Wednesday, 12 November 2014

Day Thirty-Three

1.  Misrepresenting organ donation and transplants on Holby City 

Other than those set in our own hospitals (such as the fantastic Children’s Hospital:The Chaplains on at the moment) and the beautiful ‘Call the Midwife,’  I haven’t watched any TV medical documentaries or dramas for over five years. I have quite enough of this in my own life and the last thing I want to do when I get the chance to relax with the television is bring more of it into my mind and spirit. Medical dramas always infuriate me anyway because they get things so wrong. Yesterday, I picked up from Facebook that ‘Holby City’ were doing a lung transplant story so I decided to watch to see how the depicted it.  It was atrocious! I always thought Holby researched their content pretty well but it was quite the most diabolical piece of TV drama I have ever seen.

A girl came into the ward with supposed end stage cystic fibrosis. I know a fair bit about this from friends I have made in the transplant community. I know that someone who has literally hours left to live without an urgent lung transplant would not be able to talk in sentences and be wheeled off to x-ray without any oxygen! There was worse to come though. The consultant asked everyone to do everything they can to get the organs and, within hours, one of her team came running up from A&E to announce there was an road traffic accident coming in with two people already confirmed brain dead, one of whom was a match and the family have consented. You just can’t do that! Being declared brain dead is a long and considerate process, involving independent doctors and two rounds of tests. Counselling a family to agree to organ donation is also a process that takes time and care and would not be done in the ambulance on the way in to A&E!! I was horrified at how the series had shown this side of the transplant story.

So then, we get to the transplant itself. The surgeon was a general surgeon who had apparently done one or two transplants but not for a while, not the amazing, super specialist transplant surgeons we have in our units across the country. She and her anaesthetist were all high fives about getting though and proclaimed themselves ‘team transplant!’ So it’s that easy to become a transplant team! I found this really unfair to the amazing work, training, personal development and expertise our real transplant teams have. It belittles all of this to the public! It would be bad enough on a cheesy day time medical drama but people have respect for Holby as a flagship BBC drama based on the truth and on good quality research!

The worst was still to come though. The patient arrived straight back onto the ward, to exactly the same place she had been before, looking as if she had just been for a scan or something. She would have been more groggy if she had had her tonsils out! She barely had her oxygen mask on, was breathing fine and, once again, talking in full sentences. No drains, no ventilator. Nothing like the reality of recovering from a lung transplant which starts with several days at least in intensive care on a ventilator, slowly weaning it down and then hours of hard work with physios learning to breath fully again and well enough to co-ordinate talking properly.

I think it is great that a major, prime time TV show is looking at organ donation and transplants but they need to get it right!! Doing such a bad job is worse than doing nothing at all, far worse!

2. Flashbacks and premonitions? 

Last night I had the strangest of dreams. It was so real that I really thought it was happening. I was sitting in the counselling room in the PICU (intensive care) at Birmingham Children’s Hospital and it looked exactly as it did six years ago after William’s first transplant. I was there with William’s dad and his transplant surgeon and one of colleagues were sitting in there with us, telling us how his re-transplant had gone and what was going to happen in the immediate few days. It had gone very well, other than a few heart arrhythmias apparently (not something Wills experiences in general so I have no idea where that came from) but nothing they hadn’t been able to cope with. He was going to be left sedated to sleep for the next two or three days while his body rested and stabilised and then they would wake him up and take him to the ward, all being well, so he could recover. My dream was really peaceful, I was worried of course and keen to get through the initial, PICU stage and onto the ward, but there was a sense that things had gone as well as possible.

I didn’t dream anything about the transplant first time round. I guess, this time, I know the people involved and I know the hospital so it’s easier to see it in my dreams. They are a combination of flash back and anxiety dreams I suppose.

I am very much looking forward to that moment when the surgeon comes in to tell me all has gone well but, at the same time, I know the operation is just the beginning really. I fully expect Wills to come through that OK (although have been warned there can be complications on the table that could even, at the very worst and very rarely, end up in the operation having to stop there and then). I know that the real challenges for Wills and his amazing team will begin in the days and weeks following when we balance infection and rejection and the impact of having already had a transplant and spending the last six years on immunosuppressive drugs will have on his new organs and his body as the new organs settle down and begin working. I’m very optimistic and positive about all of this too but I know there will be some huge ups and downs and it will be a real ‘hold onto your stomach’ roller coaster ride at times…

3. Midnight 

My brain is a hunter gatherer
stockpiling, as if in the midst
of a drought of ideas and stimuli
My body lags behind
its own creations

(as always, just an idea, a kernel of a poem far from anything finished)

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