Return trip

I was on call last night, just third call but there was a donor in progress so that put me to run referals so that the next day's 1st call could go and do OR fresh in the morning. Just as my head hit the pillow, my boss called me. She needed me to go see on old man across the city in a hospital about 50 min away. I pulled my body out of bed, I was so tired, and threw on a sweatshirt and scrub bottoms and jumped in my car and prepared myself with my ipod for the long drive. Once I arrived, I did my business. The pt wasn't brain dead, we would just follow. I left and thought, looong drive home and when I am almost home, my boss calls me again. Same hospital is calling in another referal. I scream WHAT?! into the phone and exit the next exit. I'm told to turn around and go see him, the nurse says he is brain dead and absent reflexes... oh wow, another 40 min back. I drive back feeling dejavu in my return trip, get out of my car and paste a smile on my face as I walk back in the ICU. I was just here, they could have called me then but they didn't. I walk back in smiling and the charge RN notices and apologizes and says she is sorry, and thank you for still smiling. I shrug, its my job... I can't be mad. Its what I do and I know they are busy... I can forgive it once. So I sit down to look at the chart and talk to the nurse. So they pt is brain dead I say, she says yes. I go through all the reflexes with her. Cough? No. Gag? no Corneals? no. Is he breathing on his own? No. Flexing? No. I chart all this but something tells me to go see first hand. Usually I dont do this, as there are 10 family members in the room, two in wheel chairs and its just cruel to ask them to leave sometimes. But I needed to know for sure and something in her affect tells me to double check. Once family is gone, I head in with the nurse in tow. I start with corneals. Yes they are there. I sigh... ok next. He has a STRONG gag and cough and continues to cough after I suction. Ok. He postures when I suction. Big sigh... ok. He isn't brain dead and I educate the RN on the nuero assessment which I feel should be something she is capable of doing correctly in an ICU? Correct me if I am wrong here. I talk over the plan, leave a note and head back home, praying I will make it back to my bed. 3 hrs later after I am originally called, I am back asleep. Little do I know the same ICU calls in another referal! My boss tells them, forget it. We have had someone there twice already tongiht, someone will come by in the morning first thing. Thank god because I would've had to go postal on them, and no smile this time.

I saw this in the hospital restroom, hanging on the wall...

The Invitation
It doesn’t interest me what you do for a living.
I want to know what you ache for
and if you dare to dream of meeting your heart’s longing.
It doesn’t interest me how old you are.
I want to know if you will risk looking like a fool
for lovefor your dreamfor the adventure of being alive.
It doesn’t interest me what planets are squaring your moon...
I want to know if you have touched the centre of your own sorrow
if you have been opened by life’s betrayals
or have become shrivelled and closed
from fear of further pain.
I want to know if you can sit with pain
mine or your ownwithout moving to hide itor fade it
or fix it.I want to know if you can be with joy
mine or your own
if you can dance with wildness
and let the ecstasy fill you to the tips of your fingers and toes
without cautioning us
to be careful
to be realistic
to remember the limitations of being human.
It doesn’t interest me if the story you are telling me is true.
I want to know if you can disappoint another to be true to yourself.
If you can bear the accusation of betrayaland not betray your own soul.
If you can be faithlessand therefore trustworthy.I
want to know if you can see Beauty
even when it is not prettyevery day.
And if you can source your own life from its presence.
I want to know if you can live with failure
yours and mine
and still stand at the edge of the lake
and shout to the silver of the full moon,“Yes.”
It doesn’t interest me
to know where you live or how much money you have
.I want to know if you can get up
after the night of grief and despairweary and bruised to the bone
and do what needs to be done
to feed the children.
It doesn’t interest me who you know
or how you came to be here.
I want to know if you will standin the centre of the fire
with meand not shrink back.
It doesn’t interest me where or what or with whom
you have studied.
I want to know what sustains youfrom the inside
when all else falls away.
I want to know if you can be alone with yourself
and if you truly like the company you keepin the empty moments.

Quotes...

Some quotes that are my favorites and that I use on a daily basis while doing this job:

"Perseverance is the hard work you do after you get tired of doing the hard work you already did. " Newt

"Perseverance is a great element of success. If you only knock long enough and loud enough at the gate, you are sure to wake up somebody." Henry Wadsworth Longfellow

"Of all that is good, sublimity is supreme. Succeeding is the coming together of all that is beautiful. Furtherance is the agreement of all that is just. Perseverance is the foundation of all actions. " Lao Tzu

"When you come to the end of your rope, tie a knot and hang on". ~Franklin D. Roosevelt

"When people show anger and malice , listen for truth in the message, ignoring the way it was said"

Hospital from Hell

Well, I started this blog and then quit. But I think I will continue it for myself, and I really dont care much who reads it, but its a good way for me to log what has happened and something for me to look back on, not to mention the therpeutic part to it.

This am I was back on call after having 8 days off over Christmas. Last night I read a man's blog, about receiving a set of lungs from a 17 year old girl. I had been sitting there griping to myself about going back to work and it set me strait really fast. I thought "hey you, most people dont have jobs like you do, most people sit at desks all day, do the computer, sell insurance, but look what you get to do the next 7 days on call, you get to make a real difference for someone, for many people, and that is so priceless in many ways." I thought, ok priorities strait, I'm ready to go back to work tomorrow. I woke up cheary and ready to go, and got a page around 8 from a local trauma center who had an older lady who met brain death criteria and was told the doctor will be in shortly to do an apnea exam to declare her. Her daughter wants her to be a donor.

I drove to the hospital, thinking what an amazing family. Here they are right after Christmas, and they are thinking of others at this horrible time. I was honored to be going to help them. I arrived, was told that the doctor wasn't there yet. Dealt with some unruly RTs who were upset about having to work, a nurse who moved about .00005 mph... and doctors who wouldn't come into delcare the patient brain dead so that we could procede. I spent the next 4 hours, trying to get someone, anyone into to do THEIR JOB, but no one would. No one would support the patient either and her blood pressure fell because of the DI. So in the end, I had to tell this family "I'm sorry but your mother can't be a donor because the doctors wont come in". I felt sick, there was nothing I could do and it pissed me off that this hospital let it happen. The charge RN, the Hosp admin RN, no one would do anything. The doc took 3 hours just to call back, making this family wait this whole time. It so sad that this was denied them. I hope to never be a patient there ever, but no I will eventually have to go back as a coordinator...

So I am sitting at the office, upset that someone today wont have the opportunity to receive what this family had to give because of tis hospital staff. I want to say that I hope one day they are in that position and someone does that to them, but I would never wish that on anyone, would never wish that anyone was denied that life saving gift that that family so unselfishly had to offer. My discust with this hospital is pretty deep right now. I need to get back in the ring and take it out on my instructor when I get back to class soon. :)

Imagine this...

Imagine, your standing next to your spouse of about 8-10 years in a foreign place, a Pediatric ICU. All around you are rooms filled with sick children, they're parents waiting for a miracle of healing so they can leave like the people they see walking through the electronic double doors. Your standing there looking down at your daughter, she is 6 months old, innocent and helpless. She moves not a muscle, around her head the sheets are stained red, tubes extend from every orfice it seems, winding their way towards machines that are keeping her heart beating, her lungs inflated. Her swollen eyes are closed and you lean forward speaking to her, knowing she cant her you. She's already gone, her brain is dead from the massive injuries from the car accident. You are in a hospital gown and bare feet, so is your spouse who sits in a wheel chair in the doorway, head in hands sobbing. Your daughter will die soon, as you have made the decision to let her go, you say to the nurse "She's suffered enough". You look up, your older daughter is headin goff to surgery to repair her injuries. She will live but it makes it no less easier. You tell her at the door to the PICU that you will be waiting for her when she gets back. She hears you, though sedated with a tube in her throat, she is still among the living. Turning back, you see your spouse holding your younger child. She looks at you and nods that its time.

This was my day yesterday. Somedays I just shake my head that I can keep doing this. I came home, walked in my door and grabbed both of my boys and hugged them until they yelled "mom!! let me go!" at which time I did, reluctantly. Everyday is precious to me now, every moment, every football game and every school play. It was before this day in the PICU, but this day just gave me a little reminder of what I was most thankful for: two healthy children and a healthy husband. I hate to send my kids off to school, some days I wonder "what if I dont make it home?" Again yesterday I was asked twice, How do you do this? I just do. You 'de think I would have a better answer than that after being asked so often, but everytime they ask, I stop and wonder how also.

So back to the PICU. This is what i walked into. The nurses were in their protective mode, flocking aorund this family like guardian angels, trying to protect them from any further harm which included me. If I would have had on a grim reaper costume I dont think I would have been treated any differently. What pains me was that they were making the decision on what was best for that family, by protecting them. Its hard for PICU nurses to switch mindsets mid stream with a case like this, I sympothize. How do you go from taking care of a little baby, to giving up, to thinking about other kids that might benifit from this tragedy through organ donation? No, I think on some level that means they have failed. Failed to keep this girl alive, despite there being nothing they could have done. Me being there was a reminder that that had happened. In the end, the process was done wrong, the family let her go, she did not help others and it was so very sad because deep inside many PICUs across the country are desperate parents waiting for miracles that yesterday did not come.

Someday, god willing never, that might be me as a waiting parent or as a parent of a dying child. Signing on that line would be the hardest thing ever I had to do, but I would do it. How can I ask of parents to do something I wouldn't even do myself? Everynight I pray that this will never happen.

Back to normal today, Kids at school, husband at work... I am relaxing with the cat on my bed. Life seems so normal for me, but tomorrow I will do it again. Because its in my blood to go to work for 100,000 people a day, and I love it. :)

The definition of difficult

To say this job is difficult would be like saying the sky is blue. While it is blue most of the times, there are stormy days, rainy days, windy days, cloudy days and clouds that change shape Sunsets that appear and dissappear, sunrises that happen and colors varying from place to place. You are knocked back by the beauty of it all and running for cover when the rain comes down. So difficult is one word yes, but never have I had a job that I can say that inside the space of a 24 hour period I have been spitting nails mad, frusterated beyond belief, saddened without hope, excited with promise, etremely energized, and just plain exhasted to no end. This job is like no other job I have ever worked, and like nothing I ever would have expected, but I can't imagine my life without doing it. Daily it gives me hope in a greater good, and it has changed me as a person for the better. I now see outside the circle that most people are so stuck in, I see what can be, I see hope in the face of tragedy. I see unselfishness and giving in the time of extreme sadness and loss. I have also met some incredible families and people doing this job and my life has been forever changed by them.

People ask me, often in fact... almost once or twice I am in a hospital: How is it that you can do this job? I am sure every coordinator has heard this question, Im not alone. My usual answer is: How could I not? This job and what I do are part of who I am. Its extremely difficult yes, and there are some days I want to quit because I can't do it another day, but I can't think of anything else I would rather do, so I continue only to be rewarded with yet another day.

This job puts my life in perspective. I am thankfull for things I once took for granted. The ability to spend time with my family. The health of my children and spouse, my parents. People live in such a bubble that they dont realize how lucky they are sometimes. Everything I have I am so much more thankful for, and this job has made me realize that every day I live is a precious gift.

Holding it all in

Last week I found myself forwarding my mail to the local trauma center PICU. I had arrived early that morning to a busy unit, nurses running everywhere, kids crashing... A kid being put on on oscillator, your general business. Somehow, a little boy who had yet to see his second birthday, had ended up there too just like me. I walk into his room, no one is there and I look down at this kid mentally throwing up the daily wall. Hey little guy, its you an dme for the next 24 hours... what do you say? Ok, first things first... Apnea exam... This gets done with lightening speed as all things do in the picu. I meet with the childs mother who stares at me with tears in her eyes and asks what he can donate. I explain in a shaky voice, even though I have done this a thousand times that he is so young that he could give other children the gift of life through his heart, lungs, liver, intestine, and kidneys. She starts crying, the childs father is to her left with his arms around her attempting to be supportive. I wonder if I ever would have the strength to make this decision about my own children. I notice that her hair is unwashed, her clothes are wrinkled, she has dark circles under her eyes and I wonder again how long she has been by his bedside hoping for a miracle. The consent process seems to take forever, the room is dark, my gaze drifts out the window to the city, and I remember looking west while mom thinks over her decision. Slowly she initials the blanks next to what she will give. I dont know if my hand would work if I were in her spot. No matter how many times I have done this, it NEVER gets easier.

A few hours later, mom decides she would like to see her son after surgery... My reaction? oh no, not again. I have done the dressing of the dead child after surgery before... very low on my most fun list. I try to talk her out of it. Do you know what he will look like? The color, the lifelessness, the lack of warmth... I explain all these things. She seems to think about it, nodding like she understands what I am saying and that it is logical as she is laying next to her son in bed. I walk out wondering if I would want to see my child afterwards. A nurse is standing outside the room with a couple others, they have heard the conversation inside. She says "No one could stop me from seeing my child if it were me"... weird. I would never want to, but then again how do I know, my kids are home, alive and healthy. So I really dont know how I would feel unless it happened.

Much later we prepare for the OR. Mom is still laying in bed and she has decided to see him later after we are done. My stomach twists at the thought. I can do this, I say to myself... and luckily the childs nurse is coming to OR with me, she would like to see the process, but we have bonded and we can do this together we agree. Every now and then I meet some very cool nurses, she was definately a keeper. The process of leaving the room is how you would expect and more. I try to hold back the tears, but they come anyways as I tie up loose cords and unplug the bed. By the time we roll out of the room, I am already mentally exhasted but know I have a few more hours to hold it together until I can sit in my dark car and have a good cry on my way home.

After the usual shenanigans in the OR by a transplant center of another state, its finally done. Or nurses are cleaning up the room and the childs nurse and I give him a warm bath, whiping off all the old blood and trying to cover up any sutures and incisions. I place a cap made of cast stocking net on his head and smaller sections over the IVs on his arms. He is an MEs case so it all has to stay in. I even put one over his ETT tube trying to cover that also. We wrap him in warm blankets as his temp is quickly dropping, dress him in a gown and I place him back on the bed he came in. We wheel him back into the PICU... utter silence as we come in the doors. I feel like the grim wreaper walking down the hall. We turn into the room and mom is waiting. She crawls into bed and holds her little boy in her arms. I think it might have been completion she needed, something to show her he was truely gone, to see with her own eyes he is gone. I finally left the room and leaned against the wall in the hallway wishing I was in my car so I could let it go. Its getting really hard to hold it in.

I gather up my stuff, its been a long shift. Its 6am, an hour left to go in my 24 hours of call. I just want to go home and hug my children, feel their warmth and life. I thank the staff and trudge to my car and call my husband to talk me home because I am afraid I will fall asleep and run my car into a tree.

At home, its still early. My kids are still asleep... I creep into their rooms just to look at them, assure myself they are there and to watch them breath. They are so warm under the blankets, their nostrils flare with proof of life, there is no wires, no tubes, no incisions. I take a deep breath, kiss them good morning and head to the shower to let it wash away some memories. I know there is so much good that came out of this, and I try to focus on that as I drift asleep.

I guess an introduction is in order...

I think I have been told that every blog needs an introduction... Well I'll keep this short and sweet so I can get on with things. I am a Transplant Coordinator, or Organ Recovery Coordinator, OR Procurement coordinator... the options on my title seem endless and I have introduced myself, and been called all of the above and more. My favorite is Donor: "Donor is here", for which I promtly correct them and say my first name..... I am not THE donor, that is why I am here. But like most people (mostly ones that dont plan on it) I never get used to being called that. I work for an OPO (Organ Procurement Organization) somewhere west of New York, and to comply with HIPPA (sheesh... sigh) I need to keep things on the down low as far as the ID goes. My job has many facets and many days I ask why, many days I KNOW why I am here and doing what I do. So this is blog is my creative attempt to log my journey and maybe one day put this all down in a book. Its about my experiences on the job and off the job, but all related to my role in helping save lives on a daily basis. I am not superman, no that title of "hero" goes to the many families that make that decision every day to let me help them save others.