“Harvesting” Part 2 by Gary Edgar Grist RN CCP Emeritus
The Pregnant Donor
In the late ‘60s, anyone could volunteer to be a living donor and donate one of their kidneys to a patient in renal failure on hemodialysis. I was dispatched to the donor hospital where a young woman would be donating one of her kidneys. I did not know if she was just very generous to a complete stranger or if she knew the recipient. Somehow, the surgeons were able to see the donor’s uterus through the kidney incision. One of them thought it appeared to be pregnant. They asked if an OB/GYN specialist was available to come give it a glance. When the specialist arrived, he took one look and confirmed that it was a pregnant uterus. Incredibly, the surgeons discussed whether they should continue with the harvest! I could not believe my ears. Women have enough problems with their health during pregnancy, like preeclampsia or eclampsia. These conditions are associated with abnormal renal function related to hypertension. Removing a healthy kidney could greatly complicate this issue. Finally, common sense prevailed and the surgeons decided not to take the kidney.
Someone had failed in their duty to the patient. ALL WOMEN of child-bearing age with a uterus MUST have a pregnancy test before receiving an anesthetic or undergoing surgery. But it did not get done! The surgeons probably assumed the anesthesiologist ordered the test, and he probably assumed the surgeons ordered it. And the OR nurses, even though they knew better, did not check for results before the surgery started. I wondered who footed the bill for this aborted surgery, since the recipient did not get the kidney. This is when I learned the old adage: Never ‘assume’ anything; it makes an ‘ass’ out of ‘u’ and ‘me’. What happened to the donor mother and her baby? I ‘assume’ they did fine. (But I don’t really know!)
Sleet, Ice And Red Lights
For the second lesson, it was a dark and stormy night when I received orders to gather my equipment and proceed to a donor hospital north of the river. It was one of those mid-western deep winter rush hour evenings with freezing rain and sleet coming down in buckets. I managed to make it from my home to my hospital to get my equipment, but I realized I was never going to reach the donor hospital in time on the icy roads with traffic snarled and accidents all over. I needed help to get to the donor hospital. I went to our ER to see if they could get an ambulance to drive me with red lights and sirens to navigate the traffic. The answer was “No!” unless it was to get a sick patient. Didn’t a couple of donor kidneys qualify as a patient? Still “No!” The hour was getting late. So I took it upon myself to contact the Kansas City Police Department. I explained the situation to them and they agreed to send a patrol car to transport me to the donor hospital. The patrol car soon arrived at the ER. I loaded up my equipment and off we went. The officer told me that the donor hospital was in a neighboring city and he was not supposed to cross the city limits unless it was a true emergency. I assured him it was. He carefully but quickly navigated the traffic, sometimes using the siren and red lights and sometimes just using the lights. He was a masterful driver, knowing all the tricks of moving through heavy traffic on a night with horrid weather. I had never been in a police car before and the ride was quite thrilling. We arrived at the donor hospital in about 30 minutes and he said he would wait for me in the cafeteria. Unfortunately, when I showed up in the OR, the surgeon told me the donor had worsened to the point that he thought the kidneys were no longer viable. I told the waiting police officer and thanked him. I would hitch a ride back with one of the transplant team members.
Exceeding My Authority
The next day my supervisor told me that the hospital administration was considering firing me because they felt I exceeded my authority by calling the police as a representative of the hospital. To my surprise, the surgeon stood up for me and I kept my job. In those days, it was uncommon for a doctor to stand up for minions. At my hospital it was considered professionally gauche for physicians to sully themselves with “labor disputes”. But the lesson I learned was this: if you want to work in healthcare, never exceed your authority, even if a patient’s life is at stake. If you fail, your job and maybe even your career may be at an end. If you succeed, the higher-ups will take umbrage for not securing their approval first, never trust you again and pass you over for future promotions. For perfusionists, each case might teach an important life lesson. It could be relevant to the patient’s life or the perfusionist’s own life.
Christopher Yancy (CY) Thomas MD was the surgeon who saved my job. He was a popular and very skilled general surgeon; actually, he was a “Jack of all trades”. He was responsible for obtaining the hospital’s first artificial kidney machine (serial #2 from Travenol Labs.) He treated acute and chronic renal disease patients before the hospital had a nephrologist. Insurance would not pay for chronic hemodialysis in those days, so he started a home dialysis program so patients could treat themselves at home inexpensively. And he started the kidney transplant program to get patients off hemodialysis; one of the first transplant programs in Missouri. In addition, he worked with Dr. Clarke Henry MD, the heart surgeon (for whom I ran the pump); assisting on many cardiac cases together. In fact, Dr. Thomas and Dr. Henry bought the hospital’s first open heart pump which they donated to the hospital. CY was pleasant and interesting to be around and the staff loved him.