On May 31, 1994, my brother Charles Uzzell donated a kidney to me. I had been on peritoneal dialysis for two years. This is my story.
My boyfriend Gary drove my mother, Charlie, and me up from San Jose to spend the night in San Francisco, in preparation for surgery the next day at California Pacific Medical Center. My friend Bill Grove was out of town on business and had given us the key to his carriage house behind his landlord's Victorian.
Charlie turned the keys Bill had given us in the lock. We surveyed the apartment and smiled at the gifts Bill had left us: a bottle of wine, a pineapple (symbol of hospitality), and a box of grits (Southern comfort food).
We figured out the sleeping arrangements: Charlie on the sofa, Mama and me in Bill's bed. We ordered pizza, salad and Sprite.
Anxiety floated over us. We couldn't agree what to watch on TV. Charlie and I couldn't have anything by mouth after 12 midnight, not even a sip of water.
Charlie fell asleep on the sofa but Mama and I tossed in Bill's creaking four-poster bed. Finally, I lay quietly in the darkness, the last one awake, as I knew I would be. For the eight months leading up to surgery, my thoughts had always been for Charlie and whether I could justify accepting such a gift. I felt more centered and ready than I had been a week ago when the surgery was supposed to have taken place. I knew I wouldn't fall apart, but I was consumed with the sort of numbness that anxiety creates when you can't focus properly, can't appreciate beauty, feel disconnected from self.
I felt guilty over the stresses I caused my family, over being snappy with Mama, over somehow being broken in the first place, coming from a family that stressed stoicism.
We set the alarms for 5 a.m. but I was awake before that and got up and showered, my last shower for awhile. By the time the taxi was to appear at 5:45, Mama and I were ready and chafing at the bit at Charlie, who was pleasant and cheery as ever but slow as molasses. He wore a pair of shorts over his tiger-striped bathing trunks. Coming from North Carolina, he hadn't anticipated the San Francisco cold.
We joked with the Pakistani taxi driver that we were going for kidney transplant surgeries that day and why didn't he just keep driving us right on up to the beach!
We checked in at registration in the lobby. At 7:00 Charlie went off to the same-day surgery waiting room and we kissed him and I told him to be good. Nobody cried. I went off to find a bathroom, glad for the primitive impulse that prepared our distant ancestors when under stress for flight or fight. It's good to go into surgery with an empty digestive tract.
When I came back, Mama said she could hear Charlie talking and joking around in some back room where they were putting an IV in. He went into surgery at 7:30 a.m. as scheduled.
So we waited. I did my last peritoneal dialysis draining in the waiting area and did some yoga stretches. Mama and I embraced and our eyes filled with tears. We sat.
About 10, a reassuringly weathered-looking nurse took me backstage and efficiently inserted an IV on the side of my wrist. They started dripping the immunosuppressant cyclosporine in me. I'll be on this medication the rest of my life or until the graft fails. It inhibits the white blood cells that fight off invaders in our bodies--and Charlie's kidney, despite being a 100%-compatible, 6-antigen match--is still foreign tissue.
My friend Tina came in to keep us company, looking worried and like she hadn't slept all night, which indeed she hadn't. It was good to have the distraction of Tina there, with her wide-open-spaces laugh and ready stories. She succeeded in keeping our minds off Charlie, though every now and then either Mother or I would say, "Well, I guess they've got that kidney out by now," or "I hope everthing's going smoothly," and later, when the surgery ran past the time Dr. Bry said it should be finished, "I wonder if something went wrong?" At 12:45, Dr. Bry came in and told us that everthing went well, though it had been hard to get the kidney out of Charlie because he's so big and because there were two veins they had to deal with that hadn't showed up on the angiogram. Charlie hadn't needed any blood transfusions. He was fine.
Now it was my turn. Dr. Bry said he was going to take a 45-minute break and he'd see me in surgery shortly. The kidney was put into a special container, drained of blood, and I think treated with some solution. A guy named Rodney introduced himself and said he'd come to take me down to surgery. I hoisted myself onto the gurney, careful of my IV.
We rode down a floor or two on an open elevator--it appeared that a guy was working on it because he paused to work the controls to send us down. Rodney said "Here's the kissing zone," and Mama and I kissed and said we loved each other and I went throught the pushdoor to my date with the surgeon.
I couldn't see much from a prone position but the hallways seemed busy with people and cluttered with equipment -- hardly the stripped-down, sterile coolness I had expected. Numbness still protected me. No palpitating fear; no raw feelings. Rodney pushed me into a room that looked like a dentist's waiting room and wished me luck. A nurse came in and said she'd be present in my surgery. She'd be the one who inserted the Foley catheter. (Good, a woman.) The anesthesiologist, Dr. Bushman, introduced himself. He was young and I liked him because he looked like an old friend from Los Angeles, with his Modigliani nose and round glasses.
When Dr. Bry came in he found me flipping through a Time magazine. "You look like you're just waiting in a dentist's office," he said.
In the operating room, a pleasant-looking surgeon name Dr. Folger ? introduced himself and said he'd be assisting in the operation. He said I wouldn't remember him tomorrow (but in fact I did). I moved over to the operating table--it was heated--and they strapped me in over my knees. Dr. Bushman ran the anesthetic into my IV line. I asked if people said things when they were going under and they said "yes, your brother told us all about his favorite Bill Cosby episodes." Between worrying about what I might babble and informing everybody that I felt the anesthetic moving up to my elbow, I still had to chuckle.
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The next thing I remember is my friend Barb and Mama standing on either side of me. "It's over." "You're fine." "It went well." "The kidney is working." "You're just going to come through this beautifully and it's going to be perfect and, and...." I manage a wan smile and struggle to match Barb's energy. Then they evaporate. Next a nurse tells me I have another visitor, but no one comes in. I find out later it was Tina and that she came in to find me sound asleep.
Now Mama is standing beside me. She says Charlie has pain and nausea but he's OK. They give both of us morphine. I accept it, though I feel little pain. Actually, I feel a sense of well-being.
During the night I hear dreadful sounds in intensive care. A man is retching. A woman is babbling incoherently and screaming and even the nurses are curious and cluster outside her room.
A doctor with a sonorous, measured voice works on the man who is retching, telling him in a solid stream everything he is doing. I drift in and out of a morphine sleep -- the doctor is still talking. I like him for his calm voice.
I realize this is the last step before death. The people who work here have to perform extreme actions on other people and make the best decisions they can.
The surgeon and physicians assistant visit me. The PA tells me, "That kidney loves being in your pelvis." The surgeon, Dr. Folger, tells me I have a textbook anatomy, lymph nodes laid out nice and clear.
In the afternoon, they wheel me out of Intensive Care (the Cardiopulmonary Unit) up to my room on the 6th Floor. My roommate was a middle-aged Chinese woman who had received a liver transplant four years previously whose kidneys now seemed to be failing. She had a rough peasant voice. Everybody called her honey because she said "thank you" so much and because she was so cute. There didn't appear to be anything wrong with her appetite; she sucked soup and noodles in noisily. She went down for a procedure in the afternoon and came back wilted. She perked up after dinner and we talked as best we could about our families and why we were in the hospital.
Meanwhile, Mother ferried information about Charles, who was in a room down the hall, back to me. He was having trouble with the epidural they had inserted near his spine for pain control with morphine. It seemed to be pinching a nerve, so they removed it and he felt better immediately. Pre-op, Charlie had dreaded the Foley catheter, so he had been relieved to hear that that would be inserted while he was under general anesthesia. He must have persuaded them to take it out--early, I thought--because that also came out that day. I kept checking to see if he had peed yet because I knew that if he hadn't they would insert another catheter to keep his bladder from bursting. By evening, Mama reported that he had managed to pee a little. Meanwhile, he had gone mobile with a vengeance, propelled by the morphine drip they'd given him. He could squeeze himself some whenever he felt the need. I called him "Motor Man" because every time I looked around, there he was with his eyes rolling in his head, motoring along with his IV pole beside him!
While I was in intensive care, they made me sit up on the side of the bed. Now I too had to stand and walk a little. I never came near to Charlie's mobility, but then I didn't have any morphine, either, except the one shot in Intensive Care. (I disliked the rolling vertigo feeling it gave me, so I refused it.) Walking didn't get easier until Friday, when I finally was allowed to have soft food. I think some of my problem with walking might have been due to lightheadness at not eating or drinking anything for 3 l/2 days.
I had three tubes coming out of me: one under my collarbone for intravenous cyclosporine drip and morning blood draws, one to drain the surgical wound, and the Foley catheter into my bladder. (A nurse had removed the pre-op IV in my wrist; it was no longer needed, since I now had the tube under my collarbone.) As if I weren't encumbered enough, I started my menstrual period the day after surgery.
I couldn't really flip around too much so I played with raising and lowering the foot and head of my hospital bed.
By 9 p.m., I starting anxiously awaiting my sister Holly's arrival. Gary was bringing her up from the San Jose airport, and I was looking forward to seeing him too. I hadn't seen him since we'd parted Monday night at Bill's house.
Suddenly they all filled the doorway. Gary came in first and came to my bedside. His eyes were red but glowing with happiness. He told me I looked great, which had to be a lie because I had my glasses on and hadn't bothered to do even rudimentary grooming. I was happy to have him lean down to me, careful not to kiss me on the lips so that he wouldn't give me any germs, so that I could kiss his cheeks and push my nose into his neck to breathe in his familiar smell.
Holly was my Florence Nightingale. She got down on her knees and washed my feet, she created a pleasant clutter around the foot of my bed with newspapers, she brought me water and ice, and she talked to me so that the time passed. Also, on Thursday, my roommate was discharged, so the nurses moved me over by the window, where we could look south and see from the Oakland Hills in the east, out across the Bay to Twin Peaks in the west. The window filled the whole wall of the room and I loved the shifting panorama of clouds and especially the early morning hours when a sliver of moon rode high in the east and the city slowly came to life.
I can't really distinguish the days that followed. One by one, tubes and bandages were removed: first, the dextrose feed, as soon as I reported that I had passed a little gas (nothing to write home about, but that's the key for being allowed to eat). Next, the wick that packed the canal where my peritoneal dialysis catheter had been. (The surgeon had removed the catheter during surgery.) Next, the drain tube in my left side, around my new kidney. Then, the Foley catheter--now I was mobile! And, on the last day, out came the tube under my collarbone.
On Friday night at midnight, I got a new roommate, a 65-year-old woman who was getting a liver transplant. I listened to the doctors come in and interview her and to the nurse giving her an IV and to her son and her talking in gentle voices until 4 a.m., when I fell asleep. In the morning I heard her go down for surgery around 7:30. I told her I knew she'd sail through it, I could tell by her attitude. I liked her immensely for her matter-of-factness and her bravery. She seemed upbeat and wryly humorous, trusting in whatever might come. For example, the plump blonde night nurse preambled inserting the IV with "I'm not a pro at this," which would have immediately caused my sphincters to tighten. Then when she predictably failed to get the IV in, she said, "I think I could get it if I try again, or I could call the resident expert next door. What do you want me to do?"
Mrs. Flournoy replied, "It's up to you, dear." Whereas, at that point, I would have been wondering why the hell the nurse didn't get the expert in the first place--but for god's sake, yes, get the expert next door (which they did)! So Mrs. Fournoy was a sturdy character and her son later told Holly and me that she had indeed come through the surgery well.