The Meaning of Life

Monday Bonnie and I drove to Minneapolis for my annual checkup at the Transplant Clinic at Hennepin County Medical Center. My appointment on Tuesday was only a couple years overdue. In 1975, when I received a kidney transplant there it was called Hennepin General Hospital, but that's another story.

View from our Minneapolis hotel

You know how when you have an appointment at the dentist or for some medical procedure and this nagging feeling of dread is constantly in the back of your mind. For me it's the dermatologist; when he comes into the exam room he is always carrying this liquid nitrogen gun-like device and I know that every time I go there I'm going to get zapped. The Transplant Clinic though, for reasons I still don't completely understand, is not like that. I always feel safe and comfortable about coming to that clinic; almost like a homecoming.

The Appointment

The appointment started with a bone scan at 7:40 and than a blood draw and physical with the nephrologist (kidney doctor)  starting at 8. Jonna drew my blood sample, then the nurse (Kathleen) did vital signs and asked about one thousand questions while she updated stuff in the computer; they are now using EPIC, (EPIC is the General Motors of medical info. systems). A very informative pharmacist went through my lengthy med list. The nephrologist, Dr. Israni, did the exam, all pretty uneventful. You know sometimes boring is pretty darn good.
They told me I was their longest surviving transplant (with a functioning kidney) being seen at the clinic. I know of at least one HCMC transplant (Darrel L.) further out than me, but he is now getting his follow-up somewhere else.

Tuesday morning blue skies

Restaurants and Coffee Shops

By the time we were done, around 10 AM, I was feeling pretty hungry after a 12 hour fast prior to the blood tests. Years ago in the bowels of the Medical Building there was the Cousin's Restaurant; they had excellent food and service. Collins cafe, now in that space, has become a shabby little hole in the wall with mediocre food and dreadful coffee. After having some food I was feeling the need for a cup of 'real' coffee. We walked through a tunnel to another building where there is a coffee kiosk. A barista (very friendly or maybe just high on caffeine) asked if I had any questions. So I asked her: "what is the meaning of life"; she said "You work until you die." A few yards past the kiosk is a staircase with a rather impressive portrait of Dr. Fred Shapiro. The late Dr Shapiro was the driving force behind a large network of end-stage renal disease programs throughout Minnesota and the Dakotas. But that's another story. Sitting there drinking our coffee we talked about restaurants and such. That brought up one memorable restaurant visit.

Dr Shapiro with early artificial kidney

The Moonface Club

In late October of 1975 there were four of us who had recently received a new kidney at the Hennepin General Hospital. High doses of prednisone will cause temporary changes to one's appearance, among them rounding of the cheeks making your face look like the Man in the Moon and thickening around the waist.
The first transplant was Tom R. He was a high school teacher in St.Paul, his wife Sue a stay at home Mom. Tom had been on dialysis for several years but had been able to continue teaching. The long hours on the machine, the anemia and other complications had been wearing on him. His new kidney came from a sister who wasn't as good a match as the transplant nephrologists liked, at that time. Tom and Sue both admitted to pressuring the transplant program into accepting Tom's sister's donation. Next was Mary Ann K. from Belle Fourche SD, who was only a year or two out of High School. She had an attractive white streak of hair, I think she called it a Mallen Streak. Mary Ann got her kidney from a deceased donor. I was third, and the latest was Amy T., an Asian girl in her late teens or early 20s; her family owned a Chinese restaurant in a northern Minneapolis suburb. Amy's kidney was donated by a brother. Sue told a story of Amy's parents "marching" her brothers into the clinic and lining them up to be tested for compatibility. Over the eight weeks after surgery that I needed to stay in the Twin Cities, we got to know all these people pretty well and frequently met for coffee or lunch. The diet on dialysis is very restricted, no salt, no fruits, only a few vegetables, and most patients had very restricted fluid intake. Just being able to eat a normal diet and drink a glass of beer felt like such a treat; add to that the camaraderie of people in the same situation and fun surroundings, each time was a mini celebration. Sue always knew the best places to go.
Sometime in late November or early December we all got together at a restaurant in downtown Minneapolis for one last time before Mary Ann went home to "Belle". It seemed to me that everyone was feeling happy and blessed to be alive and in a state of health we had not known for many months or years. Although Tom was having some minor rejection issues, that day it was like there were only good things lying ahead for all of us. We talked about getting together again next year and every year. Sue wondered out loud how many of us would still be around with functioning kidneys in five, or ten years. As I remember, the conversation went along the lines of not worrying about that, being grateful for each day and how we would apprecitate five years, but ten or twenty years would be wonderful. I don't think anyone even imagined thirty or more years.

Tom

The next summer we talked to Sue and Tom at their home in St. Paul. Tom was still having rejection problems, but was optimistic about the kidney and looking forward to teaching in the fall. The thing about Tom was his personality, a consistent optimist, he was friendly to everyone, outgoing, and always made others know he was interested in them. He loved teaching and from what we heard, his students loved him. Later that year on another follow-up appointment, we arranged to meet Tom and Sue at a new restaurant in the warehouse district of downtown Minneapolis. When they arrived, Tom was walking with some difficulty with a cane and apparently was having eyesight problems. He looked very puffy and was losing a lot of hair. The corticosteroids being used in the 'heroic' attempts to reverse his rejection were taking a toll on his hip joints as well as causing cataracts. On that day, even though he was no longer able to teach, he still had a positive attitude and was looking forward to his upcoming hip replacement surgery. Not long after that, maybe a year or so, Sue called and said that Tom had passed away from complications after losing the kidney. Although unable to get inside Tom's head, I think I might know how I would have felt during his rejection episodes. I would have had some guilt about pushing for the transplant surgery when the odds were not good and because of that I might have been reluctant to stop the aggressive treatment, even though the odds were against a good outcome.

Mary Ann

Was fun to know and be around. She was such a cheerful girl, maybe a little naive for someone of twenty or so years. Very close to her mom and dad (Nadine and Dave). They had wanted to give her a kidney, but neither was an eligible donor. Dave had medical issues and Nadine was not a match. Mary Ann was maybe a little dependent, I think that happens sometimes when a child has a chronic illness. We kept in touch with Mary Ann and her parents seeing them on trips to the Black Hills. I worked with someone (Linda J.) with whom she had been high school friends; through her family, Linda would give me updates on Mary Ann. On one of our trips to Western South Dakota Mary Ann told us about her engagement. He worked at the Bentonite mine near Belle Fourche. She was excited about the upcoming wedding, wanted us to come and would I be the wedding photographer. I had to find an excuse; there was no way I could fulfill a brides high expectations. Later that night we went with Mary Ann, her fiance, Dave and Nadine to a cowboy bar in Belle Fourche. This cowboy bar was a real cowboy bar with real cowboys (some packing iron), loud cowboy music, a lot of dancing and other cowboy stuff; we all had a great time. 

A couple years later Linda told me that Mary Ann's marriage had failed because "he had some fidelity issues". We fell out of touch for a while and then heard that Mary Ann's hepatitis B had returned. In those days, nearly everyone on dialysis for very long was exposed to Hep B. Some got ill with jaundice or other problems, but most had no symptoms; for some the virus stayed dormant. The latter group were always at risk for severe liver disease if the virus activated. In Mary Ann's case it was liver failure. She died about 11 or 12 years after her transplant.

Amy

We saw Amy only once more, but we kind of kept in touch through the Transplant Clinic. In those days before HIPPA, the law that defines patient privacy rights among other things, clinic people were less reluctant to discuss other patients. We happened to be there for a checkup when she was hosting a pre-nuptial dinner at their restaurant. We went to the restaurant, it was open for business, and she was able to sit with and talk for a few minutes. It was easy to see she was going to be a radiant bride. After that we heard she was doing well, had children, had traveled to China, and then later that her kidney function was declining. Apparently her kidney no longer functions; whether she has a new kidney or is still alive, I don't know. 

Survivors Guilt?

Yes, there definitely is some. I can't help it; kind of like surviving the Titanic I suppose, mine being the only surviving kidney from that 'moonface' club. After nearly thirty-seven years the moonface has been replaced by a mass of wrinkles, and somehow the thick waist has reappeared. The beard has turned from red to gray, the hair turned gray and is now almost white.

Postscript

Vast improvements in immunosuppressant therapy have been made in recent years. More recent transplants have a much greater chance of lasting as long as or longer than mine.

The Best People in the World

 Are organ donors, living (especially my sister Kris) and deceased, and the families of deceased donors. The nurses, nephrologists, surgeons, dialysis technicians, and clinic staff rank right up there too. I should also mention that any phlebotomist who can get blood from my reluctant veins deserves a medal. Having collected blood from thousands in a previous life I can relate; I used to hate people with crappy, thready, rolly little veins, now I are one.

My sister Kris with me at last dialysis in South Dakota

So What Is The Meaning of Life?

 I think the Meaning of Life is just to live it, embracing the sorrow as well as the joy. All are part of this precious life.