So, I'm on the road for my trip to the hospital. I have about a dozen appointments scheduled between 7 am and 4pm. I have been fasting since 5pm the day before. I can't eat before my blood tests and again four hours before my CT scan which is scheduled at 1pm. I have very little hope that I'll be able to squeeze even an apple in during this hectic day but I am fortified in other ways.....and also a little nervous. My nervousness seems to come mostly from the idea that I may not physically be "up" to the demands of donation. These are rigorous and thorough tests. They don't want someone donating a kidney who may suffer from the lack of one later in life. I knew I was in good health, took no medications, was generally fit and emotionally stable (in relative terms) but these tests would tell me everything. The fear was not that I would find something wrong in myself so much as it was that some problem in me would not allow me to donate to my friend. The emotions surrounding this process are unpredictable, often unexpected and always important to feel on your way through.
I arrived at the hospital by 6:15 and went down to the lab to get checked in. My schedule started with an EKG, a chest X Ray and blood and urine samples. Everything at this stage went very smoothly. I got to relinquish my jug of urine as well as 22 vials of blood. Then it was upstairs for a GFR test. The GFR uses a radioactive isotope to trace the passage of fluids through your kidneys and then into your blood and urine. For the test I was injected with a tiny amount of the radiation and then was asked to return in one hour and two hour intervals to give urine and blood samples. In the meantime, I would continue with my appointments.
Next was a meeting with the surgeon. The surgeon was about an hour late for our meeting, but as the schedule was tight, my next appointment, a social worker, found me in the exam room and interviewed me there. The social worker is the first line of defense for people who may need more thorough psychological screening before donation. They want to assess whether you have a real grasp on what you are doing, what it means to you physically, emotionally and financially. I kind of breezed through this one and we spent a good part of the time talking about how much we love Puggles and dogs in general. I promised to bring my Puggle, Pablo, to the hospital so she could meet him which may or may not have been a bribe. I was in it to win it, after all.
Afterward, the surgeon finally appeared. He was unimpressed with my altruism and with me in general. I discovered during my two days of testing that a lot of people make it even this far in the donor process with absolutely no clue what they are getting themselves into. They think they will be compensated for donation (it is actually against federal law to compensate someone financially for donating an organ), they don't understand the seriousness of the surgery, they are nowhere near in the right physical shape for donation. Despite the thorough questionnaire we answer before we get to the stage where you are actually meeting a surgeon, a lot of people find their way to an early denial in this process. I imagined this surgeon had interviewed at least a dozen people who didn't make the cut for every successful donor interview. He asked me a few simple questions, looked me over like I was a Thanksgiving turkey and that was it. I usually like to have better chemistry with people who are going to be touching my internal organs but that clearly was not in the cards this time. I was just along for the ride.
My transplant coordinator was my next appointment. I had pictured her as a stern librarian-type but she was really more like the Cruise Director of organ transplants. She was friendly but clear about boundaries, smart but approachable. We talked for an hour, mostly things we had talked about already and things that were explained thoroughly in the mountain of brochures she had mailed out a week before my appointment. It was a good opportunity, however, for us to get to know each other. She would be, after all, my go-to person for all things transplant. She would be the one I would call if there was ever a problem so it was good to know we got along. She took my photo like I was signing up for a dating service, told me she was going to put it in my file and checked for my next appointment. The surgeon's delay had put me about an hour and a half behind schedule and it was her job to right the ship. At this point I still had four appointments to go; my CT scan, a "skin check" at dermatology, a meeting with an independent transplant liaison and the fitting of a 24 hour blood pressure monitoring cuff. Like any good organizer, my transplant coordinator knew instinctively what to do. She cancelled the final two meetings and told me to go to the CT scan and dermatology since those appointments are hard to get. She would re-schedule the other two for the next day.. I was given my orders and I was on my way down to the basement for the CT scan, then across the campus to dermatology. For someone who had no earthly clue what I was doing I knew that I was being taken care of by really smart, kind people. That was all I needed to know.
Aside from the fact that thy technician had a really difficult finding my veins for the IV contrast, the CT scan was pretty routine. I was more tired than anything and I was afraid I might fall asleep in the machine so having my forearm continually stabbed by a needle woke me up a bit. The whole thing took less than ten minutes but my schedule was so tight I only had a couple of minutes to get across the campus to dermatology....then I would be done for the day.
I had never had a dermatologist's appointment before so I was curious. I had literally run to the office so I was a bit out of breath and the woman at the desk took my name and sent me on my way to the exam room. The purpose of this appointment, the last of the day, was to give me a head to toe skin check, looking particularly for unknown melanomas which would make organ donation impossible. Any cancer, history of cancer or potential cancer generally rules you out from living kidney donation. There are any number of reasons for this but the most important one is that cancer treatment is hard enough on a person's body. Having to endure cancer treatment with less than an optimal number or organs just makes it that much harder. Most of the tests I had had to that point were cancer screening tests. Melanoma, however, can be both silent and ruthless so they take the time to look for it separately.
I arrived in the exam room and was instructed to undress completely and put on a hospital gown. By the time the doctor arrived I was compliant. In the most methodical and respectful way imaginable, the doctor searched every area of skin on my body, somehow not making me feel like I was a showgirl hanging from a stripper pole. The whole thing was over in less than five minutes, two of those minutes spent looking at a weird area under my eye that they determined was just weird and nothing dangerous. Free cosmetic surgery was not in the offing.
After that I was free. It was already almost 5pm and I was hungry, only managing to sneak a banana and some crackers on my way between the last two appointments. I was ready to head back to my parents' house for a home-cooked meal and a good night's sleep. It had been a long day. The second day was not as long or jam packed with appointments. I had made it through the worst, I figured. Tomorrow would be a piece of cake.
Afterward, the surgeon finally appeared. He was unimpressed with my altruism and with me in general. I discovered during my two days of testing that a lot of people make it even this far in the donor process with absolutely no clue what they are getting themselves into. They think they will be compensated for donation (it is actually against federal law to compensate someone financially for donating an organ), they don't understand the seriousness of the surgery, they are nowhere near in the right physical shape for donation. Despite the thorough questionnaire we answer before we get to the stage where you are actually meeting a surgeon, a lot of people find their way to an early denial in this process. I imagined this surgeon had interviewed at least a dozen people who didn't make the cut for every successful donor interview. He asked me a few simple questions, looked me over like I was a Thanksgiving turkey and that was it. I usually like to have better chemistry with people who are going to be touching my internal organs but that clearly was not in the cards this time. I was just along for the ride.
My transplant coordinator was my next appointment. I had pictured her as a stern librarian-type but she was really more like the Cruise Director of organ transplants. She was friendly but clear about boundaries, smart but approachable. We talked for an hour, mostly things we had talked about already and things that were explained thoroughly in the mountain of brochures she had mailed out a week before my appointment. It was a good opportunity, however, for us to get to know each other. She would be, after all, my go-to person for all things transplant. She would be the one I would call if there was ever a problem so it was good to know we got along. She took my photo like I was signing up for a dating service, told me she was going to put it in my file and checked for my next appointment. The surgeon's delay had put me about an hour and a half behind schedule and it was her job to right the ship. At this point I still had four appointments to go; my CT scan, a "skin check" at dermatology, a meeting with an independent transplant liaison and the fitting of a 24 hour blood pressure monitoring cuff. Like any good organizer, my transplant coordinator knew instinctively what to do. She cancelled the final two meetings and told me to go to the CT scan and dermatology since those appointments are hard to get. She would re-schedule the other two for the next day.. I was given my orders and I was on my way down to the basement for the CT scan, then across the campus to dermatology. For someone who had no earthly clue what I was doing I knew that I was being taken care of by really smart, kind people. That was all I needed to know.
Aside from the fact that thy technician had a really difficult finding my veins for the IV contrast, the CT scan was pretty routine. I was more tired than anything and I was afraid I might fall asleep in the machine so having my forearm continually stabbed by a needle woke me up a bit. The whole thing took less than ten minutes but my schedule was so tight I only had a couple of minutes to get across the campus to dermatology....then I would be done for the day.
I had never had a dermatologist's appointment before so I was curious. I had literally run to the office so I was a bit out of breath and the woman at the desk took my name and sent me on my way to the exam room. The purpose of this appointment, the last of the day, was to give me a head to toe skin check, looking particularly for unknown melanomas which would make organ donation impossible. Any cancer, history of cancer or potential cancer generally rules you out from living kidney donation. There are any number of reasons for this but the most important one is that cancer treatment is hard enough on a person's body. Having to endure cancer treatment with less than an optimal number or organs just makes it that much harder. Most of the tests I had had to that point were cancer screening tests. Melanoma, however, can be both silent and ruthless so they take the time to look for it separately.
I arrived in the exam room and was instructed to undress completely and put on a hospital gown. By the time the doctor arrived I was compliant. In the most methodical and respectful way imaginable, the doctor searched every area of skin on my body, somehow not making me feel like I was a showgirl hanging from a stripper pole. The whole thing was over in less than five minutes, two of those minutes spent looking at a weird area under my eye that they determined was just weird and nothing dangerous. Free cosmetic surgery was not in the offing.
After that I was free. It was already almost 5pm and I was hungry, only managing to sneak a banana and some crackers on my way between the last two appointments. I was ready to head back to my parents' house for a home-cooked meal and a good night's sleep. It had been a long day. The second day was not as long or jam packed with appointments. I had made it through the worst, I figured. Tomorrow would be a piece of cake.
Being determined weird and not dangerous is excellent. Thank you for sharing your journey here, it is fascinating and I had no idea how incredibly thorough the process is. Very interesting.
ReplyDelete