“Some men see things as they are and say why.
I dream things that never were and say, why not”
George Bernard Shaw
This is post number 200 in the Bob’s Newheart Series of blogs on organ donation/transplantation and related issues
On February 17, 2014 I will turn 75. It is an incredible feat for someone who abused his body as badly as I did. By my count I have been dead three times. Once from sudden cardiac arrest, once during surgery in a hospital and I suppose once when they took my heart out to give me a new one (maybe that one doesn’t count). I have to believe that I am only alive today because I was given a mission to do everything in my power to help others who face critical and/or life threatening illnesses. The social media offer me that opportunity and I have gladly accepted it.
Before I launch into my story I think it is important to point out two factors that may have contributed to my condition but cannot be directly or medically linked to it. First, for 37 years from 1954 until 1991 I was a heavy smoker. Some days I went through as many as four packs of cigarettes. There are 20 in a package. I quit smoking in 1991 because of the onset of Chronic Obstructive Pulmonary Disease (COPD) and after watching my father die of the same disease in January of that year. It took many tries, perhaps dozens but finally with the help of nicotine gum I kicked the habit.
I am also a recovering alcoholic. I was a very heavy drinker for many years. I won’t go into detail here but finally on July 17 of 1982 I checked myself into treatment at an in-patient center in St. Paul, Minnesota. I have not had a drink since. While there is no direct medical evidence to tie my tobacco and alcohol use to my heart condition I have no doubt that they were great contributors. You cannot consume all the chemicals contained in cigarette smoke and the hundreds of gallons of alcohol I drank and not cause damage. I am quite frankly amazed that I lived long enough to get a heart transplant.
It took 12 years from the time I was diagnosed with Cardiomyopathy (heart failure) until I was listed for and got a heart transplant. When I started the Facebook group Organ Transplant Initiative in 2007 I wrote this mission statement:
The mission of Organ Transplant Initiative is to work to ensure than anyone who needs an organ/tissue transplant can get one.
Some say that’s an impossible dream. I refuse to accept that.
St. Paul, Minnesota — it is 5 PM on a Friday in mid-July 1995. I was having a very difficult time breathing all day but chalked it up to my life long battle with asthma. I removed my albuterol rescue inhaler from my shirt pocket and took two puffs inhaling deeply and holding my breath for a few seconds to give the drug time to work. It didn’t. I tried again, it still didn’t work so I thought that either the medicine was old or the inhaler just wasn’t working properly. My breathing was not only labored it was sometimes audible.
I was the founder; owner and CEO of the Aronson Partnership, Inc. a highly specialized communication consulting firm that helped executives communicate their messages in crises, media interviews, testimony and presentations. It was going to be a long day because my last coaching session of the day would begin at 6 PM and end around 9. My staff left at 5 so I would be there alone with my client. Being a consultant doesn’t require a lot of physical activity so I thought I could make it through the evening and then use my nebulizer when I got home. A nebulizer provides for a longer more effective dose of albuterol, the asthma fighting drug.
At 6 o’clock my client arrived. She was a well-known professional spokesperson for a syndicated home improvement TV show and had hired me to help refine her on camera skills. My studio was equipped like a TV studio with lights, cameras, microphones TV monitors — everything necessary to simulate the real thing. As we worked I stayed seated, unusual for me because I am usually an energetic person who moves around the room to keep my client engaged. I knew, though, that if I got up the session would be over because my breathing was becoming more labored. I struggled through three hours and finally my client left pleased with the session.
Normally I would straighten up the studio before I left. Not this night. I turned out the lights, grabbed my briefcase, locked the door and took the elevator down six floors to the parking ramp. I had a breakfast meeting with a client that day and arrived at the office late. The ramp was almost full so I had to park at the far end which was at least a block from the door of the building.
When I exited the elevator and entered the ramp I was in a very bad way. I was struggling for every breath and my legs felt like rubber. Repeatedly I tried to use the inhaler but to no avail. It gave me no relief…very unusual. Stumbling my way to the car through the deserted ramp I was stopping about every ten feet to lean on a post, another car, anything that would support my weight for just a few seconds. Had anyone else been in that ramp that would have sworn I was drunk. I was so starved for oxygen that my vision was getting blurred. I could see the outline of my car perhaps 50 yards away but it might as well have been on the moon. I was beginning to believe I could not make it there and panic began to set in. Panic made my breathing even more labored. Half way through the ramp my legs buckled under me, I dropped the briefcase and fell to my hands and knees. I remember thinking that I had not had an asthma attack this severe since I was a child. I looked around — there was no one in the ramp and very few cars.
On all fours gasping for air I somehow managed to collect myself, pick up my bag and stand on wobbly legs. Leaning on cars helped but there were few of them in the ramp, I kind of lurched from car to post to car. I don’t know how I did it, but I made it to the end of the ramp and my car — falling twice more on the way there. The knees on my suit pants were a mess, one was torn and my hands were dirty, gritty and bloody from breaking my fall palms down on the concrete floor, somehow I had cut myself and I didn’t care.. My glasses were streaked with perspiration and more opaque than transparent. And…I was cold, bone chilling cold. Perspiration had soaked my clothing and chilled me even though it was a summer night.
I opened the door, sat, started the engine and despite being cold turned on the air condition thinking the cold air in my face might help. Soaked with sweat, grimy and a little bloody from three falls in the ramp I was still struggling to breathe so I loosened my necktie and just sat there trying to calm my nerves and catch my breath. Because I was no longer exerting myself my breathing slowed a tiny bit but enough for me to believe I could make it. The cold air from the AC unit felt good on my face and I sucked in as much as I could but it wasn’t nearly enough. My heart was beating so fast it felt like it was trying to pound its way through my ribs to find freedom outside of my chest.
That’s when I remembered I had just purchased my first cellphone (they were pretty clunky by today’s standards and did nothing but make calls,) I took it from my inside coat pocked but instead of dialing 911 I called home. When my wife answered I breathlessly told her I was having a serious asthma attack that I would pick her up and she could drive me to an ER. In retrospect a dumb plan, but I really thought it was asthma. Not once did I even consider that it could be something else so I knew I could make it.
That’s when I made my second stupid decision. In my oxygen starved brain I determined that going to a nearby major medical center would be a wrong move because their ER was always very busy and the wait would be a long one. Instead, I asked my wife to drive me to a small rural hospital in Hastings, She objected saying I’d be better off at United in St. Paul but I countered with the fact that the Hastings ER would not be jammed like a bigger hospital. I was right. There was not a single patient there when we arrived. She was right, too, Hastings was the wrong place for me.
By the time we got to the Hastings ER I was turning blue and almost unable to breathe yet somehow summoned up the strength to walk in and make it to the admitting desk where I struggled to tell the nurse on duty, “I’m having a very bad asthma attack, my inhaler is not working.” I think I fell into the chair next to her. The nurse quickly took my vitals, listened to my heart and said, “I don’t think it is asthma,” and called for a crash cart. There was a scramble as I was placed on a gurney, rushed to a room, wired, had an IV placed in my arm and was given a tablet of nitroglycerin to hold under my tongue. ECG leads were taped to my chest, someone shot something into the IV, and a Doctor appeared, giving orders. I was nearly unconscious and confused not knowing what was happening I just kept thinking, “What’s wrong with these people, all they have to do is give me a shot of adrenalin and I’ll be fine.” The nitro made me sick to my stomach but my breathing was easing.
Then the Doctor spoke up, “Mr. Aronson, it’s not asthma, it is your heart and we can’t handle you here. We’re sending you by ambulance to United Hospital in St. Paul (United was a major heart center and the hospital I chose not to go to in the first place). By now I was stabilized and almost breathing normally but the ambulance wasted no time and made the 20 or so miles from Hastings to St. Paul, Minnesota in about fifteen minutes with the aid of the siren and flashing lights. I told the attendants I felt fine and they should just take me home but they were having none of it and brought me straight to the hospital where we were met by a medical team that rushed me to cardiac intensive care. That’s when the excitement, the drugs and exhaustion caught up with me and I lost consciousness.
When I awakened I was surrounded by people who were setting up some equipment. “We are going to do an echogram, Mr. Aronson, and that will tell us how well your heart is functioning so please lie on your left side.” I did and the operator of the machine got on my right side, reached over with what looked like one of those mortar things that pharmacists use and placed it on my chest. It had some kind of cold wet clear goo on it and as he moved it over my chest I could hear my heart on the monitor going “squish boom boom, squish boom boom.” The monitor was in front of me so I could see what the operator saw. The difference was that he knew what he was seeing, it meant nothing to me. Again, though, exhaustion set in. Each of my eyelids felt as though they weighed twenty pounds. I could not stay awake and drifted off only to awaken to the sound of the echo machine being wheeled out of the room about twenty minutes later. As the operators were leaving I thought I caught a glimpse of my wife and some family members but again fell into a very deep sleep.
It was morning when I began my return to the conscious world and for a while I was confused, I didn’t know where I was until I heard the voice of my daughter Hank. “Hi daddy, we are all here with you.” For just a minute I didn’t know where “here” was or why they were all there. Then I heard the beeping of a monitor, saw the IV drip, felt the oxygen tubes in my nose and saw the nurse reading my blood pressure. I got the idea that the situation was not a good one. Families don’t gather first thing in the morning in a hospital room unless you are in dire straits.
I looked around and saw my wife, two daughters and their husbands, my son and his wife and several medical people. My usually jovial family looked very somber. “All of this, I thought, for asthma?” forgetting about the echogram and what the doctor in Hastings had said just a few hours earlier. Just then a very distinguished gentleman walked in. Dressed like a model from Gentleman’s Quarterly, he was relatively young but had white hair and spoke softly but firmly. “Mr. Aronson,” he said. “My name is Dr. Thomas Johnson and I’m a cardiologist. You have a very serious heart problem. It’s called cardiomyopathy which means your heart muscle is failing and you may need a heart transplant.”
“Boy,” I thought, “that’s laying it on the line.” I felt as though I had just had a nuclear weapon detonated in my gut. But strong men don’t show weakness in front of their family. I noticed that my youngest daughter was crying and everyone else was silent. “Ok, I said, if that’s what it takes let’s do it.” I had a passing acquaintance with organ transplants but really had no idea how complex the process was or how difficult it was to get a heart, plus I had to put on a brave face for my family.
While my mind was racing Dr. Johnson began to explain my condition. His style was firm but calming and compassionate. He explained that while they would do further testing he was certain that I suffered from cardiomyopathy which is a very fancy term for heart failure. He pointed out that I would likely be able to get out of the hospital in a few days and go back to work but that my energy level would not be the same. He also said that while I would likely not need a heart transplant right away it was inevitable that I would need one at some point. He said he had scheduled a stress test for later that afternoon. I thought the whole situation was a stress test and that this must be a bad dream. Someone brought in a tray of something that resembled food but I wasn’t hungry just very, very tired and I drifted off again after telling my family to go home and come back later. It was obvious then that I was in no immediate danger at least not anymore.
“Mr. Aronson,” the voice said, “Mr. Aronson, it’s time for your stress test.” Again feeling dazed and almost hung over I awakened and was helped up so I could sit on the side of the bed. I was given a fresh gown and robe to put on and helped into a wheelchair. A friendly and talkative male nurse pushed me through a series of hallways to the stress test room. It was tiny. There was room only for a treadmill a table with a lot of electronic gear on it and a chair. Dr. Johnson was already there and I was wired again with several of those sticky leads that rip the hair off your body when they remove them. I had no idea what a stress test was other than getting on a treadmill. I found out quickly enough that it involved walking on the treadmill as the operator slowly increased the speed and the grade. Dr. Johnson was there carefully watching me and the monitor. The speed and grade changed every couple of minutes and by the time I reached 8 minutes I could go no longer, my legs were rubber, my lungs were about to explode and my heart felt like it was going to hammer its way out of my body and then out of the room. I did not know that one could get so thoroughly exhausted in 8 minutes.
The stress test was just one of a series of tests, labs and other evaluations that confirmed the initial diagnosis of dilated cardiomyopathy, cause unknown. My heart was growing larger because it was not pumping enough blood out. Dr. Johnson explained that my Ejection Fraction (EF) was between 20 and 25. Here’s what that means. Normally the heart pumps out about 60% of the blood it contains. That’s the EF. My heart was only pumping out 25% so in order to contain the excess blood the heart had to grow but there’s a limit to the growth and to how long your other organs can survive when they are not getting enough blood. In a few days I was released from the hospital with a boatload of medication and strict diet orders. Sodium intake was limited to 1800 milligrams a day, liquid consumption was capped, I was told to lose weight (at 6’4” I weighed about 240 lbs. and have a large frame so I didn’t appear to be overweight) and exercise, lots of exercise.
I took it all very seriously and followed the diet and all the other restrictions and suggestions very carefully. I dropped about 40 lbs. and with daily exercise got in the best condition of my life. Each morning I would get up and do 75 stomach crunches, 100 pushups, walk the treadmill for a half hour, do about 40 curls with 20 lb. weights in each hand and then go to work. Actually I felt better than I had felt in a long time but I tired easily. By 10 AM I would get sleepy but I’m a Type A personality and push myself so I kept up the same pace I had always been on. I was a consultant and traveled a great deal. At least once or twice a week I was running through airports to catch a plane or make a connection somewhere and for a while I did pretty well but I could feel myself slowing down. I saw Dr. Johnson regularly and he kept adjusting my meds and re-testing me but it was not yet time to be listed for a heart transplant, I was not sick enough to qualify.
Then in 1996 we got the news that my wife, Avis, had lung cancer. They found it in her legs which meant it had metastasized or had already spread from her lungs to other parts of her body. The news was a devastating blow for the entire family and I simply forgot about my condition as I took her to the series of chemo and then radiation appointments. The side effects were sheer hell and even expensive drugs like Zofran for nausea didn’t always work. The treatments took place over several months and took a heavy toll on her. Cancer is ugly but so are the treatments.
Slowly, though, the combination of therapies started to have a positive effect. Her hair grew back, the pain was gone and there was no sign of the cancer. We all thought that maybe she had beaten it.
We were feeling good about Ave’s progress and I was still following all the instructions that had been given to me but my health was deteriorating, I could feel it. My ejection fraction was about 20 and I was tired all the time.
Ave did quite well for about a year and then in October of 1998 she started complaining of pain again and tests made real our worst fears. The cancer was back but far worse than it had been originally and there was no longer any treatment that would offer hope. The disease had invaded not only her lungs but also her colon, legs and brain. She entered United Hospital in St. Paul in Mid-October never to return home. She passed away with her family around her on November 28 of 1998.
After the funeral I took time off to try to figure out my life. 35 years of marriage does not prepare you for living alone. It was awful. Staying home only made things worse. My way of dealing with the loss was work. I spent more time than ever at the office and on the road. I traveled even more than I had in the past.
Finally, exhausted, I decided I needed a rest away from phones, clients, employees and everyone else. In May of 1999 I booked a flight to Rome, Italy to see my friends Ron and Carla Marinelli. They arranged for me to stay at the lovely old Hotel Quiranale on the via Nacionale. The rest, the food, the surroundings did wonders for my mental health. Each morning I would arise, go to the breakfast restaurant and have a cappuccino, some biscotti, melon and a little bit of prosciutto (Italian ham and definitely not on my heart diet). After a couple of days the waiter didn’t ‘even ask me what I wanted, he saw me come in said, “Buon Giorno” and brought what I just described.
The visit with Ron and Carla was magnificent. Ron was the man who hired me for my first job as a radio announcer in 1960 in Hibbing, Minnesota. He later married Carla, an Italian national, and moved to Rome where he taught English as a second language to Italian military officers. One day Ron and Carla decided we should take a trip. It was a lovely surprise, too. They would take me to Sassoferrato to the North East of Rome in the mountains of the province of Ancona about half way to the Adriatic Sea.
The trip was significant because Sassoferrato is the town in which my grandmother and grandfather on my mother’s side were born and from which the emigrated in the early 20th century. I won’t go into detail but to stand near the sulfur mine where my grandfather worked and to walk the roads where my grandmother delivered the mail stirred my emotions in a special way. But all of this is another story for another time.
I left Italy feeling good and arrived in the U.S. ready for work and threw myself into it like never before almost forgetting that I had a very serious heart disease. It was about then that I met Robin Diffie. She lived in Jacksonville, Florida a city I visited often because the Mayo Clinic there was one of my clients. We hit it off immediately and in August of 2000 were married in my home in Eagan, Minnesota, a St. Paul suburb.
It had now been five years since my diagnosis and while my ejection fraction had not changed I was noticeably tired more often. About a year later I was driving to visit a client that had an office in a shopping center across town and got hungry so I stopped at a supermarket and got a deli sandwich that came close to my dietary requirements. I sat in the car and ate it then, with seat belt off drove around the corner to my client’s office.
As I entered the parking lot I slowed to about 5 or 6 miles an hour to pull into a parking place when suddenly everything turned the brightest white I’ve ever seen…cars in the lot next to me danced in the light and I felt really good but sleepy. I know not how much later it was that I awakened but I was slumped over the steering wheel and the car was up against a tree. I awoke with a terrible headache and my balance and speech were not quite right. Somehow I made my way into the client’s office and told them I had fainted. The client was a medical company and they told me to stay seated and called Robin who came to get me and took me to the hospital.
At the emergency room a cardiologist examined me and said, “You need to have a defibrillator implanted, it appears as though you may have suffered sudden cardiac arrest and running into that tree may have jarred you enough to save you, it was a good thing you weren’t wearing your seat belt.
I said, “Ok doc let me check my calendar and I’ll see when we can schedule the defibrillator.”
He chuckled, “No,” he said, “We need to do that right now, you could have another attack any time and the defibrillator could save your life.” Needless to say, we were in surgery within the hour and the Medtronic Implantable Cardioverter Defibrillator (ICD) was implanted. It was a little smaller than a hockey puck and was just to the right of my left shoulder. You could hardly tell there was anything there. The bad news was that my heart condition was changing and not for the better. This new development was not good. And..if in fact I did have cardiac arrest when I hit that tree I was extremely fortunate because only about 5 percent of cardiac arrest victims survive. It is unpredictable and there is really no way to diagnose it. About 350,000 people die every year due to sudden cardiac arrest. Those who survive usually do so because of a defibrillator. Either the implanted variety or the kind you find hanging on walls in public buildings.
By 2003, eight years after my diagnosis I was on a drug called Amiodarone which is used to correct abnormal heart rhythms. The medication is prescribed only for people with serious heart problems. It is a powerful and effective drug but also one with many side effects some of which are potentially fatal. One of the side effects and the one that most affected me was weight gain because Amiodarone can have a very negative affect on the Thyroid gland. For me the result was ballooning up to nearly 250 pounds despite my making every conceivable effort to stop it. For the first time in my life I was buying pants with a 40 inch waste and had developed a belly that hung over my belt. I took to wearing suspenders to keep my pants up. I didn’t like the way I looked and I couldn’t do a thing about it.
It was summer and I had just showered and shaved and was getting dressed for work when I felt as though a mule or a horse had kicked me in the chest. The impact sent me to my knees in the bathroom and at first I didn’t know what happened. Slowly it occurred to me that my defibrillator had just gone off. That means the rhythm of my heart was also off so I called 911 and explained what happened. The voice on the other end said, “So what would you like us to do?”
I responded, “I don’t know, I thought you could tell me what to do.”
She said, “Often patients do nothing and sometimes we take them to the hospital. Would you like an ambulance?”
“I guess,” I said. Not really sure what to do but still unsteady on my feet as a result of the shock. The ambulance was there in a flash and I walked out the front door of our town home.
The attendants made me lie down on the gurney and carted me into the back of the big Red and White vehicle where they wired me with the electrocardiogram and started an I V. I heard the paramedic on the radio saying something about atrial fibrillation and they turned on the lights and siren. Déjà vu all over again as we raced for United Hospital in St. Paul.
Robin had been out when I was shocked by the ICD but I called her immediately and she met us at United. More tests and finally the same Doc that placed the ICD in my chest came in to say that I needed a new and different one. Mine had two leads and they wanted to put one in that had three leads but that meant the procedure was a little trickier because one lead had to go behind my heart. He said they would do the procedure the next day but that he was going to Greece on a vacation and one of his highly skilled colleagues would do it.
They wheeled me away in the morning for a routine procedure that almost killed me. In order to place the ICD and connect it they have to stop your heart for a while and then start it again. Well, they had trouble with the third lead; they couldn’t get it in no matter what they tried so they gave up on it and decided to try again on another day. Now they had to restart my heart — again and again they tried the paddles but it wasn’t until 6th or 7th attempt that the damaged organ began to beat. Now there was a new concern because a long time had elapsed and there was fear of brain damage.
Robin tells me that when I awakened I was babbling. What I was saying made no sense and I stayed that way for a while. The hospital sent a neurologist in to see if I had suffered brain damage in the aborted attempt to place the third lead of the ICD. By the time he got there I was doing a little better so the questioning began. Who are you? Where were you born? What month is it? Robin said she thought I was doing pretty well. Then the Doctor asked who the President of the United States was and I said, “George W. Bush the SOB.” I don’t remember saying that but Robin said she knew then I was OK. That episode, though, was not the end of the saga.
The third lead still needed to be connected and I couldn’t leave the hospital until it was. They said I could rest for a day or two and the would try again. They did in the following week and this time with a different doctor but the same result. They could not attach the third lead and again had trouble reviving me. I told the medical team that there would be no more attempts until my Dr. returned from his vacation and no one argued the point. Finally when he returned he was amazed to find me still in the hospital. It had been almost three weeks. The next day we went back to surgery and this time at the hands of the master it worked flawlessly and I was released.
All of this had taken a toll. I was still working as a consultant but had to change my style. When I trained or coached people for various communication situations or when I made a presentation on communication I was animated, energetic, walked around a lot, invaded people’s space and did a good job of getting and keeping people’s attention. I could no longer do that. Moving about left me exhausted. For a while I tried to walk around, sit a little and then walk around again but I finally had to give in and do my presentations sitting and I always explained to my audience why I was sitting.
For about 25 years the Mayo Clinic in Rochester, Minnesota had been my client, at least once a week I traveled from the twin cities to Rochester to work with Mayo physicians or executives and when I did I’d stay at a Hotel about a block from the studio they had set up for me. I found that I could no longer walk the block without stopping several times to rest and I knew the end of my career was near. That’s when Robin and I decided to move back to her hometown of Jacksonville because there was a Mayo Clinic there also and they had an excellent record of getting organs. Reluctantly I told my long-time client Mayo that I had to retire, that I could no longer take the physical strain of doing the work and I recommended another consultant.
Then came the task of selling our Eagan, Minnesota town home. It was 2006 just the beginning of the real estate market bubble burst. We purchased a home in Jacksonville thinking our very nice town home would sell quickly. It didn’t. It took ten months to sell it after we had dropped the price several times. Needless to say we took a bath on that sale.
The next step was to go through the transplant evaluation process at Mayo in Jacksonville.. There was a battery of tests over a period of several days but the outcome was never in doubt. By now my ejection fraction was around 10 I could not walk from our family room to the bathroom which is about 25 feet without stopping to rest. It was clear to me and to my docs that I was in end stage cardiomyopathy. I was dying and there was nothing that could be done short of a heart transplant. “Ain’t gonna happen,” I told myself. “I am 68 years old and not hospitalized, there’s no way I get a heart. Certainly if there is one available it will go to a much younger and sicker person.” I had pretty much given up hope. The Mayo clinic hadn’t and neither had Robin. Dr. Hosenpud, my transplant cardiologist at Mayo took my case before the transplant committee and I was approved for listing. I gave it no further thought. Although I was convinced that I would not get a heart I said nothing to Robin or my family. I’ve always prided myself on being very logical and the logic said I would not get a heart. Well, Mr. Spock, the logic was wrong.
It was thirteen days after being listed when the phone rang. Here’s the play by play. Tuesday August 21, 2007 noon. My home phone rings, “Hello.” “May I speak with Robert Aronson please?”
“This is Dr. Hosenpud from the Mayo Clinic in Jacksonville. We may have a heart for you.”
Silence, confusion, “Did you say you may have a heart for me?”
“Yes,” pack a bag with some essentials and come to the clinic in the next couple of hours, I’ll see you then.” Click.
I hollered for Robin who was in the next room. “I struggled to hold back tears when I said, “Dr. Hosenpud called, and they may have a heart for me.” I have always taken pride in being able to be cool under fire. I don’t panic, I logically work things out. Not today. I think I packed a tennis shoe a sandal a toothbrush a comb and some mouthwash….nothing that made any sense.
I thought I was supposed to rush to the hospital even though Dr. Hosenpud did not say I should. So we raced to the car and made record time. I had visions of pandemonium when I got there. I thought I would say, “I’m here for a heart transplant” and all hell would break loose. I thought there would be people running around, bringing out a gurney for me…tearing my shirt off and rushing me into surgery…Hah! None of that happened.
Here’s reality. Me at reception desk in hospital, “Hi I’m Bob Aronson and Dr. Hosenpud just called to tell me there might be a heart for me and I’m here for a transplant……” I fired words out like a machine gun my eyes darting here and there and everywhere, my voice shaking.
Receptionist. “Your name again?” I told her. Click, click, click (computer keys)
“Ok here you are Mr. Aronson. Have a seat and someone will be out to get you in a little while.”
We sat. There was no pandemonium. There was no movement of any kind. No one seemed to care that the all-important Bob Aronson was here for a heart transplant We waited for maybe a half hour when finally I was called to go back to a room to answer some questions, change into a hospital gown and begin the preparation process. I was still amazed that no one was excited about what was happening, they were all so calm and just went about doing their jobs. I wanted pandemonium, I deserved pandemonium, the situation called for pandemonium…but it never happened. I guess I’ve seen too many movies.
Robin accompanied me to what I called the “Staging” area, that’s where everyone buzzes around you each with a special job, all of them pleasant and very formal. Mayo has it so ingrained in their system to refer to people by their title (Mr.) I quit trying to get them to call me Bob for fear they might choke.
With the IV line in and working we talked for a while with the people in the room and finally someone said, “It’s time.” A syringe appeared out of thin air and the needle was inserted into my IV, “Just a little something to relax you,” the voice said and I was in la la land in a split second.
I was tied tightly and they were coming to interrogate me again. They thought they were being quiet but I could hear them coming, “No, no please not anymore, please don’t cut me up for parts anymore,” I begged as they tugged at my arm.
“Mr. Aronson, are you awake, we are doctors and we are here to remove your dressing,” was what I heard when I awakened from my dream where I was being held captive while my organs were removed. In my haze I vaguely remember some doctors coming to intensive care and ripping off the dressing that covered my chest. It sounded to me like they had torn a 50 foot sheet of canvas in half. I felt nothing but I’ll never forget that sound then.
While all this was happening Robin and her sister April were sitting in the surgical waiting room. It was August 21st which is also April’s birthday and instead of spending it celebrating she chose to sit with Robin praying for my recovery. Robin and April are people who gain great satisfaction from giving and in helping others. These sisters, like their parents are generous and considerate to a fault. T
The next time I awoke I was more alert and Robin was holding my hand and saying, “It’s OK, you are fine and you have a new heart.
I felt a great sense of relief, like a huge weight had been lifted from my shoulders and I was thirsty, so incredibly thirsty. I asked for water and a nurse brought me ice chips. I sucked on those for a while and then fell asleep again. I don’t know what time it was when I once again blinked myself into being awake but Robin was gone and it was just me, a bunch of beeping, flashing machines and a nurse.
“Water,” I feebly said.
“Not yet,” she said with what sounded like attitude. I was so dry my lips were stuck together, my tongue felt a foot thick, my throat was parched and I was almost without a voice because of the tube that had been down my throat.
“Please,” I’m so thirsty.
“It’s time for once” I said may I please have the ice chips now?”
“In ten minutes,” she said. At that moment that nurse became the “Ice Nazi.” I remember watching the clock waiting for the next hour so I could get more ice chips but despite my impassioned pleas, appeals to fairness and kindness and outright sycophantic flattery she never budged a second. I got my ice chips exactly on the hour not a split second sooner or later and….I lived.
Once released from the hospital I entered cardiac rehab where I met a strange mixture of people. I quickly found that while all of us had transplants in common some were more committed than others. One man whom I shall never understand just refused to comply. He wouldn’t follow the diet or the exercise regimen. He was very nice but just wouldn’t comply despite being alternately cajoled and chewed out by both physicians and nurses. I don’t know what happened to him but his survival chances weren’t good. Conversely there were some there who so desperately wanted to live they would have doubled their effort if asked. I was one of the very oldest people in the rehab program at the time and decided that the older you get the more you realize the value of life and the harder you are willing to work to stay alive.
I hadn’t been out of rehab for but a few weeks when a friend and former Mayo Client Lee Aase called me. Lee is the social media guru for the Mayo Clinic (the whole system). He is a 6’5” blond Scandinavian with a winning smile and attitude. Lee could gain the confidence of almost anyone in a matter of seconds based on personality alone. And…he is one of the brightest communications professionals I know.
Because of my age my recovery from the heart transplant was slow. My body just didn’t want to regain its strength but I could still think and I could still type and the internet kept me connected to the goings-on in the world. When Lee called me at the end of October 2007 to suggest I get involved in the social media on behalf of organ donation I had no idea what he was talking about. When he mentioned Facebook and WordPress I had not heard of either of them. I was somewhat familiar with blogs but had never written one and had read only a few. What rang my bell was when Lee said I could use these forums to promote organ donation. I knew I wanted to try to pay back the gift of life that was given to me by a stranger but I had no idea how I would do it. Lee just opened that door. He took a great deal of time on several occasions on the phone to “Train” me in the use of social media. He helped me set up the Facebook group and my WordPress blog and it was Lee Aase who came up with the name, “Bob’s Newheart.” And so it was on November 3rd 2007 that Organ Transplant Initiative and Bob’s Newheart were born.
It was also on or near that date that I began to suffer extreme pain for reasons unknown. Some of it may have been the result of the position the surgeons placed my left arm so they would have better access to my heart. Whatever the cause the pain was extreme and it was spreading and debilitating. Both shoulders were affected as was my neck and lower back. Sometimes the pain was so great I sat in my recliner and cried. Even powerful painkillers only dulled it..it never went away. Specialists gave me injections in both shoulders which helped. Later it was determined I had torn rotator cuffs in both shoulders but not how I got them. The pain seemed endless and in fact lasted for over a year. Oxycodone helped but did not kill the pain completely. In the meantime I would get up early in the morning and take a pain pill so I could tend to the Facebook group and the blog. It was only early in the morning that I could produce anything that made sense.
As the day went on the pain grew and I was unable to think never mind write anything worthwhile. I could not drive because of the pain and often because of the pain pills I would forget to set up my meds for the week. The narcotics, I believe, also caused me to forget to eat so not only was I not following the suggested diet I wasn’t following any diet Robin had her hands full. She had two businesses that she started and was running out of our house and she had me to take care of. She drove me to medical appointments, took care of my needs at home, reminded me to set up meds and renew prescriptions and made sure I ate, even though I didn’t want to.
The biggest challenge for both of us was that I was becoming increasingly more depressed. Because of the pain I slept in my recliner in the family room at the back of the house. The comfortable leather chair was in a corner of the room that was naturally dark – a great place to be depressed. When I awakened each morning I would leave the lights off …sometimes I would shower, often not. I didn’t care about anything. I would sit for hours with the TV on but never look at it. It created flickering shadows in the room but no light. Usually I had the volume turned down so it was just white noise. I was crabby, uncommunicative, looked like a homeless, deranged old man and didn’t care and yet I continued with Facebook and WordPress for at least an hour each morning. It was the only thing I felt I had an obligation to do each day.
One day, though, something clicked, I think it was guilt. Somewhere in the dark reaches of my mind I knew I was being unfair to Robin and I loved her too much to put our relationship at further risk so I called Mayo and asked for psychiatric help. It was almost two years after my transplant before we found the right combination of medications and then one day even though the sun didn’t come up (it was hidden by clouds)…it did. I felt something stir — a twinge of optimism of ambition a feeling that life might be worth living after all –.and each succeeding day got a little bit better. The pain diminished, I began sleeping in bed again and best of all began looking toward the future and participating in family life. The anti-depressants I was taking changed my mood completely. I started doing the grocery shopping, some light housework and best of all Robin had asked me to make some fixtures for her art show booth and I was doing woodwork…one of my great loves.
As time when on my assignments in the woodworking shop became more interesting and challenging. Whenever Robin needed a shelf, a display case, an ear ring display frame or box or lazy susan I would make it and I found it most enjoyable. Then we decided to try Jewelry boxes and I found a new artistic niche for myself. Soon I found myself busier than I ever imagined I would or even could be. I was up and around and using both my head and my hands to be productive and in the process was helping Robin. After all she had done for me it was the least I could to help her and it felt good to do it.
So here we are at 2013 and this is my 200th blog. I’ve written and posted on subjects ranging from anorexia to Xenotransplantation. Our blogs have become internationally famous and respected. Bobs Newheart is a leading source for transplant and donor information in the world. We are now averaging nearly 4,000 readers a month. Organ Transplant Initiative (OTI) recently got its 3000th member and we grow larger every day … no small achievement when there are scores of transplant groups on the internet. Size is important if we are to be an effective advocacy group. Decision makers listen when large groups of people speak up. The bigger we get, the more the people who make life and death decisions will listen.
I am not a particularly religious person but I am positive that my life was saved so I could help to save or at least comfort those who languish on the transplant list. I have committed to my unknown donor and to all who join OTI and read my blogs that I will do whatever I can to get more organ donors, promote and support further scientific and technological research into alternatives to organ donation and to provide information that people need to make good sound medical decisions. I will not quit until this new heart I have stops beating and then I’m hoping others will pick up what I started and make it even better.
That’s my story. It isn’t much different I’m sure from thousands of other transplant recipients who underwent some tough times but overcame them. We all have a thousand thank you notes to send primarily to our donors and donor families but also to medical team that retrieved then implanted a new heart or other organ, the nurses and doctors who took care of us In the hospital, for continuing care and of course our caregivers…what on earth would we ever do without them?
In my case my thanks go to my unknown donor and his family, my wonderful loving wife Robin, my kids and Robin’s, our grandchildren and great grandchildren my brother and sister and cousins, the Diffie family, Mayo Doctors Hosenpud, Yip and Patel and coordinator Stephanie Orum and all my Facebook and WordPress friends.
The mission of Organ Transplant Initiative is to work to ensure than anyone who needs an organ/tissue transplant can get one. Some say that’s an impossible dream. I say nothing is impossible.
The song Impossible Dream from Man of LaMancha seems fitting in many ways but more than anything else it speaks directly to the OTI Mission.
To dream … the impossible dream …
To fight … the unbeatable foe …
To bear … with unbearable sorrow …
To run … where the brave dare not go …
To right … the unrightable wrong …
To love … pure and chaste from afar …
To try … when your arms are too weary …
To reach … the unreachable star …
This is my quest, to follow that star …
No matter how hopeless, no matter how far …
To fight for the right, without question or pause …
To be willing to march into Hell, for a Heavenly cause …
This blog is dedicated to my unknown donor and to all those who are awaiting transplants all over the world.
Reprinted and reformatted from WikiHow
With Additions by Bob Aronson
Have you just started a new medicinal regimen that requires you to take pills every day? Remembering to take your medication every day can be a chore, but it is also very important for your health. If you’re forgetful or simply have too many medications to track, then maybe this guide can help you remember to get the job done.
Start using a calendar. You can purchase a paper calendar and hang it in your room and teach yourself to look at it every day, making and leaving notes accordingly. You can also search through free electronic calendars on the Internet or use calendar software that may have come with your computer. Some of these allow you to add notes and automatically send you reminders by email or by SMS (i.e. text messaging).
Set visual reminders.
- Put the medication close to something you need to deal with on a daily basis anyway. For example, if you take your medication in the morning, make sure that before going to bed at night, you place it next to the coffee pot, if you make coffee in the morning. Or, you can attach your medication bottle or pill box to your toothbrush with Velcro.
- Make it part of your routine. If you take it every morning, make it a habit to take it as soon as you step out of the shower, or as soon as you get out of bed.
- You can purchase sticky notes to leave in your kitchen, your car, or anywhere that you frequently visit. For medication that is stored in the fridge, you should paste a post-it note on the fridge door (or on your coffee pot) that says Take Pills.
- Remember medication that needs to be taken with a meal, by keeping it right on the table, in front of the place that you eat.
- If you are on your computer often, you might create a text file on your desktop that contains a list of things that you need to do. You can search the Internet for “electronic” sticky notes that you can place directly on your desktop, rather than purchasing paper ones. These programs will often allow you to set timers and reminders directly to the notes to flash or emit sounds accordingly.
- If you have a complex regimen, write a list with the medication, time and date and tape the list to the mirror in your bathroom. You can also print this on a grid and check off each medication after you take it.
- Set an auditory reminder. This is a common and fairly effective way to remind yourself to take your medicine. Most cell phones have an alarm function that allows you to set a “daily” alarm time where it rings. Choose a tone that will remind you that you need to take your medicine. If you do not own a cell phone, you might set your alarm clock to go off at a particular time each day for the same effect. Another alternative is to buy a digital watch and set the alarm to go off as many times per day as you need to take medication. A small digital kitchen timer with a numeric keyboard can be useful. Be sure to get one that can be set for hours, not just minutes and seconds. As soon as the alarm goes off, immediately take your medication to reinforce the habit. Saying “Oh, I’ll do it in a few minutes” can lead to repeated forgetfulness and defeat the purpose of having an alarm.
- Sort your medication. Place all your medications, including your daily dose of vitamins on your kitchen counter. As you take one pill, close the bottle, and place it to the left of the counter, making two piles. Do the same for each pill you take. Remember that the ones you need to take are in front of you. The ones you have already taken are to the left of you. After you are finished taking all your pills for the day, place all those on the left hand side back into the kitchen cabinet. Now you will know that all of your pills have been taken. Pre-sorting the pills into a plastic container designed for this purpose (a pill box or medicine box) is another way to avoid taking the same medication twice by accident. If that compartment is empty, you know you took the meds. Pill sorters come in different sizes and different colors. Aim to have enough to sort two weeks of meds at a time.
- Adopt a “divide and conquer” strategy. In other words, take half of your medicine and keep it in a place other than your household, such as your office at work. If you happen to forget to take your medicine in the morning, you can easily access your medicine at work.
- Be mindful of your medicine’s storing conditions, especially if you plan to keep your pills in your car’s glove box on a hot summer day.
- Get another person to remind you. Have a friend or loved one to remind you to take your medicine, or to ask you if you remembered to take your medicine.
- Use your phone calendar to set recurring reminders daily. It’s a more subtle way to be reminded. If you use your company phone/Outlook, make sure you mark the appointment as “private” and keep the reminder description generic to protect your privacy
Be careful when deciding on reminders. If you get too comfortable with them (such as a note on your fridge or by your pill box) you may be more likely to overlook it or ignore it.
- Not all medication is available or legal in all countries so you should check ahead. Any medication that may have a controlled substance may not be allowed in some countries so make sure you bring your prescription bottle and if possible a photocopy of your physician’s prescription.
- If you choose to set an alarm on your cell phone, be sure that it is a tone that you can easily associate with taking your medicine, so that you do not become too accustomed to hearing a soft tone. Or, if all else fails, set it to the same tone as your normal ring tone.
- Remember to take your medication with you when you go on holiday. When you pack your toothbrush, pack the medications you take also. IMPORTANT! NEVER CHECK MEDICATION WITH YOUR BAGGAGE. ALWAYS KEEP YOUR MEDS WITH YOU IN CASE YOUR BAGGAGE GETS LOST.
- If on vacation, pack your original, pharmacy-labeled medication bottles or keep a detailed list in your purse or wallet. I have attached a sample list to the end of this blog.
- Your meds list should also include critical medical information like insurance, physicians and clinics, and medical conditions. If it happens that you need emergency medical care, this will help the care providers to quickly determine what medications you take and how and why you take them, should you not be able to remember them or not speak for yourself. It is difficult, time-consuming and sometimes impossible for health care providers to identify unlabeled pills. For the same reason, do not dump different medications into the same bottle.
- Before you go on a long vacation, ask your doctor to give you an extra prescription for your pills, so that if you run out, lose them, or spill them, you can have the prescription filled at any drugstore.
- If you are taking medication for a serious condition such as heart disease, wear a Medical Alert tag, necklace or bracelet listing the name(s) of your illness and the medications you use to treat it/each. Also list any potentially hazardous interactions and allergies.
- If one or more of your medications causes photo sensitivity, be sure to put on sunscreen before leaving your house, no matter what it looks like outside; you’d be surprised how little light is required to get a full-blown sunburn!
- Be mindful of making a mental note to yourself when you take your medicine. Forgetting to take your medication is one thing, doubling your dosage because you forgot that you’d already taken your medication for today is another. You could make a box next to your “Remember Pills”-note, tick it off when you’ve taken it.
- If you do forget to take a dose, read the instructions that come with your medication carefully. Don’t assume that you should take your dose anyway- although this is the case for most, it can be different for others. If you have trouble reading, ask the pharmacist to explain the dosage directions.
- Before leaving the pharmacy, check to make sure that the pills in the bag are the pills that you use. Pharmacists make mistakes also.
- When leaving your medicine bottles around to remind you to take them, be careful if you have children so you do not leave the pills in a easy spot for a child to grab.
- Be aware that certain prescription medications have a high potential for addiction or abuse. If you find yourself taking more of a medication than prescribed, call your doctor immediately to talk about the change.
- Some medications, such as those classed as controlled substances, may not be appropriate to leave around the house. Place them in a locked cabinet, box or drawer, and do not move them from one building to the next. Try to not let others know that you are on such medications and avoid taking them in public. It’s not uncommon for people to steal certain medications, either to abuse themselves or to sell to others with similar intent.
- It’s a Federal offence to transfer a controlled substance to anyone other than the person to whom it was prescribed (you). If you do wind up victim of a theft, report it immediately to avoid potential prosecution.
- Some medications have ‘black box warnings’. This means that when taken incorrectly, or by those with certain conditions, fatalities may arise. Place these and other such medications in a safe location and call your doctor right away if you think you might have accidentally taken more than prescribed.
- Sometimes the pharmacist gives out a stranger’s prescriptions by accident, read the label carefully.
Sample Medical Info Sheet to Carry With You
HEART TRANSPLANT RECIPIENT
Best Hospital USA
Birth date 2-17-1950
9180 orchard lane anycity, USA
Home 555-555-5555 Cell phone 555-555-5555
SS # 555-55-5555 Spouse; Jane Doe; Cell phone 555-555-5555
Primary, Dr.Sawbones Anycity USA
Transplant Pulmonologist, Dr. Breatheasy best clinic USA
Transplant Cardiologists, Dr. Heartthump best clinic USA
Transplant Coordinator: Nurse Jane best clinic USA
Primary: Best Pharmacy USS
Secondary: Second best pharmacy USA
Primary — Medicare part A, Hospital, part B, Medical.
Secondary, AARP Medicare Supplement .
Medicare part D Prescriptions, AARP Medicare RxEnhanced
Allergies:Penicillin, cats, all seafood/fish, mold, dust.
Blood Type: B Positive
Heart related medications
- Anti-rejection Cyclosporine 200 mg twice a day
- Anti-rejection — Cellcept 1000 mg twice a day
- Anti-cholesterol — Prevastatin 20 mg once a day
- Blood Thinner – Aspirin 81 mg once a day
- Blood Pressure – Amlodipine Besylate 5 mg twice a day
- Reflux – Omeprozole (Prilosec) two 40 mg twice a day
- Thyroid — Levothyroxine .088 MG once a day (upon arising)
- Asthma – ProAir albuterol rescue inhaler as needed
- COPD – Foradilinhale one capsule twice a day
- COPD – Spiriva inhale one capsule once a day (upon arising)
- Depression-Remeron 7.5 –mg once a day-
Calcium – 600 mg tablet with Vitamin D twice a day
Multi-vitamin– one tablet once a day
- Asthma, hay fever, allergies diagnosed 1941
- COPD diagnosed October 2000
- Restless leg syndrome diagnosed 1996
- Chronic lower back pain
- Heart transplantBest Hospital
- Anywhere USA August 2007
- Cholecystectomy 1994
- Total left knee replacement 1998
Bob Aronson of Bob’s Newheart is a 2007 heart transplant recipient, the founder of Facebook’s nearly 2,500 member Organ Transplant Initiative and the author of most of these donation/transplantation blogs.
- You may comment in the space provided or email your thoughts to me at email@example.com. And – please spread the word about the immediate need for more organ donors. There is nothing you can do that is of greater importance. If you convince one person to be an organ and tissue donor you may save or positively affect over 60 lives. Some of those lives may be people you know and love.Please view our video “Thank You From the Bottom of my Donor’s heart” on http://www.organti.org This video was produced to promote organ donation so it is free and no permission is needed for its use.If you want to spread the word personally about organ donation, we have another PowerPoint slide show for your use free and without permission. Just go to http://www.organti.org and click on “Life Pass It On” on the left side of the screen and then just follow the directions. This is NOT a stand-alone show, it needs a presenter but is professionally produced and factually sound. If you decide to use the show I will send you a free copy of my e-book, “How to Get a Standing “O” that will help you with presentation skills. Just write to firstname.lastname@example.org and usually you will get a copy the same day.Also…there is more information on this blog site about other donation/transplantation issues. Additionally we would love to have you join our Facebook group, Organ Transplant Initiative The more members we get the greater our clout with decision makers.
Are brain dead patients really dead? That’s the question many people are asking because of stories circulated by irresponsible journalists, TV shows and movies who seek sensational plots and people who just refuse to acknowledge the facts.
The simple answer to this question is, “Absolutely. If you’ve been declared brain dead by a qualified team of experts in a hospital setting then you are dead. The New York Organ Donor Network put it best, “There are more tests to establish death done on potential organ donors than there are on people who are not donors.”
There have been several stories circulated about how “Brain Dead” people have recovered and gone on to live normal lives. I have spent the last month looking into these stories and have determined that while one or two are unexplainable primarily because families won’t release medical information all the rest were simply not true.
I have interviewed two world famous neurologists who have written extensively about brain death and who were part of the process that developed the rules for making that determination. The protocols for determining brain death are more rigorous than for proclaiming death under normal circumstances. Every single neurologist, physician or other medical expert I’ve talked with has said the same thing, “No one recovers from brain death!” New protocols were established in 2010 to make the testing even more rigorous and they require the physician who is declaring brain death to fill out a check list to be sure every step has been completed. Again, this process is more rigorous than what is used to declare death under normal conditions.
Here’s the checklist that must be followed in order to declare brain death:
Cause of Brain Death:
Date of Exam: ____________________________
Time of Exam: ____________________________
A. Absence of Confounding Factors: RESULTS
1. Systolic blood pressure > 90 mmHg ______________________
2. Core temperature > 36˚C ______________________
3. Negative for drug intoxication or poisoning _______________________
4. Toxicology results ______________________
5. Negative for neuromuscular blocking agents ______________________
B. Cranial Nerve Reflexes and Responses:
1. No spontaneous muscular movements ______________________
2. Pupils lightfixed
3. Absent corneal reflexes ______________________
4. Unresponsiveness to intensely painful ______________________
stimuli, e.g. supraorbital pressure
5. Absent response to upper and lower ______________________
airway stimulations, e.g. pharyngeal and
6. Absent ocular response to head turning ______________________
(no eye movement)
7. Absent ocular response to irrigation of the ears ______________________
with 100 mls. of ice water (no eye movement)
8. Apnea PaCo2>60 mmHg ______________________
a. PaCo2 at end of apnea test
b. PaO2 at end of apnea test
C. Medical Record Documentation of the above Examination
Certification of Death
Having considered the above findings, we hereby certify the death of:
Physician Signature Printed Name Date/Time
There will always be naysayers and people who “know of people who recovered” but I am satisfied after considerable research that when brain death is declared it is final.
Brain death is never declared by anyone with any connection to organ recovery and transplantation. The transplant team is not even aware of the patient until after brain death has been declared. The physician who declares brain death is independent of the recovery and transplantation team. Physicians who attend to patients on a regular basis are sworn to and legally committed to do everything possible to save your life. They are not part of the transplant team either and in many cases the hospitals where people are declared brain dead don’t even have transplant teams because they are not transplant centers.
To add to theevidence I have offered is this information from Stacey Gelowitz Renal Transplant Coordinator at Alberta Health Services Edmonton, Canada Area Hospital & Health Care. While she is in Canada the American and Canadian processes for declaring brain death are virtually identical. Here’s what she wrote:
“At our center, we define neurological death by two criteria: irreversible loss of the capability for consciousness AND irreversible loss of all brainstem functions (including breathing). The protocol we follow for adult NDD is as follows:
Done twice by 2 physicians independently, who are not associated with transplantation
(1) Deep unresponsive coma with known cause
(2) Absence of confounding factors (eg. alcohol, tricyclic antidepressants)
(3) Temp > 34 degrees C
(4) No brainstem reflexes
a. No motor responses except spinal reflexes
b. No cough
c. No gag
d. No corneal responses bilaterally
e. No vestibulo-ocular responses bilaterally
f. No oculocephalic reflex (Doll’s eyes test; contraindicated in spinal injury)
g. No pupillary response to light bilaterally (pupils 6mm)
h. Apnea test, pH < 7.28 and PaCO2 > 20mmHg above pre-apnea test level
(5) If pt doesn’t meet all above criteria, do ancillary tests to show absence of intracranial blood flow:
a. Radionuclide cerebral blood flow study
b. Cerebral angiography
It can be hard for families to comprehend that their loved one is dead because the heart continues to beat spontaneously and the person is supported by machines so they look asleep. Important to note is that…
* No brain function remains (in contrast to coma/vegetative state).
* Heart continues to beat because of mechanical support stabilizing body, e.g. ventilators. Remember: Sinus rhythm is controlled by cells within the heart (SA/AV nodes), so as long as the heart is being perfused adequately (getting O2 via blood), it is happy to continue beating. Medulla oblongata in brain controls rate and strength of beat, but not basic rhythm).
* Blood still flowing to body organs (heart, lungs, liver, kidneys, pancreas) allowing transplantation if donor family consents, the organs are functioning adequately, and the potential donor has no serious health concerns
It is VERY IMPORTANT that the donor does not have any factors that confound the diagnosis of brain death. I think it is in these circumstances that brain death is (very rarely) wrongly diagnosed. A great website that you can refer to that touches on these ideas: http://www.braindeath.org/clinical.htm. It goes through different confounding factors and why physiologically in their presence brain death cannot be declared.
I have not seen any reports where pts recover from ‘brain death’ and it was not due to one of these confounding factors. We have gotten much better as a medical community at recognizing the suppressive effects of this list and know now not to declare brain death in the their presence. I think where patients extremely rarely slip through that can lead to wrong diagnosis of brain death is in the following two circumstances: (1) pts are on an unknown substance that is not tested for on toxicology panels and suppresses brain stem reflexes. Or, (2) a pt receives a drug in hospital (eg sedative to stop seizures or allow intubation) and the pt metabolizes the drug extremely slowly. The latter example (slow drug metabolism) is more applicable to children/babies rather than adults, but can happen in both (here is a case study from our center describing just that: http://www.ncbi.nlm.nih.gov/pubmed/19818943). As a result, the time in which brain death is declared was extended.
People need to understand that these instances are incredibly rare. If there is any doubt that one of these confounding factors is contributing to a wrong diagnosis of brain death, another tox screen or temp etc can be done to rule out such factors. Take a look at the cases people are presenting on reversible brain death. I would bet that all fall under what is discussed above. That said, some people will still stick to their guns and not believe you no matter how much info is provided, and that’s okay too”
If anyone needs more information that I have provided here I suggest you contact a neurologist at your nearest transplant center and ask him or her. If you still doubt the process then perhaps you should not be a donor.
Bob Aronson is a 2007 heart transplant recipient, the founder of Facebook’s 1700 member Organ Transplant Initiative and the writer of most of these donation/transplantation blogs on Bob’s Newheart.
You may comment in the space provided or email your thoughts to me at email@example.com. And – please spread the word about the immediate need for more organ donors. There is nothing you can do that is of greater importance. If you convince one person to be an organ and tissue donor you may save or positively affect over 60 lives. Some of those lives may be people you know and love.
Please view our video “Thank You From the Bottom of my Donor’s heart” on http://www.organti.org This video was produced to promote organ donation so it is free and no permission is needed for its use.
If you want to spread the word personally about organ donation, we have a PowerPoint slide show for your use free and for use without permission. Just go to http://www.organti.org and click on “Life Pass It On” on the left side of the screen and then just follow the directions. This is NOT a stand-alone show, it needs a presenter but is professionally produced and factually sound.
Also…there is more information on this blog site about other donation/transplantation issues. Additionally we would love to have you join our Facebook group, Organ Transplant Initiative The more members we get the greater our clout with decision makers.
Each day 19 people die because there are not enough transplantable human organs to fill the need. The United Network for Organ Sharing (UNOS) which coordinates all transplants in America maintains a list of people who need life-saving transplants. As of today, January 2, 2012 the numbers are:
Waiting list candidates 112,702
Transplants January – Sept. 2011 21,354
Donors January – Sept. 2011 10,558
Right now, as you read this a patient, maybe a child, is near death. She needs a heart but there won’t be one. As the electronic monitors beep and chirp, the family is devastated, inconsolable in the frustration over the lack of organ donors and the imminent death of their loved one. The best medical care in the world is at their fingertips but they are helpless without an organ donor. The patients vital signs are dropping more rapidly now, the Doctors aren’t holding out much hope.
Right now as you read this, another patient not too far away has already been declared brain dead as the result of an auto accident. He is surrounded by a grieving family. It is not known if the patient is or wanted to be an organ donor. The family is considering a request to donate his organs but the decision must be made soon and they don’t know what to do, their loved one never told them of his wishes. Through tears and indescribable grief they discuss, they argue and then decline. Both patients die.
Each year Americans bury or cremate more than 20,000 transplantable organs – 20.000. Surveys continually indicate that over 90 percent of Americans approve of organ donation but in one of the greatest mysteries ever, only 46 percent actually make the commitment to do so. This inaction, this procrastination is causing people to die, families to grieve and patients who are awaiting transplants to live their lives in absolute terror. People who are not organ donors are not evil, they are not bad, they just don’t understand that their lack of action causes terror among patients as great as that caused by the real terrorists of the world.
Most people who aren’t donors, “Just haven’t gotten around to it.” After all, there’s no rush for them. Organs are recovered after a person dies and most potential donors are in pretty good health. The problem is that the patients who need the organs are not in good health. Everyone who is on that UNOS list mentioned earlier, is dying. Without a transplant they will die. Period. End of story.
Well, let’s make the donation process really simple, so simple you can do it from home, your office, on your I-pad or Kindle in your doctor’s waiting room anywhere. You don’t even have to get up. Just go to www.donatelife.net and follow the instructions then tell your family what you have done. It only takes minutes. Then make very sure they clearly understand that you want to be an organ donor. “That means when I die I want the medical people to take as much of my tissue and as many of my organs as they need to help save or enhance the lives of others.” Those are my distinct wishes please respect them should the time come.
That’s the first step to saving lives by helping to increase the number of donors. The second step, just in case you like this cause and want to do more, is to spread the word to convince others to do the same. “So,” you say, “How do I do that, how do I spread the word?” Here are ten easy tips, I’m sure that if you think real hard you might be able to come up with ten more.
- 150 words is about a minute’s speaking time. Write out about 150 words on why organ donation is important to the donor…the donor and then post it everywhere you can think of on the internet.
- Call your local Organ Procurement Organization (OPO) and volunteer to speak on behalf of donation.
- Buy the green “Donate life” wristband at www.donatelife.net and wear it every day. If someone admires it give it to them and ask them to wear it. What’s a few bucks to save some lives?
- Ask your pastor to give a sermon on organ donation…offer to help gather the information for him/her.
- Write a letter to the editor…actually send it to every editor you can think of.
- When some radio talk show host least expects it…call about the importance of organ donation
- Offer to speak to a local service club about donation/transplantation issues (Kiwanis, Rotary, Lions etc).
- Add a short note about organ donation to the signature of every email you send “Did you know that one organ/tissue donor can save or positively affect up to 60 lives?”
- Talk to a public school class about donation/transplantation
- Start a blog…it’s really easy. Just Google “free blog sites” and go for it.
You may comment in the space provided or email your thoughts to me at firstname.lastname@example.org. And – please spread the word about the immediate need for more organ donors. There is nothing you can do that is of greater importance. If you convince one person to be an organ and tissue donor you may save or positively affect over 60 lives. Some of those lives may be people you know and love. Please view our video “Thank You From the Bottom of my Donor’s heart.” Just go to www.organti.org and click on the title. This video was produced to py romote organ donation so it is free and no permission is needed for it’s use. You’ll also find other useful information on this web site about other donation/transplantation issues.
We would love to have you join our Facebook group, Organ Transplant Initiative (OTI) The more members we get the greater our clout with decision makers and the more clout we have the more likely it is that we’ll be able to increase not only organ donation but the many alternatives that science and technology people are working on.