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.

300 Christmas Cards

Jim Southerland in 2013

Don’t hold your breath.  There’s no dramatic progress to report from Durham.  Unless waiting is dramatic.  And it’s not.  I want to tell you that a team of doctors has a decisive plan for returning Jim to the mountain cove he adores.  I want to tell you there’s a prescribed schedule of procedures and therapies that aims to return him to the Montreat art classroom.

Instead, Jim’s daily regimen expresses a fuzzier, more boring reality.  Nurses wake him.  They roll him onto his left side.  Then onto his right.  They check the path of fluids through a macrame of tubes.

For breakfast, they feed him a thick liquid.  Through a tube.  A thick liquid.  Not solid food.  Not water.  “That’s one of the things I miss most,” Jim told me.  “I just want to pull a big glass of water from the tap in my own kitchen and drink it all.”  But speech pathologists (experts in swallowing) fear Jim’s throat might not know what to do with water.  It might go to his stomach (that would be a good thing) or it might go to his lungs (that would be a bad thing).  Water in the lungs would increases his chances of pneumonia, a complication that would exacerbate every other problem he has.  So for now eating’s going to be a gluey slur of protein and vitamins.

Again nurses check the tubes.  Some of the checking is done by an internal camera.  Occasionally, the camera spots a leak of blood around the pumps in Jim’s chest.

And then there is the part of the day that Jim dreads: the walk.  There’s an irony in Jim’s foreboding.  Hardly a month ago, walking with his dog, Yo-Yo, around Lake Tomahawk ranked among his favorite activities.  Now, even 70 feet to the nurses’ station demands the entire day’s energy.  Maybe Jim doesn’t actually curse his physical therapist, but he certainly attempts negotiation.

Later, when he collapses from exhaustion, technicians look for some uptick in his kidney function.  But there isn’t any.  There hasn’t been any for weeks.  That’s troubling.  Renal improvements would make him a better candidate for transplant.  Being younger would also increase his chances, but the clock seems only to work in one direction.

A laptop lets him check his e-mail (so keep those cards and letters coming, boys and girls).  Occasionally, he Skypes with a close friend.  Then he’ll try to sleep.  But if you’ve ever spent time in a hospital yourself, you know how perpetually active that world can be.  I’m told a considerable number of hospital patients actually suffer from sleep deprivation.

This is where I’m supposed to conclude with a look forward.  This is where I’m supposed to tell you what the doctors are waiting for.  Or what his family’s next decision might be.  Wouldn’t it be nice if I could do that?

Instead, I’ll remind you that Christmas cards are a lovely thing.  And some cards feel more important than others.  And, maybe, if you were an art teacher, you’d really appreciate receiving one that was especially well-designed.

So far, over 1000 friends have visited this webpage.  Please consider being one of 300 to send him a Christmas card.  That's the goal.  300 Christmas cards.  Let one of them be yours.

Jim Southerland

10 Duke Medicine Circle

7 West, Room 10

Durham, NC  27710

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