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plein air landscape by James D. Southerland

"I think I can do it," he tells her.

Buni waits, two steps below him.  "Take your time," she says.  "Whenever you're ready."

"No, really.  I can do it."  Gripping the rail, his knuckles go a shade paler.  Jim Southerland is descending the stairs.  The stairs of his own house.  Of course, going down is measurably easier than going up.  Thank you, Merciful Gravity.  Getting from the main floor to the driveway taxes Jim's skeletal limbs.  He's lost a lot of weight since November.  Hasn't exercised much.  And -- oh, yeah -- he's had a heart transplant.

After only four days at home, his wife drives him back to Durham.  Even without her hand on the wheel, the truck probably knows the way.  It's been up and down Old Fort mountain more than a few times in the last three months.  They spend Tuesday night in a hotel.  Up for tests Wednesday morning.

"You're going to feel a little pressure," the doctor says.  Turns out he's not lying.  A tube crawls into a faint blue blood vessel on the side of Jim's throat.  It snakes down into his chest.  A tiny claw at its tip snatches a sample of Jim's new heart.  Duke labs will test its tissue for any sign of rejection.  They've performed two such biopsies already.  Neither has given the slightest cause for concern.

The only red flag since the surgery was a small pocket of fluid that collected just under and behind Jim's sternum.  Some folks fretted that it might signal infection.  But that turned out not to be the case.  Nevertheless, it postponed Jim's parole until the 24th of January.

Now, his B.P. is normal.  Likewise, his blood sugar level.  His incisions are healing.  His pulse is a little fast, but that's not atypical for the newly transplanted.  Since his discharge, Jim and his family have been meticulous.  A daily regimen of 30 pills.  A PICC line for preventive antibiotics.  Meals cut into childishly small pieces.  Visits from a corps of home care nurses and therapists.  "Don't want to violate the warranty," he jokes by phone.  The check-up concluded, they're following I-40 west to Black Mountain.  Until next week when they'll do all over again.

Everything is going as it should.  The odd caregiver goes so far as to describe his recovery as "miraculous."  Still, everyone is cautious.  Like people quietly circling a game of Jenga.  Impressed by resilience.  Aware of frailties.  Yet above the necessary tiptoe of careful prudence, one truth shouts loudly:  Jim Southerland is home.

Things We Simply Don't Discuss

After two foodless months, an unspeakable delicacy.

“The dashboard ‘check engine’ light turned itself off.  We can probably go another couple of months without a new muffler.”  This is a prime example of things we do not ever, ever say aloud at my house.  

We do not say “Sixty percent of the election returns are in; it looks like our candidate is going to win!”  If we say these things, if we form the air in our mouths into the shapes of these particular consonants and vowels, there’s a chance the heavens will hear our optimism.  There’s a chance that — just to swat at our hubris — the second shoe will drop.

So here are some things we’re definitely not saying this week about Jim:

• We’re not talking about the man’s “swallow test.”  We’re not saying that he passed it.  We’re not saying that even hospital lasagna tastes in-freaking-credible after two months of gruel through a feeding tube.

• We’re not saying that after two biopsies, his heart shows no sign of rejection.

• We’re not saying that the last of the drainage tubes has been removed.

• We’re not talking about the laps he’s walking around the hospital floor, relying a little less each day on a walker.

• And under no circumstances are we claiming — I mean, we are definitely, absolutely not repeating the doctors’ prediction that Jim will be home in the next couple of days.

painting by Jim Southerland

If we were going to say anything it all, we might remind folks that Jim has an exhibit at the Seven Sisters Gallery in Black Mountain until January 25.  We might say that, had events in Durham gone another way, few people reading could afford the artwork that can now be had at astonishingly reasonable rates.  Get down to Cherry Street, folks, and take home a piece of Jim.  Your living room wall will thank you.

Miracle Man

Jim and YoYo 2014.  Before the trauma.

First, the raw vitals:  Today makes 18 days without dialysis.  Not that everyone’s counting.  Jim still hasn’t passed his swallow test (so, no solid food yet).  He has his laptop these days, but his fingers aren’t yet as facile as he’d wish.  He’s in no pain whatsoever.  “Are you pain free because you’re on good meds?” I asked. 

“No medication,” said an emphatically bewildered Jim.  “I’m pain free because there’s no pain.”

“Does that surprise your doctors?”

“I got holes all in me, Brian.  It surprises everybody.  There’s just… no pain.  No pain, no pacemaker, no anything.  The heart feels like it belongs here.  Dude, I’m a miracle man!”  He makes it sound like he just been cast in Marvel’s latest feature film.

Tomorrow, doctors have scheduled the first of six routine weekly biopsies.  They’re monitoring him for signs of rejection.  But so far, nothing remotely suggests an organ mis-match.  His progress is so promising, he’s been moved to a step-down room:  Jim Southerland, 10 Duke Medicine Circle, North, Room 3117, Durham, NC  27710

Jim talks about coming home within weeks, not months.  But a visitor dropped by his room today, a graduate of the program, you might say.  A man whose own transplant is 13-months young.  He advised Jim to “take it easy.  You’re running a marathon, not a sprint.”

But Jim’s thinking about more than the mechanics of recovery.  It seems he is remembering with new clarity spiritual milestones of the recent past.  “I died, Brian.  I died.  Sometime, way back in November, when I was still in Asheville, still at Memorial Mission, I was dead.   But I wasn’t fearful.  I was sad; of course I wanted to be with my family.  But I wasn’t scared.  I felt safe.  

“I felt like I was being offered a choice.  I knew that if I lived, it was going to be a painful, expensive fight.  And maybe I wondered whether it would be worth living through that kind of hell.  

“I also felt that I could have simply let go.  I felt like I understood what it means when we say ‘death has no sting.’  I really was ready to go to the next level.”

Breathing

Short.  Sweet.  Special.  Jim's breathing tube is out.  He's alert and lucid.  And he's the star of a forthcoming film (a brief preview appears below).  The movie is far from finished... and, thankfully, so is Jim.

Jim Southerland

10 Duke Medicine Circle

7 West, Room 18

Durham, NC  27710

The Big One

Rewind to 6 p.m. Sunday night.  Jim gets a phone call.  Duke’s transplant coordinator starts the ball rolling with the words:  “We think we may have something for you.”  

We’ve been waiting for this announcement since Thanksgiving.  But the mood in Jim’s hospital room is suddenly tense, not wildly celebratory.  Yes, there’s grateful excitement, but it’s tempered by nervous caution.  Like a woman who’s just found out she’s pregnant, but doesn’t yet want the world to know. What if it’s not a perfect match?  What if some complication derails the whole thing at the last minute?  

Yep.  Call the neighbors.  This is the one you've been waiting for.

The family huddles closer.  Jim calls a couple of close friends.  He’s in good spirits, but nobody passes out cigars.  Nurses draw blood.  One vial.  Another.  Four more.  Testing.  A lot more testing.  More closely than ever, they’re screening the component parts of his blood.  Has a recent transfusion left him with enough antibodies for a successful transplant?

9 p.m. The transplant surgeon puts his kids to bed in a comfortable Durham neighborhood.  He considers taking a nap.

Meanwhile a helicopter ferries the “procurement surgeon” from North Carolina to Pennsylvania  and back again.  A procurement surgeon.  A harvester.  The “go-take-it-out-of-the-donor” guy.  “It’s a young heart,” he observes.  What does “young” mean?  20?  40?  But there can be no specifics.  Apart from its blood type, that single adjective is probably the only identifying information we’ll ever get.  Can it be said that Jim is about to become “younger”?

1 a.m. Monday.  Orderlies wheel Jim to an operating room.  He needs to be prepped, of course.  But he also needs to wait.  For two hours.

3 a.m.  The surgery begins.  And it’s tough.  For two months, Jim’s tissues have been hardening around tubes in his chest.  In a way, that’s good news.  It speaks well of his body’s healing power.  But it makes his heart damnably difficult to remove.  Think of dragging stubborn tendrils of kudzu or ivy from a chain link fence.  Later, one of the two surgeons will liken this part of the procedure to “getting something out of cement.”

5 a.m.  Nurses tell a waiting family that Jim’s still in surgery.

7 a.m.  Nurses tell a waiting family that Jim’s still in surgery.

9 a.m.  Nurses tell a waiting family that Jim’s still in surgery.  

Fortunately, no one gets antsy.  Absolutely no one.  Nope.  Why would anyone get worried at this point?  I mean, what could possibly go wrong?  He’s only been gone for eight hours.  Only in active surgery for six.  Six hours.  The length of the average school day.  The time it takes to fly from New York to Los Angeles.  Nobody in the waiting room thinks about strokes or breathing problems or kidney failure or blood clots or bleeding.  No one.

11 a.m.  Mission accomplished.  Jim returns to the ICU.  A machine is breathing for him, but the room is otherwise strangely silent.  Buni and the kids had grown used to the wheezing clicks of a heart pump the size of a refrigerator.  The pump is gone now.  Its absence makes the room seem bigger.  Like the day you drag a Christmas tree to the brush pile.  Suddenly, the living room opens right up.

Yes, the surgery was a success.  Jim’s new heart is doing what it’s supposed to do.  But the man won’t be awake for days.  Good thing, too.  Despite his healthy pallor, he might be startled to learn his chest is still open.  Doctors expect they’ll need to mop up some routine bleeding.

7 a.m. Tuesday.  Enough with the open chest, already.  Time to sew him closed.  Back to the operating room.  Remain calm, people.

Now what?  Now, he sleeps for a couple of days.  Surely no one can begrudge the man a catnap.

A New [Year of] Hope

The latest word from Durham is extremely positive.  Doctors have essentially retired Jim's dialysis equipment.  For the last week, his kidneys have been functioning on their own as healthy organs.  Levels of input/output volume and creatinine (a measure of phosphate indicating muscle metabolism) have both returned to normal range.

Following surgery the week of Thanksgiving, Jim suffered considerable edema, a swelling of limbs caused by the build-up of fluid beneath the skin.  That condition has resolved.  "He's actually got ankles again," said his wife Buni by phone Thursday evening.  

Jim has graduated to yogurt, applesauce, and foods of similar consistency.  He's walking longer distances with greater ease.  He's alert (and bored) enough to binge-watch episodes of Lost.

What would you binge-watch from a hospital bed?

Everything is humming.  Except his heart.  Apparently an organ became available last week, but doctors weren't 100% convinced of its compatibility.  So they passed.  Now they wait for the next one.  

Feel free to insert your own ambivalence here.  Heart transplants necessarily represent a zero sum.  They offer no net gain of life on the planet.  Someone dies.  Someone else lives.  Thus we who love Jim are wishing for the sudden, traumatic end of another life.  I say "wishing," understanding the word's solemn weight.  I say "traumatic" because disease and old age disqualify donor hearts.  

But I am not praying that a college athlete will hit a patch of black ice.  I am, instead, recognizing that accidents happen.  That people die.  Some of those people will signify benevolence and foresight with an organ donor card. 

What's in your wallet?

A Bottle of Champagne

If you're toasting the holiday with a little bubbly, take a good look at the bottle.  It's probably 750 milliliters.  That's how much Jim drank today.  Not champagne, obviously, but a honey-thick cranberry-flavored liquid that he really likes.  Well, maybe "likes" is a bit of an overstatement, but it sure beats having gooey stuff slip down the back of your throat through a tube the nurse has run up your nose.  

Anyway, the point is, that Jim put 750 milliliters of liquid into his body today.  And here's the magic: that's approximately how much came out.  Without the aid of dialysis.  How's that for a slice of fried gold?  To celebrate, his renal staff decided to try a little experiment.

See, twenty days ago, Jim's kidneys were in awful shape.  They weren't working at all.  He needed dialysis all day, every day, 24-7.  Eight days ago, doctors downgraded his dialysis from "constant" to "intermittent."  Today, his team decided to see what happen if Jim skipped a day of dialysis entirely.

Tomorrow, we see whether he can do it again.  Hold your breath.  And keep your eyes on that Christmas champagne bottle.