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.

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.

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