Week 6 GOL (July 10-July 14)

Happy Sunday! This week was extremely educational, emotional, and overall an incredible experience. I did write this blog post already, however, the system glitched and erased my entire post so I will work my hardest to make sure I complete this as detailed as before it was all deleted. Most of the photos in this post are from Monday at the Donor Care Center in Philadelphia. 

Monday (July 10): Today, I was called at 6:15am by the Transplant Coordinator (TC) in charge of dispatching us to the different hospitals this week. I arrived at the Donor Care Center at  a little after 8am and introduced myself to the Transplant Coordinator following the case. As we were waiting for the OR, I was able to observe the Transplant coordinator while she searched for homes for the gifts this patient would give for transplant. This patient was brain-dead due to anoxia (lack of oxygen to the brain).  When we went to the OR around noon, there were two medical students I was working around to see the recovery, however, I managed to see most of the recovery. This patient gifted their liver and both kidneys for transplant (Saving three lives in the process), their heart valves which will help pediatric patients born with heart defects, and their lungs to research. This was a particularly interesting recovery to observe as I could see the entire thoracic and abdominal anatomy of a human which was much more educational than looking at a diagram in a classroom. Overall today was incredible! 

Tuesday/Wednesday (July 11/July 12): Both of these days I was dispatched to a pediatric hospital. Due to HIPPA and the case being pediatric, I will not disclose too many details, however I can confirm the case is very sad all around. The patient was a young donor who became brain dead due to anoxia. I spent these days sitting at the nurses station with the same Transplant coordinator collecting information from the Health Care Team about where the family stands on deciding the withdrawal of care or not. On Tuesday, neuro had examined the patient and got a very sluggish pupillary response indicating that the patient was not brain dead. On Wednesday, they decided to conduct a cerebral blood flow (CBF) exam, and the results showed there was no flow of blood through the patient's brain. They then conducted the first brain death exam Wednesday night (I was not present to observe due to familial presence in the room). The brain death exam came back positive for brain death. On Thursday, they were to conduct the second brain death exam and talk to the family about end-of-life care and next steps, leading Gift of Life to be present for the conversation about donation. I did not see this aspect of the case as there were two TCs in training with a trained TC and four people on the unit would be far too many. 

Thursday (July 13): Today, there were no cases in the city for me to follow so I was not dispatched. Instead, I worked on my project and sorted through allocation data, and created graphs to add to my project. Overall today was relatively productive project-wise. 

Friday (July 14): Today was extremely educational and emotional. I observed a late referral family conversation, resulting in a very polite decline for organ donation. A late referral is defined as when Gift of Life receives a call later than what is timely. In this case, Gift of Life received the referral after the legal next of kin had already decided to withdraw care that day. This is not the time to approach family as they are usually ready to say goodbye at the point where they choose withdrawal of care and do not want to continue with the process. I also observed a follow-up family conversation with a family that had previously said yes to donation. This conversation was mainly to sign paperwork and go over the medical and social history of the patient. The family was very lovely and I pray that they are able to hold onto the fact that their loved one has saved people as they grieve. What was emotional about this day was when I observed the transplant coordinator conduct their physical exam of the patient. I had not realized/put together that a non-recoverable injury or illness could mean that the patient was semi-conscious. This patient will die waiting for a lung transplant. They had been admitted to the hospital about a while prior to this event and over time got more sick. Something happened with the patient's heart and they developed to the level of sickness where they could no longer receive a transplant. Over time, the patient got sicker and now cannot live without being attached to the hospital's machines. They are attached to the ECMO machine (heart/lung machine), where the patient's blood is taken out of the body, re-oxygenated through a machine, and then the oxygenated blood flows back into the patient's body. The patient is very sedated so as not to feel the pain or have too much awareness of breathing through a tube or the machine keeping them alive. It was heartbreaking to see this previously funny individual (according to their family) and now to see them attached to machines without hope for a meaningful life. Today was very educational and extremely eye-opening to the real world and what/who I might come in contact with throughout my medical career. 

Overall, this week was amazing. I learned so many things and saw a different side of the world. I am excited for the second week I am dispatched with the Transplant coordinators. This next week I will be primarily working at Howie's House. Howie's House is a place where transplant recipients, families, and people awaiting a transplant can stay inside the city and close to hospitals as they heal/recover at a reduced price (not living in hotels). The House also provides home-cooked meals to the guests staying at Howie's House. But more on that next post. 

Thanks for reading and have a wonderful day! 

-Rachael Triglia 

    

Photos of the Hospitals I observed today.