October 6, 2014

Catching The Bus

Post-transplant day 300.  Catching the bus.

Yesterday, on my two hundred ninety ninth day after my transplant, I went on my longest run in several months - a mere 2.25 miles.  My legs were jelly after a mile and a half and my blood sugar was running low - a problem I have a lot these days.  Once again, it came back to me that recovering fully from such a surgery takes far longer than I'd anticipated, and I guess I'm a bit older than I was last time I trained for a race.  I turned off RunKeeper, sat down for a bit, and walked the rest of the way home.

My route took me past several bus stops.  Some of them had whole families waiting there and it was clear they'd been waiting quite some time.  I got to thinking about those bus stops and the families.... just waiting.  There is little doubt the bus will eventually come, but perhaps some will give up and find another way to go where they're going.  Perhaps some will just give up and just stay home.  Or maybe the bus really isn't coming. It felt uncomfortably familiar.

It seems to me that the road to transplant is very much like waiting for a bus, but a bus for which you have no reliable schedule and you can't actually be sure it will come at all.  If it does, it can carry you on, possibly for a long, long time.  Nobody knows what distance your ticket is worth.  For me, I had to fully switch buslines!  Some of my friends nearly missed their bus.  Others, like Heather James, are still waiting and no one has any idea when her bus will come.

And still others won't be getting on the bus at all.  For one reason or another, the bus doesn't stop at their stop, or worse yet doesn't open its doors.  Getting confused by this metaphor?  Sorry.  What I am saying is that for some people transplant is not an option.  I suppose for a few that's by choice, but for almost every person who has been denied this life-saving treatment, it is mostly the doctors making this choice for them.

Friend Kenna Taylor is one of them.  I don't know the exact reasons why doctors have turned her down, but at a mere 17 years old, she has been sent home on hospice care - sent home to die.  And as of right now, she's back in the ICU.  I believe they will make her comfortable, but the stop for transplant is not on her ticket.  And I am emotionally panicked.  I just want to grab the driver or the conductor by the lapels and scream at them - WHY AREN'T YOU STOPPING FOR HER??

Who are these men and women who make the life and death calls?  What gives these mysterious conductors of the night the right to refuse to punch your ticket?  Oh, sure - years of schooling and experience; yeah I get it.  Nobody else is qualified to determine whether a candidate is a good transplant risk or not.

But here's the deal: the system is rotten.  It doesn't reward hospitals for number of lives saved, but rather penalizes them should there be too many patient deaths.  It penalizes by dropping their rankings in nationally published lists.  For instance, Duke is the nation's top transplant center, according to US News and World Report.  The system further penalizes, if it has to, by pulling the hospital's certification as a transplant center.  And so hospitals shy away from patients culturing B Cepacia, or who have multiple organ problems, or anything else that cause the pulmonologists or surgeons to believe the patient won't survive.  My friend Kyle O'Neil was a B. Cepacia patient.  By the time he found a center that would take him, he was way too sick and simply didn't survive the wait for lungs.  He passed away a little more than a year ago.  The hospitals near him - arguably the better hospitals - just suggested he look elsewhere and sent him home to die, just like they have with Kenna.

But shouldn't that choice be solely and wholly in the hands of the patient??  If I culture B. Cepacia, yes there's a possibility I won't survive the transplant.  But there's a possibility I will!  The few  hospitals that will do B Cepacia patients have hundreds of success stories.  Why doesn't the system recognize that?  Give me the choice to either go home and die, or at least TRY before I die.

I know....there's also the bald fact of a lack of organs.  There aren't enough to go around, even factoring in high-risk lungs.  And so, again, the doctors are forced into making choices.  Who gets to get on the bus?  Who gets a seat?  I had a seat saved for Kenna....and I really thought Kyle was gonna get one too.

Tonight, I am reminded of how very lucky I am; not just to have lived 300 days after transplant, but to have gotten one at all.  And I am terrified that should I need a second one, the doctors will find something that makes them shake their heads, tell me I'm not a good candidate, and refuse to open the bus doors.  But that day is hopefully a long, long way off.  In the meantime, I take good care of myself, get my exercise, and try not to obsess over the unanswerable question: why me, and not them?

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