Makes Me Wonder...

"Why are people like this? They can't be bothered to show up when the person is alive (but very sick), so why do they think they can/should show up when they are dead?"

At work, I have heard some family members comment how disappointed and angry they are about the fact that this happens. They have watched their loved one/family member go from being vibrant members of the community who may have been the life of the party... to people suffering from long term illness and eventually death. Why do "friends" and family stay away when times are hard? I guess this is a cruel lesson to learn about who your friends are and who they are not. It is cruel lesson to learn that the people you thought loved and cared for you or your loved one, really don't know how to be there in the tough times.

I know that there is a idea of the fair weather friend. The friends that are there when times are good. Or the people that meant to be in your life for a time and place and then fade away or move on. And that there are people who are able to stick it out in the difficult times. True, we don't always know what to say or what to do when things seem bad. True, at times there are people that we question why they are there, or what their motive/intent is. And there are some people that we don't really click with anyhow....

Illness or suffering brings out the true nature of people. Weddings and funerals are said to be the times when you will see the family dynamics come to life. The things that we had hoped to ignore or had hoped would go away come floating to the surface and that is when you see the "ugly-ness" of the system dynamics.

I guess this comment makes me wonder.. what is the motivation of the people who show up for the funeral but not when the person is alive, and who is/are the people that I have been neglecting in my life?

From CBC news.. this past week..

Multi-donor, long-distance kidney swap a first in Canada

Last Updated: Thursday, June 25, 2009 | 6:30 PM ET Comments25Recommend63

CBC News

Domino kidney transplants mean fewer people are left on waiting lists, says Dr. Edward Cole. (CBC)

Four Canadians have new kidneys thanks to the country's first pay-it-forward exchange of organs from Toronto, Edmonton and Vancouver.

Living-donor kidney swaps are based on the idea of group co-operation: a donor whose kidney isn't compatible with a loved one who needs a new kidney agrees to donate to a stranger. In exchange, the partner receives a kidney from someone else.

Simultaneous kidney swaps have been done in Toronto before, but this multi-city swap had to be carefully co-ordinated across three time zones.

"It's been challenging," said Dr. Edward Cole, chair of the National Living Donor Kidney Exchange Program. "This is a real success story of people collaborating across the country, and with important input from Canadian Blood Services."

Timing is key, given ethical fears that once a patient receives a kidney, their partner could rescind an offer to donate. A donor or recipient might also have to back out after falling sick.

To avoid any last-minute problems, all donors were put under general anesthesia and none of the donor operations were started until all surgeons confirmed by telephone that they were ready to begin.

In this case, donors travelled to where the recipients were: two to Toronto General Hospital, one to Edmonton's University of Alberta Hospital, and another to St. Paul's Hospital in Vancouver. Each site had more than 50 medical personnel involved.

It's also possible to fly kidneys between cities, since the organs remain viable for 12 hours after donation.

For some patients with severe kidney failure, a donation from a live donor offers better and faster results than transplants from deceased donors, said Cole, who is also the head of the University Health Network's kidney transplant program in Toronto.

Good Samaritan

In kidney swaps, the living donors are medically acceptable but are incompatible with their loved one based on blood type and other traits. The intricate process was featured on an episode of Grey's Anatomy.

There are 4,380 on Canadians on the kidney transplant waiting list, according to the Canadian Organ Replacement Registry. In many cities, people wait seven or eight years for a kidney from the time they start dialysis, said Dr. Edward Cole, chair of the National Living Donor Kidney Exchange Program.

Previously it has not been possible to use donors in this way because there was no national database to co-ordinate the matches.

Three of the donors had offered to give loved ones a kidney before, but weren't the right match. The fourth donor was a Good Samaritan.

"The best untold story is that one of the donors is an anonymous donor," said Dr. Sandra Cockfield, medical director of the renal transplant program at the University of Alberta.

"So this is an individual who came forward to donate not to someone they actually know on the waiting list, but had heard about the long waiting lists and the difficulty of living on dialysis," and came forward to donate to a stranger.

In this surgical marathon, the Good Samaritan or "non-directed donor" came forward and was matched to a recipient, allowing the chain of paired exchanges or domino surgeries to take place. The Good Samaritan was thus able to facilitate four transplants, including the last to someone on the waiting list.

Since many pairs are needed to improve the odds of a match, a national program works much better than a local one, Cole said.

The transplant surgical marathon required months of planning by Canadian Blood Services, which set up the national registry. Paired exchanges have also been performed in the U.S., but no national registry exists there.

"We're offering a new of getting transplants, and then it puts less pressure for all those who are waiting on the wait list," said Dr. Peter Nickerson of Canadian Blood Services in Winnipeg.

Donors and recipients are all recovering well in different wards to maintain their anonymity.

The pilot project involving B.C., Alberta and Ontario is going national.

"The fact that it's a possibility for me now opens up so many more doors, and it's a very exciting prospect," said Didja Nawolsky of Calgary, who is on the waiting list for a kidney. While she waits, Nawolsky gets 10 hours of dialysis daily.

Doctors involved are already scouting their next cross-Canada, multi-kidney swap.

Thought for the day

My colleague mentioned that he had heard a speech by a military chaplain who referred to our work as "intentional loitering". Neat idea.

Question to ponder

"What is the Spiritual meaning of this event in your life?" This is a question that was posed to me in recent weeks. I think that this is a question at the heart of most events in our lives. What is the significant of this event/happening in our life? at this point in our life, as we are living it and in hindsight, what do we make of it as we reflect on some event that has occurred in recent months or years? I suppose that various events take on different meaning to us depending on what we are dealing with at any given time. It is usually hard to figure out the meaning of things as we are in the midst of the chaos or action, but upon reflection, it might be easier to discern the impact on our lives.

Often this is the question that I ask of my patients. That based on where you are at this time in your life, how do you make sense of this event? What is the meaning of this happening? What is giving you purpose at this time in your life?

This may seem simple, but really, it takes a while to ponder. One patient told me yesterday that when I went her months ago, it was what I told her and the fact that I listened as she tried to make sense of her illness that helped her to see it in a different light. Often the answers are not known to us right away, but take time to discern. Sadly, not everyone engages in self-reflection.