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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.

Stepping Down

Not everyone has what it takes to be a heart donor.

Check HERE to see how you can become one.

Jim's out of the ICU (room 3110 if you're looking for a new place to send cards and letters).  Duke medical personnel are doing what preparation they can for a heart transplant, though a date for such a thing is still yet to be determined.  Doctors still have not made a final decisions about whether the transplant will also include his kidneys.

The List is Life

A cardiovascular surgeon stopped by the room early this morning and told Jim and his son Mike that Duke was moving forward to fully activate his listing for a heart transplant.  Despite yesterday’s progress, renal specialists have still not decided whether Jim’s in the market for someone else’s kidneys.  For now we have to file that under “up in the air.”  Getting this decision right may determine whether Jim requires some form of dialysis for the rest of his life.

“Should we downgrade yesterday’s enthusiasm?” I asked Mike.

“I don’t think so at all.  I feel like it’s good news to be officially listed for a heart.  One cannot live without a heart.  One can live on dialysis.  It’s just one more step.  He may get a kidney still.”

A Hard Reboot

Sometimes a buggy computer just needs a hard reboot.  You mash the power button, hoping a drastic restart will unscramble your RAM.  The machine shuts down.  You mentally catalog all the precious things on your hard drive:  homework you didn’t save; irreplaceable family photos; a list of e-mail contacts; the stuff you don’t want anybody to find.  Panic rising, you bargain with the gods of technology.  Oh please, just let me get one good back-up before I lose it all forever. 

One one thousand.  Two one thousand.  Three one thousand.

The screen flickers back on.  But you don’t risk breathing.  Not yet.  The password prompt.  007_BrIaN_iS_cOoL. The operating system’s signature chime.  So far so good.  Desktop.  Star Trek wallpaper.  Batman cursor.  Recovered Word document.  Browsing history cache.  Yep.  It's all there.  Thank you God.  Thank you thank you thank you.

If you think you’re happy when your data is rescued from peril, maybe you can imagine how encouraged Jim was yesterday when his kidneys came back on line.  Okay, he’s not at 100%.  But it looks as if his body remembers how to pee.  That’s something it hasn’t done for about a month.  This sign of recovery makes Jim a more hopeful transplant candidate.  Obviously, it’s easier to find a single organ (heart) than a matching set of three (heart + kidneys).

Doctors are taking the positive step of downgrading his dialysis from constant to intermittent.  That increased freedom simplifies a walk down the hall.  Yesterday Jim managed two 500’ excursions, pausing for only standing breaks.  His therapist teases that Jim can leave when he can walk a mile.

If you’ve been wishing for good things to happen to Jim Southerland, this corner-turning hard reboot of his kidneys deserves your celebration.  Tomorrow morning, doctors will weigh in on just how cautiously we should party.

Transplant List

Jim's signed the paperwork to join a transplant list, though until his body settles into a higher degree of stability, he won't enjoy the list's most urgent action grade.  As a patient spends more time on the list, they work their way up the eligibility and priority ladder.  Some elevated prostate enzyme deserves a second look.

The Story So Far

Today, from his bed in Durham, Jim asked me to relay the story so far...

It’s my great pleasure to tell owners of Jim Southerland’s artwork that his drawings, paintings, and ceramic pieces are worth no more today than they were on November 19.  November 19 is the Wednesday Jim hobbled, short of breath, into Asheville’s Memorial Mission Hospital.  There, a cardiac enzyme study revealed Jim had suffered a couple of heart attacks.  The first was (surprise) sometime back in the summer.  The second was the weekend of November 16.

Jim’s heart was not happy with his body.  Indeed, much of the muscle simply couldn’t be convinced to work.  A blood pump was installed which temporarily addressed one problem (circulation) but exacerbated another: his kidneys were grumpy.  This level of grumpiness — high even for Jim — had local doctors worried enough to call in the heavy artillery.  Up the mountain came a shiny operating-room-on-wheels.  A team of eight medical professionals rode with Jim to Duke.

It might say "Duke Life Flight" on the outside, but I'm pretty sure this is really a Transformer.

At Durham’s Medicine Pavilion on the 23rd, his heart was upgraded to a couple of mechanical pumps attached to something the size of a small refrigerator.  Doctors put him on dialysis, hoping to reduce his creatinine level from 6 milligrams per deciliter to a normal level of 1 mg/dL.

A machine was circulating his blood.  A machine was breathing on his behalf.  A machine was performing the functions of his kidneys.  Nurses periodically lifted Jim from a deep, drug-induced sleep for basic neurological functions.  Disoriented, he was nevertheless able to signal and respond before receding back into the narcotics.

On Tuesday the 25th, Jim was breathing on his own.  Alongside the new pumps, a tiny sliver of his heart was still functioning, but without predictable rhythm.

The next day he was aware, but mentally cloudy.  He complained of seeing golden aphids, gnats, and mosquitos.  He was certain that someone had restrained his extremities, when in fact they were merely so swollen with edema (and he so weak from surgical procedures) that he couldn’t lift them.

He was as irritated as any of us would be in similar circumstances.  Fortunately, his nurse for the day, a Navy veteran, had recently completed a tour of duty in Afghanistan; she’d already heard most the words Jim was slurring in frustration.

When I left the day after Thanksgiving, doctors were discussing next steps.  Can he be upgraded to a smaller, internal pump?  Is he eligible for transplants (of both kidneys and heart)?  Those are still matters of concern, but they don’t have to be immediately addressed.  Jim can now stand and walk across his room (though with an attending army to keep straight a spaghetti of hoses and pumps).  His family is pretty much incredible.  They're as tight and supportive today as they've ever been, buoyed by visits and calls from many Black Mountain neighbors.

Duke Medicine Pavilion.  If you squint, you can see Jim's room on the 7th floor.

As much as I’d like to avoid clichés, circumstances such as these created those clichés in the first place.  Jim is anxious to benefit from your prayers.  During a Skype chat this morning, he told me he is also anxious to hear from alums, colleagues, students, friends, and neighbors who might care to contact him.

If you’re inclined to drop him a note, you might use his e-mail address, mail@jimsoutherland.com, or send a card using Duke's in-house patient e-mail service [here].  You could also go “old school” and use a stamp (.49 if you haven’t been paying attention).

Jim Southerland

10 Duke Medicine Circle

7 West, Room 10

Durham, NC  27710