Transplant evaluation day 4: Overwhelmed

"God excels in overcoming the overwhelming."

~ Jan Brazeau

This was the final day of my evaluation.  Last night around midnight, the fire alarm in the hotel blared for what seemed an eternity.  Thankfully, nothing was amiss, but it certainly added to the exhaustion I felt this morning. Originally I was to be here through Friday, but one test was completed when I came to the pulmonary clinic in September. The schedulers offered to move my heart cath from Friday to today so that I could go home.   The test I had in September is called esophageal manometry.  It is done to evaluate the muscle strength in the esophagus.  Swallowing is crucial, because aspirating into new lungs could be disastrous.  I wish I had thought to take pictures, but most of you would not have wanted to look at them. During this procedure, a tube is threaded through your nose into your stomach.  It is larger and stiffer than a feeding tube- as a matter of fact, it feels like a garden hose.  Once it is in place, you are given small sips of water  and asked to swallow as they measure the pressure your esophagus exerts upon the tube. It is a difficult test as it hurts to swallow, you gag often, and the tube is uncomfortable.  However, it is not terrible.  The nurse was very patient and encouraging.  Thankfully, my test was normal.

Since the heart cath was scheduled for today at 2 pm, I could not eat or drink anything.  We got to the hospital early, so Michael and Chelsea got a quick bite in Au Bon Pain.  Yes, they have one in the hospital! (I have been scoping out the restaurants- there is a Ben and Jerry's, a Mellow Mushroom, the Grilled Cheeserie, and Biscuit Love very close).  Michael made up for eating in front of me by purchasing a pastry for me to eat after my procedure.

My first visit of the day was with the transplant surgeon, Dr. Bacchetta.  I had looked him up and he is very accomplished!  He recently came to Vanderbilt to help expand the lung transplant program.  

I had been looking forward to meeting him.  This was another time I had to have a secondary caregiver present, so our daughter Chelsea came.  I was anticipating being told details about the surgical procedure and learning what would happen afterwards.  We had been given some of this information during other visits this week, but all of the information we were given was overwhelming, and repetition would help us process things.  I was so excited about seeing the brilliant surgeon who might be performing the surgery that would give me healthy lungs (there are two other lung transplant surgeons at Vandy).  I was very eager when I heard the knock on the exam room door.  He walked in, shook hands with all three of us, sat down, and said...... get ready for it..........

 "What questions do you have for me?"  WHAT?????  SERIOUSLY??????

I did not know where to begin and could not even articulate coherently.  This is an 8-12 hour surgery. I expected him to talk to us first.  That did not happen.  Chelsea and Michael had questions, but I was pretty much in shock.  I will say that he answered every one of their questions, and was very reassuring, but I was just put off by the way he began the visit.  Chelsea did ask about the HLA antibody situation- he talked about that some, and about using the lung in a box (like Dr. Shaver had talked about) to buy time in order to be certain the donor lungs matched perfectly.  He also said he had transplanted someone with an antibody level (PRA) of 98% and she is doing well 3 years post transplant.

It was also interesting to learn that Vanderbilt did 21 lung transplants in the last 3.5 months.  The highest number they have done before this was 27, in 2015. 

When I left the visit with the surgeon, I felt like I might punch the next person who asked my to verify my birthday, address, etc.  I had just had enough.  I honestly did not want to continue, and if this were not the last day, I might not have.  I was surprised by this feeling.  The overcast, rainy, freezing weather was not helping my disposition either. 

The next thing on my schedule was another pulmonary function test.  The respiratory therapist who did my test this time told me his wife works with Tennessee Donor Services!  

Here is a picture of the PFT "box" again, in case you forgot what it looks like.

The very last thing on my schedule was a heart catheterization, to ensure that my heart is healthy enough to withstand such complex surgery.  Chronic lung disease can cause heart disease. We had to check in as soon as I finished the PFTs, but the procedure was not scheduled until 2 pm.  

I was taken into a small pre-op area and admitted.  The nurse taking care of me, Amanda, was delightful (just like my niece Amanda, who is also a nurse).  She had recently earned her master's degree and passed the certification exam as a Family Nurse Practitioner.  We had fun chatting about that.  She is moving to Colorado, so I encouraged her to come to Union for her doctoral degree!  I will recruit anywhere and everywhere.  

The pre-op room was a frozen tundra.  One of the nurses said that even her sinuses were frozen. My favorite nurse, Amanda gave me warm blankets, and even draped one across my shoulders and back.  This was a great way to get a shout out on the evaluation I will be doing!  The only downside was that the blankets covered my designer gown.  This is a picture of Amanda and me.

If you thought I was going to get out of there without another stick, you were wrong.  It took two attempts this time to start the IV.  I believe this is 13 sticks for the week, and this is the fourth IV.  To commemorate the occasion, I took a picture.  Don't be jealous. 

They got me into the cath lab around 3:30.  The cardiologist was such a nice man.  He was funny and upbeat.  Here is his artwork - and he did not charge extra for it.

I had a heart cath about 5 years ago, and I refused the sedation because I wanted to hear what the doctor was saying.  Well, this time they had to access vessels in my neck as well as my groin, so I let them give me the drugs.  There is just something about a needle in your neck......... They could not use my wrist because of my height (or lack thereof).  Oh yes- that added two more sticks for the week.  Anyway, whatever they gave me was great because it relaxed me but did not affect my ability to interact or remember.  Also, I never felt the stick in my neck.  I did feel the one in my groin, but it was not bad.  The best part was that the entire test was normal.  

I had to wait for two hours with pressure on the areas and with my head flat on the  pillow.  I was starving by then, so I ate the pastry Michael brought from Au Bon Pain.  Yes, you can eat with your head flat on a pillow if you are hungry enough.

As I was lying there waiting I remembered how badly I hate being in the hospital.  I was so very tired and I just wanted to get back to the hotel. I was so thankful that we did not have to drive back to Jackson, even though I wanted to be home.

Buh-bye, Vanderbilt!

We left the hospital around 7:30 pm.  I was drained.  I was exhausted.  I was overwhelmed.  On my Facebook memories, there was a old posting from my dear friend Jan Brazeau.  I met Jan during a mission trip in the Dominican Republic.  Her wonderful late husband Steve was a dentist, and Jan is a nurse.  They had been full time missionaries in the past, and still brought teams to the DR each year.  I learned so much from Jan, and she inspires me to this day. She is a faithful servant of the Lord, and a treasured friend.  It was no coincidence that her quote popped up today- I typed it at the beginning of this post.  I needed to hear it!

Now I wait.  The transplant team meets on Fridays to discuss the people who have completed their evaluations.  I will get a call at some point telling me their recommendations.  It will be one of these things:

                           You are not a candidate for transplant 

                                    We need more tests
         You are a candidate, but you are not quite "sick enough" at this point
                    You are a candidate and we want to list you now

Listen to Mandisa sing "Overcomer."  This may be my new theme song.