In many ways, it is the job of the kidney donation nurse coordinator to try to rule you out as a candidate. Enduring major surgery under general anesthesia to remove a major organ requires that the medical staff test your health and suitability in every possible way. Being supremely healthy is an absolute requirement.
So far, I’ve had to be a blood type match, have my glucose levels, blood pressure and cholesterol checked, pass an ultrasound screening of my kidneys and bladder, share enough antigens and be a cellular match with Niem to get to my big test day at Stanford. This is a medical evaluation which includes a 24-hour urine collection, blood draw, second urine sample, meetings with the nurse coordinator, doctor, social worker, and EKG and chest x-rays.
The big test day was scheduled for a Wednesday, but in reality, it started a day earlier. I had to collect all of my urine into a medical-grade container for 24 hours. It was also recommended that I drink at least eight glasses of water during the collection period, so I had to make sure to be extra hydrated.
The least conspicuous bag to carry the urine container turned out to be our kid-friendly pink and gray cold-insulated tote bag. Besides that challenge, it wasn't too difficult to manage collecting my day's output. That is, until I realized I had already filled 3/4 of the jug after just six hours.
What doubles as a medical-grade container when in the middle of your workday? A large water bottle of course, but should it be a liter or a gallon? I went with my most doctor-y hunch and opted for the latter, so as not to have to repeat the procedure. Somehow, I managed to also squeeze it into the tote bag, along with the three ice packs I kept in there. In case you’re wondering, I have a deep love for Niem and as much as you might be cringing at hearing this story, I can tell you that it takes the sort of commitment you’d have for a close family member to get through this whole process.
I was at Stanford’s medical facility by 9AM and went right in to drop off the jugs. I got a little smile when the nurse looked at my makeshift medi-vessel and she commented that it was a good choice. First, I had to pee into a cup and then I had a record twelve vials of blood drawn! I did surprisingly well and even chatted with the phlebotomist, but I felt a little woozy as soon as she put the gauze and tape on my arm. A deep, sharp, but short-lived pain panged at the bend of my elbow. It cleared up pretty quickly but felt like a rather ominous start to my test day.
Melanie arrived just in time for our meeting with the nurse coordinator at 10AM with Lily, our five-year-old, following close behind. After putting on a movie for Lily, we dove right into all of the details that a surgical candidate must sign off on. Marilyn, my nurse coordinator, covered everything there is to know about the pre-op prep, surgery, post-op, follow-up appointments, possible risks, probable outcomes, long-term effects, and answered every question we had. It was reassuring to see that every detail was discussed openly and professionally, while all along making it clear that I could walk away from the whole thing at any time.
As we wrapped up that first meeting with Marilyn, I started feeling those two bananas I had after my blood draw were probably not enough to hold me over. It was all I had eaten since my dinner eighteen hours ago when I started my fast for the blood draw. I tried eating a few bites of a ham and cheese croissant sandwich I brought before the doctor walked in, but it wasn’t too tasty. I asked Melanie if she had some ibuprofen because I was starting to get a mild headache, and managed to pop them in before the nephrologist came in.
He said he usually only met with the patient, but was okay with my wife and daughter being there for a few minutes. I could sense his discomfort. But, as soon as Melanie asked some questions, he answered them to her satisfaction. Unbeknownst to everyone, I had told Mel, who’s been a physical therapy assistant in hospitals and recently was accepted into UCSF’s nurse practitioner program, the doctors would have to pass her litmus test, or this donation was a no-go for me.
Once Mel and Lily left, the doctor seemed more in his comfort zone and covered more details about the surgical procedure. He said he didn’t anticipate any issues with my health that needed managing. He did recommend that I get my BMI (Body Mass Index) below 30%. Marilyn had already made that clear when she told me I was at 30.9% and said, “The less there is to cut through, the easier it’ll be for you and the surgeon.” That was just about the nicest way I’ve been asked to lose weight, I must say.
After the doctor left, the social worker came in. She focused on the more social/psychological/practical part of the donation. She asked questions like: “If after you donated the kidney, you were to experience kidney failure, how would that make you feel?” She was a breath of fresh air from all the medical talk and really seemed to hone in on the more important day-to-day things involved in recovering from major surgery. Melanie had a chance to come in and ask plenty of questions. By the end, I really felt the social worker had my family’s best interest at heart.
It was about 1:15PM when we ended our meeting with the staff and I was to go upstairs for the EKG and chest x-ray. I said goodbye to Mel and Lily and felt like we really had things going for us. That is, until I made my way up to the second floor.That mild headache started turning into a medium one. Then, as soon as I checked in and walked into the testing room, I started to break out into a cold sweat. The nurse asked if I was okay and I said I felt nauseated and just started getting a headache. She connected the electrodes quickly, as I began to perspire all over. I thought I was going to pass out, but the test was quick and she had me up and drinking water before you knew it.
She connected me to a couple of monitors and said “Your vitals are fine.” We concluded rather quickly that it was my lack of food that was probably to blame. I had two bananas in twenty hours, had to hydrate extra which probably lowered my electrolytes, had twelve vials of blood drawn and had taken ibuprofen on an empty stomach. As soon as I made it out of the EKG lab, I booked it to the bathroom and puked. It was puppies and rainbows an hour ago and now it felt like the sky had been parted by a hail of thunder and rain.
I didn’t know what to do because I couldn’t think straight while I was lying on the floor of the bathroom trying to prop myself up. The headache was head splitting at this point and I managed to make my way down to Marilyn’s office. The social worker happen to be walking by at that moment and could tell I wasn’t well. Marilyn was not in so she grabbed another nurse. I tried to eat some crackers, but couldn’t manage to open the wrapper.
The nurse took me back and brought me some apple juice. The same nephrologist came in to see me and also concluded it was the lack of fuel. I then asked where I could vomit and he pointed to the sink next to him. I only barely made it there, as he pulled the curtain to cover himself.
Ten minutes after lying on the bed, I went out to the lobby where I began to feel a little better. All I wanted to do was sleep and/or be out in the sun which was beaming through the windows.
The nurse didn't advise it, but said she couldn’t stop me. I went out and immediately started feeling better. The color started to come back into my face and I could actually sit and think about what to do next. I decided to text my friend Omar, who worked nearby, to come and pick me up so that I wouldn’t have to be alone for this. A different nurse called me to see if I was alright, and I said I was doing much better. I was afraid this would somehow affect my candidacy as a donor and was going to go back for the chest x-ray, but she said that it was no big deal and I could do it at another time.
I drove with Omar and spent the night at his place. We had a great evening catching up and looking at amazing photos of his trip to Cuba. I called and left a message with Marilyn at 7 the next morning and she left me one, too, saying that these things happen and that they had enough info on me to make a final decision on my candidacy the next Tuesday.
That Tuesday couldn’t come soon enough. I got a call from her while I was at my daughters' school picking them up. She told me I passed all of the exams and I qualified to be a direct donor to Niem! All that remained was to go in for the chest x-ray and a mandatory psych eval for non-blood relatives. A pre-op MRI is required to map out how they’re going to remove my kidney, but all looks good for a December surgery date.
Tears quietly streamed down my cheeks and I thank her for everything she’s done. I immediately called Niem and didn’t care that it’s the middle of his workday or that I’m surrounded by parents and kids going about their business, because after I shared the news with him, for a moment, time stood still for us and we could feel we were part of something bigger than ourselves.
There have been two times in my life I’ve been so sure about something that I decided all I could do was record its unfolding. The day after I went on my first date with Melanie, I went out and bought a journal to document our first twenty-five dates. Likewise, when I started on this kidney donation journey with Niem, I started to journal it in this blog, because when there’s no question something is meant to happen, all you can do is embrace it and be grateful you’re a part of it.