My living breathing organism.

Day 4 at Mercy.

Started doing some more clinical stuff, but it's intensely hard to follow patients when you still don't have computer access. Oh well, my badge works so I can go check on them anyways.

Came in this morning with a bunch of pts on heparin drips to monitor. Preceptor and I passed through ICU and on the way to ICU-east, I overheard a conference between the intensivist, nurse, and OHSU transplant nurse. Organ harvesting happening today. Sounds exciting. Scanned through my mental list of patients- yes, this was one of my patients. I remembered him as 58 cause that's what his PTT was today- at goal for dx of ACS.

Hours later, I return to the ICU to bring down some IVs for this unfortunate patient- apparently a man who became brain-dead after suffering a heart attack. He was helping a neighbor with yardwork. The OHSU transplant nurse was busy at work, checking his labs, checking this and that, and ready to flag the OHSU transplant team to come down and retrieve his valuable organs. But wait- they were waiting on something. Something is telling us that he's perhaps not brain-dead. The patient's wife has already arrived and agreed that organ donation is what he would have wanted.

Another few hours later, while pt's family is present, they find that he's got some spontaneous respirations. Consequently, because of this finding, they can't carry out their normal organ harvest protocol. Essentially, this man is a living, breathing, organism. Though his heart no longer works on his own, his body still knows how to spontaneous breathe every once in a while.

"what's the protocol here?" I asked his ICU nurse.

"well, since he's technically still alive, we can't harvest, it's unethical. So, with the wife's consent, we will pull life support, then wait for the heart to stop beating on its own."

"....and how long does that take?" I asked

"dunno. Can be five minutes. Can be five hours."

I know, this sounds horrible. The nurse had the same conversation with the wife. And she was stoic throughout the decision-making process. But then, she had to say good-bye to him. And that's when she breaks down. The well-meaning nurse tries everything she can to console her and tell her that many members of our hospital community have personally benefited from organ transplantation; that her husband was gone, and only a body remains now.

"I know" she says, "but this is the body that I've slept next to for 34 years. 34 happy years. We're doing the right thing- what he would have wanted...but how can I not be sad?"

=( That did me in too.