and I hope this is the final bump in the long road back to good health.

When I get back to the office on Monday, I’ll have a stack of applications sitting on my desk from other people who want to donate and I’ll start the process all over again with them. I haven’t fully appreciated what these people are willing to do but I know I’m looking forward to being the one to help them during every step of the way.

So far, from what my patients have been saying, they like the job I’ve been able to do. It’s a great feeling to get that kind of positive feedback from someone who, in the end, I admire as being incredibly selfless and unimaginably brave.

A Little Bit Hard to Fathom

I’m now the new Living Donor Transplant Coordinator RN for my hospital and it’s the biggest responsibility I’ve ever had in my life.

My job will be to increase the number of living donor kidney transplant cases we do in our department.  Put another way, it’s up to me to walk people through the process of donating their kidney to someone they know.

If I have difficulty writing about it, it’s because I have difficulty absorbing the impact this work has on other people.  People have died because of this surgery.  Perfectly healthy people have died because of their decision. 

I understand the good that comes from choosing to donate but when I sit three feet from a perfectly healthy person who could die because of this process, I find a little part of me shaking inside.

My position is a new position.  That is to say, it didn’t exist.  I’m not taking someone’s place.  I’m developing a new role in our service from scratch.  There’s no getting around the fact that the difference between success and failure centers on my efforts.  Holy crap.

Scientifically speaking, the best chance for health for someone with renal failure lies in obtaining a kidney from someone who is alive.  Psychosocially speaking, that’s a heck of a thing to request.

I sat in with a patient today who will be donating her kidney to a friend in two days.  I’ll be following her case from today to the minute she checks into the hospital to the operating room to the post-op floor to two years from now.  She is my responsibility and there is no circumventing that fact.

If you think about how much you like your kidneys where they are and think about what it would take for you to give one up then you know have an idea of what I think about when I go to work now.

As I was sitting next to my patient, we talked about another person who died because of this surgery.  A clip had failed.  A little piece of plastic that was to stay on a blood vessel slipped off and the patient bled to death.  I’ve never been in this position before.  The seriousness lays like lead in my stomach.

I know I was meant to do this job and that all of my experiences put me in the best possible position to succeed but at the same time it’s all very, very humbling.