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?

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.”

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