Not so much like a "Rock Star"

Rock Stars are mercurial and given to rising and falling moods and output. Holly's new kidney is steady, dependable, performing consistently to standards in a context of change. Maybe more like what you would wish from an excellent accountant.

'Like a rock star'

The head nurse in the procedure room at the U's transplant clinic said, "Holly's going through this like a rock star."

Randy and I made some jokes about trashing hotel rooms and smashing guitars,but the staff insisted: they very rarely let someone go just a week after being released from the hospital to get their labs done at their home clinic. (Usually, they find medication levels and other measures are still rising and falling and people still need to come to the U for at least another week so they can supplement either immunosuppression or other infusions.)

That's something I've heard along the line, from transplant-floor nurses, from physical therapists insisting I slow down while "practice" walking and from nephrologists and surgeons, so I guess it must be true.

It makes me curious: is it my natural bullheadedness and determination to pass whatever "test" is given me? Is it the fact my father's experience has been such a success I simply didn't expect anything less? Is it the prayer pouring in from all over?

My mother laughed when I told her on the phone, "Maybe all those people at Bethel were right -- maybe Cheryl and I are sisters!" "It makes you wonder, doesn't it?" she chuckled.

Whatever the answer, all I know is gratitude -- an abiding peace combined with a fierce joy. Could I close my eyes right now and just send up a fervent prayer of thanksgiving? Yes. Could I go out and wheel and leap and dance on the driveway? Oh yeah!

Well, except for some lingering incision pain, that is. But, just today, that started itching as well as hurting, so. . . more progress!

More great tech

When I woke up from surgery, I was, as you often hear, "hooked up to tubes."

The most annoying of these, of course: the urinary catheter. I heard a few theories on why it's used: "We don't want your bladder distending and undoing the attachment to your new kidney" and "We have to keep track of how much fluid is going through you." Regardless, it's uncomfortable, especially when the exit bag fills up or the tube gets kinked -- starting to fill the bladder despite all intentions. When that thing came out, it was a GOOD day.

I also had oxygen coming in through a tube with double prongs going into my nostrils. The main annoyance with this was that I'd been intubated during surgery, and so had a dry, swollen throat -- to the point it would feel like it was flapping "closed" at times. However, it took a while for me to keep my O2 rates up above 96 percent on my own. After they removed that tube, I could use a tip a nurse gave my dad -- thanks, Pete from Marquette! -- of keeping a wet washcloth over my nose and mouth to help moisten the air and ease the swelling.

Most unexpected: the "pressure pants" they put on my legs prior to surgery and kept on at least 2 days. These inflate every few minutes, first one leg, then the other, to help prevent blood clots. What does it say for my drugged, recovering state that I was basically able to sleep through all this?

But the best intervention ever, diagrammed above, the external jugular catheter. It entered about 2 inches below my ear and 2 above my clavicle, and extended for a good 5-6 inches down my jugular vein. As you can see, the end comes out quite close to the heart. With this, they could not only take blood samples without a needle stick and run multiple lines of IV fluids and drugs into me, they could also measure venous pressure.

If you've ever been hospitalized with the classic hand-located IV, you know how uncomfortable it is. Every movement affects it, whether you're trying to eat, shift positions in bed, get up or just fall asleep and have the misfortune of moving then. When sitting up on the edge of your bed is an existential challenge, the last thing you need is this thing hooked to your hand that you have to make sure doesn't get caught, tangled or kinked.

Though they put it in while I was asleep, they took it out while I was awake. It was stitched in -- the only place I did have stitches, and the nurse carefully snipped and pulled those out. She then told me to take a deep breath, let it out all the way and hold there -- and pulled the catheter out.

This is where I love professionals -- at the intersection between "This is just my highly-trained, demanding job" and the layman's "It's all way cool, isn't it?" Nurse Beth turned to Randy and said, "Do you want to see it? Are you OK with looking?" He rather reluctantly agreed. I, of course was anything but reluctant. Way cool, Beth!

I had what looked like a pretty little bullet hole in my neck for a few days, but that's healing up nicely. Even if I end up scarred, it was well worth it.

The new resident

This is what my kidney transplant looks like. See the light-colored "bagel" on the left side of the screen? It's a transplanted kidney, cradled in the "iliac fossa" of the right hipbone, probably in a safer spot than it had been originally!

This is something that's puzzled lots of people -- "So which kidney do they take out to put Cheryl's in?" I still have both my monsters -- the nephrology fellow was somewhat surprised to encounter them today where no one expects to find a kidney -- and this one has been tucked into my hip and is the third connection to my bladder. This is done mainly because the right iliac blood vessels are easiest to attach to the new kidney. I'm told my "native kidneys" will soon realize there's a new, avid worker in town and will gladly give up their fight. They'll still be alive, attached to their original blood vessels, but they'll probably stop producing urine.

Cheryl, thank goodness, also just had abdominal surgery, with about a 3-inch incision next to her navel. Years ago, removal of a donor's kidney involved an 8-inch incision from your back around your side -- LOTS of muscle involved -- and removal of a back rib! The only thing Cheryl had to worry about was whether she was subject to back pain -- once she was out on the operating table, the surgeons twisted her hip back and chest forward so that the kidney "popped" up as other organs pushed against it.

I found my incision is a little bigger than I expected when the nurse held her thumb and finger about 5 inches apart during one of my "T - 1" (the day before transplant) appointments.When I finally got to a mirror where I could see the whole thing, I found out it's at least 8 inches long. And you know what? There's not a stitch or a staple in it!

That's thanks to the brand-new world of surgical adhesives. Where do you find a glue that works on admittedly wet -- and constantly generating more wet -- surfaces?

I haven't been able to run into a surgeon at my lab appointments, but I suspect it's "BioGlue." It's a biologic (based on purified matter from cows) system where two materials are mixed together as they hit the wound, and knit it together within 2 minutes. Hmm. . . sounds like my father's favorite kinds of epoxy!

Thank heavens for advances in medicine.

image from www.medcyclopedia.com
Components of BioGlue:http://www.cryolife.com/products/bioglue-surgical-adhesive
New fields in surgical adhesives, including slugs (!) and mussels:
http://www.sciencedaily.com/releases/2009/05/090501200853.htm
http://www.sciencedaily.com/releases/2009/03/090318085923.htm

Prayers from all over

This is my smallest prayer warrior, my niece Maggie.

She's Randy's sister Karen's daughter and, her mom reports, has developed a real empathy over the last year.

"I sat down with her and explained what people's kidneys do for them and the fact yours weren't working well anymore," Karen told me. "And I told her that because people can get along with one rather than two, your friend Cheryl volunteered to give you one of her kidneys.

"She looked up at me and said 'I'm so glad Miss Cheryl could help Aunt Holly!'"

Maggie and her older brother Michael have been praying for Cheryl and me with their classrooms at school. Being the recipient of prayers from those direct minds, those pure hearts, is just awe-inspiring.

I'm not good at praying for myself, and am just so grateful to everyone who is keeping us in mind. People I knew as a girl in Crystal Falls, people my in-laws have known since college, people at Bethel and at Cheryl's and our church, people I've never met. The reassurance of knowing all of you out there are lifting us up goes beyond words.

And you know what? Cheryl may have given me a "great little kidney." I may be a pretty determined (or "bullheaded") patient. But my progress is astonishing health professionals across the board.

Your prayers are working!

Knitting up the raveled sleave of care

Thursday, April 29 was the first night I was able to sleep through the night, rather than moving from bed to couch to futon trying to get comfortable -- or wear myself out enough to override the steroids.

It's incredible how even after an hour or two of sleep I have noticeably less pain than when I lay down. Apparently a lot of things are being knit together during these times.

A handful of pills in the morning, a handful of pills in the evening, and things seem to be going OK.

I was back at the U only once for a "booster" IV of steroids to try to get my immunosuppression up to therapeutic levels, thank goodness. Life's a lot easier to deal with without steroids on board!

That 'new kidney smell'

At my "T-1" appointment, the head procedure-room nurse explained what happens in a living-donor transplant:

"Cheryl will go into the operating room first, about 15 minutes before you. They'll start surgery on her to remove her kidney, then carry it in a tray over to the operating room where you are.

"Then they "bench" the kidney -- I don't know why they call it that -- but they take it out of the tray and run saline through it and clean off any excess tissue that might be on the outside.

"That part always makes me think of when you take your car to a really good mechanic and get it back all cleaned and detailed."

Here's to really good "mechanics" !