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Code Blue, Special Care...Code Blue, Special Care... - Nobody wears a white coat any more...
...a tribute to becoming a doctor.
ayradyss
ayradyss
Code Blue, Special Care...Code Blue, Special Care...
Ran through Triage. "Not us," nursing comments, stopping me in my tracks. "We're all CBU." Code was cancelled by the time I'd made up my mind to go down to the ICU. All in all, this has been a slow OB day.

One morning R presented in Medicine rounds. Seventeen-year-old girl, smoke inhalation, V-fib on site, shocked back into rhythm, intubated and getting hyperbaric oxygen but not responding well. She should, technically, have gone to peds - but here she was, in the ICU, and R facing the family.
You grow attached to certain patients, O Best Beloved, patients you may never even have met. Other people's patients - you have to listen, you will be cross-covering them eventually.

17 years old. Baby died in the fire. Girl was dying, slowly, by bits and pieces - neuro exam changes, decreased cerebral blood flow, posturing and EEGs that were nothing but dismal. And finally, R went to the family and talked about a no-code status, and then talked about withdrawing support. And there she was, seventeen, smoke inhalation, brain dead, and the organ donation people came to talk to the family.
In Indiana, O Best Beloved, they ask you when you renew your license if you want to be an organ donor - and there it is on the driver's license, a little red heart for "Organ Donor". And most people, most of the time, think that that means you will be an organ donor when you die. She had it on her license. Little red heart. Little red gift of one seventeen-year-old heart, two kidneys, one liver, a pair of corneas and a pancreas. Discount the lungs; smoke-damaged and abused. Discount the blood and bone marrow - those are tricky. Seven organs left.
But she was seventeen, and when you are seventeen that little red heart means that your family must give consent. And her mother had come all the way from a very far away state to see her daughter dying, and it was her heartfelt wish that she not have to watch her little girl kept alive by machines, waiting for the harvest. And none of the family members would argue with her.
They withdrew support and let her die, O Best Beloved, and nothing at all was donated. And R came into the callroom and told us that there would be no donation, and told us why, and I was furious. I still am.

There are religious and personal beliefs that prohibit organ donation. I do not subscribe to them and I do not necessarily agree with them, but I am willing to respect them. I am willing to accept that you may not be able to come to grips with a young child's death - although I have seen parents who chose donation for their two-year-old's body - and I am willing to accept that you may simply not wish to give your organs. I will discuss it with you if you like. Many times refusal is rooted in fear, superstition, or misinformation. But we as physicians are not to discuss it; we must leave it up to the organ procurement people. Otherwise, people fear that we will treat them differently - withhold treatment - not try to save lives. Which is ludicrous, but I digress.
I understand all this, O Best Beloved. It would have been different if she had not elected donation on her license, if this seventeen-year-old girl had not already made a decision and expressed her wishes. For her mother to act in direct opposition to those wishes violates the autonomy of the patient and makes her decision an empty pledge - but the fact that it was pure selfish thought by a woman who did not even have custody of her child made me tremble. She did not make her decision with any consideration of her daughter's wishes or any thought as to the consequences - a decision made in grief and pain, I am certain, but a decision made selfishly nonetheless. And no-one else would say her nay.

People died because of that decision, and I think perhaps it is my moral rigidity on this issue that leaves me inflexible, judgmental. But I cannot shake my conviction that what happened there in the ICU was wrong, and I cannot shake the anger that still shivers through me.

In theory, if you are over 18 and you sign consent for donation, and your driver's license shows it, in theory that is all the permission we need - the organ procurement agency states that that is sufficient legal grounds for donation - but they will still address it with the family. Thus far, I have not seen it put to the test in an adult.

Tags: ,
now feeling:: angry angry

22 whispers echo . o O ( ... ) O o . whisper a word
Comments
shoebucket From: shoebucket Date: December 20th, 2005 03:18 am (UTC) (etched in stone)
Agreed!
reynardo From: reynardo Date: December 20th, 2005 04:17 am (UTC) (etched in stone)
Which is why, in my family, anything they can get from my body (and my husband's, and my son's) they are most welcome to. And we have all discussed it and put it on our licences and let our parents know.

I feel your anger. I pray that your post might encourage someone else to donate, and that might be enough of a difference.
missysedai From: missysedai Date: December 20th, 2005 04:48 am (UTC) (etched in stone)
My heart is hammering so hard, I'm so angry...

I've had the organ donation discussion with the Monsters, and like me, they want to give the gift of life to those who need it. Gods forbid I should outlive my children, but should it come to that...they'll live on in others.

I live in fear of losing one dear to me for want of a kidney. People so selfish...I can only think that they've never had to watch someone they love waste away for want of a donated organ.
fyrfitrmedic From: fyrfitrmedic Date: December 20th, 2005 05:21 am (UTC) (etched in stone)
[nodding in agreement]

I was brought up from an early age with the idea that organ donation is what should be done.
deadrose From: deadrose Date: December 20th, 2005 05:33 am (UTC) (etched in stone)
There are times I'm incredibly thankful to have been born in a medical family. I'm debating going all the way and willing my body to the Body Farm, since I'm no longer 'young and healthy'. If they can get a few organs good out of me, more power to them, if not at least I can help forensic science out.
attickah From: attickah Date: December 20th, 2005 06:24 am (UTC) (etched in stone)
I've had that discussion with my parents many times, as well. I've been marked for donation since I first got a driver's license. And I know, full well, that if it were left up to my mother, not a single soul would receive donation from me--she, for selfish rather than religious reasons, is completely against giving any parts of me to anyone else for their use. Nevermind that it could save others' lives. She is against the mutilation of her child for reasons I can't even begin to fathom. If something does happen to me, I can only hope that my wishes for what happens to something of mine prevail against hers one final time.

Then again, being alive, I'd still donate some of my spares (need any kidneys?) if I knew people needed them and mine would help. I just don't think that's the way they usually go about that sort of thing.
ayradyss From: ayradyss Date: December 20th, 2005 06:31 am (UTC) (etched in stone)
Living donors can give single kidneys, liver/lung/pancreas bits, and bone marrow/blood.
http://www.abmdr.org/ and http://www.marrow.org/ are registries for potential bone marrow donors. There are multiple others.
clipdude From: clipdude Date: December 20th, 2005 09:28 am (UTC) (etched in stone)
That makes me angry, too.

It is horrible that the young woman’s organs will go to waste instead of being put to good use, but it is even more sad that her parents disrespected her decision, even if she was under 18.
chibent From: chibent Date: December 20th, 2005 12:05 pm (UTC) (etched in stone)

I, too, have had my license marked ever since I first got one. I've discussed this with my mom, who's okay with it.

My husband is a different story.

He is completely against my - or his - donating. I don't understand. We've talked about it a little; as best I can tell, it's a combination of not wanting his wife/himself mutilated after death and fear that the doctors will let me/him die if they see us as potential organ donors.

I'm a nurse, and I know this is bunk, but I can't convince him. I actually hope I outlive him, since if I go first, he won't okay donation - and that makes me feel all wierd inside.

Do you know of any resources I can point him to? (Though I have to say, I'm not sure he'd even look at it. He doesn't even like to talk about this. I tried to show him some things from http://www.organdonor.gov/ but he didn't even want to see.)

As a Christian, I believe that my body's just a shell. It will rot. If someone else can make use of it, great! I'm all for that. My husband is Christian, too, and has no religious objections. I just don't understand him.

He doesn't even like me to give blood - though in that case, it's because he says it's unhealthy for my body. I love him, but I give blood anyway.

mama0807 From: mama0807 Date: December 20th, 2005 03:00 pm (UTC) (etched in stone)
I'm a donor. It's one of the most important decisions I've made in my life. For someone to trump the wishes of another just baffles me, and the notion that people honestly believe if you're a donor, they'll withhold care to harvest you baffles me even more.

attickah From: attickah Date: December 20th, 2005 04:14 pm (UTC) (etched in stone)

doesn't baffle me a bit...

Even though we've come a long way from thinking that diseases are based on the Evil Eye and that doctors cure with magical powers, there is still a lot of mistrust on the part of the world at large aimed at physicians.

This is quite possibly because knowledge is a double-edged sword--if it gives you the power to heal and restore health in ill individuals, it also gives the power to kill and take life in healthy ones. It can be used either way and we normal humans won't know until it's "too late" which way the doctor chose to go. Add to that the fact that doctors speak in a language that only their own (or a medical dictionary) can understand, write in a way that none of us can read, and can occasionally make mistakes.... In general, people have a tendancy to mistrust that which they don't understand--be it a culture, religion, or profession.

Either that, or people have just read too many emailed forwards about the guy who wakes up in a bathtub full of ice with no kidneys and a missing wallet.
orangemike From: orangemike Date: December 20th, 2005 11:04 pm (UTC) (etched in stone)

Re: doesn't baffle me a bit...


Even though we've come a long way from thinking that diseases are based on the Evil Eye and that doctors cure with magical powers, there is still a lot of mistrust on the part of the world at large aimed at physicians.


Some of us have just dealt with one too many arrogant MDeities.

Which doesn't stop my family from being fanatically pro-donation. As Christians, we know the difference between the person and the flesh they leave behind. Heck, my redneck dropout momma went to Medical School in Memphis that way!
ayradyss From: ayradyss Date: December 20th, 2005 11:15 pm (UTC) (etched in stone)

Re: doesn't baffle me a bit...

MDeities....I like it.
orangemike From: orangemike Date: December 20th, 2005 11:21 pm (UTC) (etched in stone)

Re: doesn't baffle me a bit...

MDeity?

I got it from ozarque's old snail-mail Newsletter.
vvalkyri From: vvalkyri Date: December 20th, 2005 04:50 pm (UTC) (etched in stone)
I think. . . it's not so much that people fear a withholding of care as too early a giving up of hope.

This doesn't seem to be the case with the woman described above; she seemed to accept the death but not want to have the machine support necessary for harvest. This I don't understand.

I don't subscribe to the view but I can get my head around the viewpoint of "What is this 'brain death'? The heart beats, the body breathes, and yet you tell me my loved one is dead and shall never come back? Some come back from [a place that seems much like this one]; if not for this 'harvest' we could wait indefinitely for my loved one's return."

Oddly, I think also you might be seeing a manifestation of "Doctors can perform near miracles; they must have been able to save my loved one, and the fact that sie looks alive and I'm told sie is not... there must have been a subconsious wish to fail."

I've seen the former in certain places around the web*, and I well remember a coworker expressing the latter feeling about, I think, her sister in law, who died after somehow choking on a dog chew toy - essentially a disbelief that the doctors couldn't save the relative.

*when I was looking for more info on last month's face transplant
blueeowyn From: blueeowyn Date: December 20th, 2005 03:25 pm (UTC) (etched in stone)
{HUGS}

Hopefully some who read your journal (or who are pointed to your journal) will see the short-sightedness of these choices and make better ones.s
waifofthenorth From: waifofthenorth Date: December 20th, 2005 05:32 pm (UTC) (etched in stone)
I haven't signed my driver's liscense, because I know my Dad wouldn't want my organs donated (my mom's weren't), and I'm guessing my heavily chemo-fied organs won't be much use to anyone anyway. My dad should've let them take my mom's though...I would have said that if they had asked my 16 year old self. She was perfectly healthy expect for her brain...My dad's more attached to my mother's grave as well, to me it's just a place we put my mom's body, nothing more.
waifofthenorth From: waifofthenorth Date: December 20th, 2005 05:37 pm (UTC) (etched in stone)

Bone Marrow Donation

I'd like to echo the above and say that everyone who can and wants to should sign up to be a bone marrow donor...That, at least, can be your decision...

Saved me, anyway...
From: clypheous Date: December 20th, 2005 06:11 pm (UTC) (etched in stone)
I know there's always been the thought that if you are set to donate the doctors won't try as hard to help you as they otherwise would. I personally think that this is complete bunk. A lot of time doctors don't even know if you're eligible for donation while they are working on you. They certainly are not going to nix an operation because it might damage an organ that you could be donating. Most of the time these are people who are brain-dead or so obviously going to die from massive trauma that there's really no reason to worry that a doctor is going to let you die so they can harvest your organs.

I understand that some people hold on to their religious beliefs and therefore don't think that we should cut up the dead to harvest their organs. I personally believe that those people should be removed from eligibility to recieve organs from anyone else. Regardless of my religious beliefs (if any) I don't see any reason to believe that my body is useful to me after I'm dead. In my case it's going to be incinerated a couple days after I die and a couple lungs more or less being cremated isn't going to make a great deal of difference to me.

Now, my public service announcement type of thing. If you are under 18 this really doesn't apply to you because your guardian will have the ultimate say in this regardless. You MUST, I cannot emphasize this enough MUST go and do a couple of things if you want to be sure you will be an organ donor. You should first go out and complete a health care proxy filled out properly for your state (anyone needs help with this, reply to this message and I'll do what I can to assist). A health care proxy is not a living will, although sometimes people use the terms interchangably in error. A health care proxy gives someone else control over pulling the plug when you die. If you become brain dead and you don't have one of these, you could wind up like Terri Schivo and chances are you don't want that. Choose someone you trust and KNOW will do what you request. I personally don't recommend choosing mothers as they tend to not be as willing to cut off life support as fathers. I actually recommend a close friend or spouse over parents or children.

Second write out a document and have it notorized that states that you intend to have your organs donated when you die. Make a million copies of this document and give it to everyone that you know. Make sure that you keep the orginal somewhere that people can find it as well (although an original is not needed to be valid, I believe in better safe than sorry). Make SURE that you have this document signed and notorized or a hospital will likely not even bother to look at it.

Between these two documents you should be able to determine what happens to your body after you die. If Ary has any thoughts on this please let me know, as her perspective could also be helpful.
ellisande From: ellisande Date: December 20th, 2005 06:58 pm (UTC) (etched in stone)
I had a talk with my mom about organ donation years and years ago. As we talked, I noticed that in her mind, organ donation was a final tribute to the person who had died. A way of keeping a part of that person alive and a way of making something good come from something bad. I signed consent not long after, knowing that my parents knew my wishes (and I theirs) and we would all uphold them.

I read a news article, perhaps a month ago. A child in the Middle East was killed in a bombing, I believe. I don't remember the child's specific age or where this was, but I do remember that his parents donated his useable organs in hopes that it would forward the peace process. And all I could think was how remarkable of these parents, to be presented with such a horrible situation and use it in a way to try to prevent it from happening to someone else's child.

As a soon to be mother, I can't even contemplate the horror and grief of losing a child. What I can't contemplate even more though is deliberately ignoring the selfless wishes of your child in order to spare yourself. And the judgemental voice inside my head whispers, "No wonder she didn't have custody of her child." It isn't a very charitable thought, but I can't help it. My anger at this double loss is too much. She had a chance to honor her daughter's wishes and let her be a hero to others. What a shame that she couldn't see past herself to do it.
coanteen From: coanteen Date: December 21st, 2005 01:15 am (UTC) (etched in stone)
i've heard of family countermanding a deceased relative's wish to be a donor. adult relative's, i mean. doctors won't go gainst the family's wishes, they won't fight them for the organs; bad press and all.
From: broken_onewon1 Date: December 22nd, 2005 03:42 am (UTC) (etched in stone)
The mothers selfish choice disgust me. The only slim rationalization I can even try and cobble together for her total lack of judgement and disreguard for her daughters wishes is she may have been over come with grief, I doubt this was the case. It was a tradagy to begin with but to toss aside all the lives her daughter could have saved and all the people she could have helped sickens me. I'm a organ donor and my mother is a nurse, and long ago we decided if it were possible and I could donate my organs it would be done my father being in agreement to. Atleast I have the reasurance that my wishes will be honored should the occasion arise unlike the unfortunate girl.
22 whispers echo . o O ( ... ) O o . whisper a word