Spare Parts: Part One

The story continues…


…and with a mix of excitement and trepidation I’m off on a 60 mile trip to the transplant center. I’m traveling alone as Amy is making plans to follow later in the day. I arrive around 4 a.m. and I’m ushered to the transplant floor. Here I learn my new pancreas is coming from down South. My hero is a young man who lost his life in a car accident; he’s a near perfect match. His death hits me hard as I know what this looks like on the other side. A family has faced devastating news — there is no hope, no second chance. The only thing they can do is gift hope to strangers they will never meet. It is sobering and I feel an overwhelming responsibility to turn their tragedy into triumph.
There is much to be done to prepare me for surgery including 20 tubes of blood drawn, EKGs, echocardiograms and ultrasounds. Additionally, an order for “enemas until clear” is issued – Joy!!! The surgeon provides me with all the details of his plan; he respects my clinical background and holds nothing back. The pancreas is both an endocrine and exocrine organ. The endocrine portion provides hormones like insulin and glucagon to control blood sugar. The exocrine side produces digestive enzymes that help break down the food we eat. The endocrine function is what is broken in me. My native pancreas produces digestive enzymes just fine which means I’ll keep it to continue doing that job. The transplanted pancreas will need its exocrine function diverted so I don’t double down on my enzymes. This is accomplished by tying the new organ into my bladder where the extra “juices” will be washed out via my urine. The endocrine portion (with the hormones I need) will be connected to my vascular system.

Image courtesy of The Society of Interventional Radiology

I sign consents for surgery and anesthesia then my nurse walks into the room; I see a one liter enema bag among the supplies she carries. She gives me a smile and asks if I’m ready for this. My mouth says “yes” but my nether parts are screaming in revolt. She tells me one bag should do the trick and I guess that’s supposed to be good news. A liter in and I realize I should have listened to my region below because revolting is the right word in every sense! I’m still flowing as brown as the Ganges River after completing my third liter of warm water soap suds (I’d often been told I was full of it and the evidence was conclusive!). In the the process, I created a clog that made the power flush of an industrial toilet cry “UNCLE”. This provided me a brief respite as Maintenance was called. Quickly, this guy shows up with a plunger with a four foot handle on it. The noises emanating from the bathroom as he practiced his art was epic. I tried but failed to not make eye contact with the man as he exited the bathroom. His only word to me was a stifled “Damn”.

Photo courtesy of AP

Amy, the twins and my mom arrived just after the fecal fiasco started. They encamped in the waiting room to save me from embarrassment. Here, they suffered their own torture. Every person passing by asked about the twins. How old? How much did they weigh. Are you breastfeeding? We’re they preemies? What’s that thing he’s hooked up to (apnea monitor)? Unsolicited advice was also provided ad nauseum. Formal inservices were provided by my mother and wife on how boy/girl twins cannot be identical. This baffled many in their audience.

As enema numero cuatro was prepared, a resident entered my room. He said, “It’s here! We’ve got to get him to Holding”. The nurse balked because I wasn’t “clear” yet (sadist!) but he told her three liters was good enough (praise the Lord!). I removed the insulin pump that had been my ball and chain since age 11. Freeing myself from it filled me with the hope and resolve to see this through.

I was whisked off to OR Holding with my family in tow. We were coolly greeted by a nurse. She informed us that things were going to move fast so we better say our goodbyes. Amy leaned in to kiss me when my surgeon walked into the room. “I’m sorry to tell you this but I’m cancelling your surgery.”, he said. He went on to explain that the blood vessels of the donor pancreas were inadequate to ensure successful transplantation. Dumbfounded, I barely heard a word he said; it never entered my mind that this was possible.

It took days to get over my disappointment despite the reassurance that I’d be back soon. The best reminder I got was from a friend (a former transplant nurse) who said “The best surgeon is the one who knows when NOT to operate!”. The only lingering grief I held was for for the donor’s family — I so wanted to have a great outcome for them! Moving on, I pulled it together, strapped my transplant beeper next to my insulin pump and went back to my new life as usual — anxious and scared!