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JOINT VENTURE On the day of the transplant, I woke up
at 5, a few minutes before the alarm. I got out of bed, put on a pair of
jeans and a black t-shirt, took the dog out, and carried the garbage cans out
to the curb. The morning air felt warm and humid. My bag was packed and I was
ready and there was nothing else to do so I sat on the front step and waited
for the cab. The cab was early
too. The driver drove quickly, as though keeping time with the South Asian
rock and roll playing on his radio. The streets were empty and every light
seemed to turn green as we approached. I walked into I was in the
hospital on the last Tuesday in June because I was donating my left kidney to
my 26-year-old grand-daughter, Amelia. My last encounter with a surgeon had
been in 1965 when I was 12 and had my appendix removed. But I wasn’t
scared or nervous. I felt intensely alive and full of purpose. For five
months the drama of the transplant and the anticipation of how it might
change our lives had filled my heart to overflowing. If at that moment
someone had turned and asked me why I was there I would have burst into tears. There were
fifteen of us waiting in the office, all middle-aged or older. A young clerk
took our health cards and then clerk called us in two and threes, and another
clerk led us to a yet another waiting room. Then my name was called and I
changed into a hospital gown and put blue cloth booties on my bare feet. I
handed my bag to someone, and walked to the prep room, a large open space
holding about 20 beds, and got up onto a bed. A nurse brought
me a warm blanket. “How are you this morning?” she asked. “Actually,”
I said, “I feel very excited.” She smiled. “Oh,”
she said, “that’s a bit different.” How could I even
begin to explain what I was feeling? Lines from a poem kept running through
my mind, I wake to sleep and take my waking slow / I feel my fate in what I
cannot fear. How could I explain that to her? The nurse took my
temperature and blood pressure. The junior surgeon appeared and introduced
himself and smiled, and then carefully raised my gown and took out a pen and
wrote his initials on my skin under my bottom left rib. He made a small arrow
above his initials. “Just so
there’s no mistake,” he said. “Yes,”
I said. “We want to make sure you and Dr. Mike take out the right –
I mean the correct – kidney.” More people
showed up to ask me questions about allergies and how I was feeling and to
reassure me that everything would be fine. Then they left. I lay there very
comfortably under the hot blanket. The lines of poetry ran through my head
again. Then suddenly I
was in motion. The clock on the wall said two minutes to eight and there was
no time to waste. They wheeled me down one hall, around a corner and down the
next hall. A fierce headwind was blowing in my face. Then a door opened and I
was in an operating room lit brilliantly by a constellation of overhead
lights. A nurse appeared on the right and helped me move from the gurney to a
narrow table covered with a turquoise foam pad. A man standing to my left,
the anesthesiologist, put an IV into my left arm. He asked me if I was
comfortable and I said yes and we talked and then suddenly, with no warning,
no countdown from 100, everything went black. Amelia Bruce came into my life 25 years
ago because I met and fell in love with her grandmother, Judith, at a party
in I met Amelia a
few months later when Alison brought her to Judith’s apartment. I was
painting the baseboard a bright pink when they arrived. Alison said hi. I
said hi. Amelia said something like “Garble garble
GOOGIE garble”, Googie being her version of “Judy”. “I don’t
remember any of this!” Amelia says now. “I mean, I was only two
and a half.” “I remember
it very clearly,” I say. “What I do
remember is that you were always there,” she says. “You were
always my grandfather.” Actually, I was
Amelia’s third grandfather because Judith had two ex-husbands. Being
number three reduced the pressure. This was good because my 30-year-old brain
knew absolutely nothing about being a grandfather. A few years later, after
Judith and I had moved in together, and after Amelia had become a regular
Friday night sleep-over guest, the three of us were having dinner in a “He’s
not my dad!” she piped up. “He’s my THIRD grandfather.” The waiter quickly
apologized and withdrew. Amelia was a
sunny kid, almost happy go lucky in a way. She was also smart, resilient, at
ease in any social situation, and somehow innocent and practical at the same
time. She had a strong side; she was never afraid to voice her opinion, or
ask for something she wanted. She was surrounded by friends and family,
including the multiple grandfathers. Everyone loved her. Philip Bull, who
lived with Alison for nine years when Amelia was growing up, adopted her as
his daughter. (Amelia has had very little contact with her biological father,
who now lives in Judith also
changed direction in the mid-1980s. She went back to nursing, first at a
seniors home and then at Casey House, the palliative AIDS hospice. In 1990 we
moved to Everything
changed for us in April 1997. Judith and I were spending Easter weekend at a
resort in the Gulf islands. Judith called our Amelia had woken
up that morning with swollen ankles. She was having trouble breathing. Alison
took her to a walk-in clinic, where the nurse wisely took her blood pressure.
It was well over 200. They called 911 and got her to Sick Kids as quickly as
possible. Her kidneys had failed. She was on dialysis before the end of the
day. Her disease is
called Henoch-Schoenlein purpura.
It’s a form of vasculitis and in most cases
it’s not serious. Amelia has a rare form that attacks kidney function
and therefore is lethal. Within a year, she had a transplant from a deceased
donor. Those were terrible months for everyone. Judith went to And everything
went well for several years. Amelia was on various medications and a
controlled diet, but her life went on. She finished high school, did an
undergrad degree at U of T, worked at a law firm and eventually landed a good
job as a junior policy analyst with the provincial government. Then, cruelly,
the disease came back. By late 2005 the transplanted kidney was beginning to
fail. We moved back to Judith wanted to
donate but she was over 60, the cut-off age for donors. Philip was the wrong
blood type. Alison was next in line. She began the testing program at Judith called me
at work and asked, “Will you get a blood test?” A donor doesn’t
have to be a blood relative of the recipient, but usually must have the same
blood type. If the blood type matches, a long testing process begins. At the
end of this process, the donor gets a thumbs up or
thumbs down from the transplant team kidney specialist. At any time, though,
the donor can change his mind and back out. Judith’s
words sent a chill up my neck. I said yes, I would get a blood test. Before the
results came back, Judith went out of town to visit a friend and I said I
would spend the weekend deciding whether or not I would donate a kidney. In
fact, I spent all of fifteen minutes thinking about it. I was healthy, I
knew that. Donors lead perfectly normal lives with one kidney, I knew that
too. The kidney is a complex organ, but you don’t need two of them. The
transplant surgery would mean two or three weeks
recovery at home with no pay (I’m a freelance technical writer and have
no benefits) but I was well paid and would quickly earn the money back. The
odds of dying were 3 in 10,000; to my mind this represented no great risk
than what I’d faced single-handing a small sailboat across the The truly
important thing was that donating a kidney was a good and ethical thing to do.
I didn’t need a weekend of reflection to come to the conclusion that
this was a rare opportunity in my otherwise easy and rather self-centred life to help someone who needed my help. Amelia
was my family, not by blood, but by choice and by love. And in helping
Amelia, I would be helping Judith too. So in my mind there was no moral
ambiguity to this decision, and how often in our lives can we say this? To be
honest, I thought that in helping to save her life I might in a very small
way redeem the purpose and value of my life. On February 14,
the results of the blood test came back: I was A positive, the same as Amelia.
She was happy. So were Alison and Judith. So was I. Over the next two
months, I took a few hours off work once or twice a week and rode the subway
up to The strangest
test was the CT scan, used to create a 3-D image of the kidneys. For this
test, you lie down on a white bed in front of a huge, gray, donut-shaped
machine. The technician inserts an IV into your left arm. A woman’s
voice coming from a speaker in the ceiling tells you to close your eyes and
hold your breath. For a test run, the bed moves through the donut and back
out again. If you peek, you see a sign overhead that says, “Close your
eyes or the laser beam will blind you.” Then the
technician activates the IV. A liquid dye, used to improve the contrast of
the image, enters your body. You feel a tremendous surge of heat flow through
your body from head to foot. Then you feel like you’ve peed your pants. Then a funny metallic taste fills your
mouth. None of these sensations inspires confidence. The bed moves into the
donut and stops. You count to 50. Then the bed pulls back out again. The
technician removes the IV. The test is over. Later, the
surgeon who performed the transplant, Dr. Mike Robinette, showed me the image
from the CT scan. It was amazing: there on the computer screen, rotating
merrily in 3-D glory, were my two kidneys, purplish
and plump, like distended fruit, suspended from arteries branching from the
skinny white aorta, the main blood vessel leading down from the heart. My
kidneys looked beautiful. Dr. Mike smiled. By early May, the
tests were done. Both kidneys were in good shape and my heart was strong. Amelia,
meanwhile, was on dialysis three times a week at TGH and suffering such
intense abdominal pain that she needed morphine shots to finish each four-hour
session. Philip, married now to Erica and with a son of his own, continued to
play an important part in her life all through her illness; when she was in
dialysis he picked her up at the hospital on the days she was too groggy from
the morphine to make her own way home.. Before I was
approved to donate, one of the transplant coordinators spent an hour
explaining the risks associated with surgery: possible death, post-operative
pneumonia, gas trapped in the lung cavity, blood clots, allergic
reactions to the general anesthetic. She explained that I would spend the
rest of my life with 75% kidney function, and higher blood pressure and
higher protein concentrations in the urine could occur after the operation
and would need regular monitoring. The last
interview was with a social worker, who assessed my motivations for donating
and made sure that I wasn’t pressured by Amelia or anyone else in the
family. I had to describe my life while she took notes. I described my
academic history, my girlfriend history, my work history. I described my
relationships with Judith, Alison and Amelia. At one point she
said, “Does Amelia appreciate what you’re doing?’ I paused. “Of
course.” “How do you
know that?” “By
everything she says and does,” I said. “By the fact she called me
one weekend when Judith was away because she thought I needed some company.” And then I
started to cry. Tell the world you’re donating a
kidney and the next sound you hear may be the soft whoosh of a halo moving
into position two inches above your head. Even before I had the final go-ahead
from Dr. Richardson, one of the kidney specialists on the transplant team, I
told everyone I knew and almost everyone I met, and the halo effect worked
about 95% of the time. “You’re
my hero,” said Amelia’s mom. “What a
wonderful thing to do,” said a friend in “It’s
a beautiful thing to be able to give such a gift,” said another friend
in “You’re
very courageous,” said a co-worker. “It is a
very brave thing for you to take on,” said another co-worker. “You’re
doing a good thing,” said my manager. “It is
inspiring to witness such an act of humanity,” said my yoga teacher. Of course it felt
good to get praise. Did I need it? I don’t think so. You have to
separate the action from the actor. Of course I was doing a good thing. Did
this make me a good person? Not exactly. A few reactions
were skeptical, or negative, or ignorant. “What about
the ick factor?” “Why doesn’t
Amelia go to “What if
you get a kidney disease later on? You’ll only have one left!” I asked the
skeptics whether they would donate to a family member who needed a kidney. If
they said yes, they regained my respect. I thought the worst part of the whole
transplant experience would be the first hours after the surgery. I was wrong.
When I came to, around But I felt fine. I
felt better than fine. Thanks to the morphine I felt, well … euphoric. “How do you
feel?” asked Alison. “I feel
great,” I said, smiling. “I feel very relaxed.” She smiled. “I think
everyone should donate a kidney,” I said. She laughed. Once the morphine
wore off, later that day, I didn’t feel quite so wonderful. The
incision hurt and the bed wasn’t comfortable no matter how I adjusted
it. My throat was sore from the breathing tube used during the operation. I
couldn’t eat or drink. I had to sip tiny chunks of ice in a plastic cup.
Every four hours, day and night, a nurse came and took my blood pressure and
temperature. I had a little button for dispensing morphine into the IV feed. This
is called a PCA (Patient Controlled Analgesic) and means the patient has
complete control over pain management, in theory at least. But pressing it
didn’t seem to make a huge difference. Pain is a big
topic with nurses and doctors. It seemed like every five minutes I was asked,
“How’s your pain? On a scale of one to ten?” “What’s ten?” I asked on the first day. “The worst
pain you’ve ever experienced,” they said. “Well,” I said, “if a
ten would be two sharks ripping off my legs, I guess right now I’m a
one or two.” They wrote this down. On day two, the
gas began and got worse and worse. My belly swelled. Coughing and laughing
were very painful. The gas is a function of the fact that the lower digestive
tract does not like surgery and therefore shuts down. Gas is produced but not
allowed to exit the body. You must walk to relieve the gas, even though
walking is painful and when you walk you shuffle down the hall like a tired
old man. You have raced ahead in time. You are an old man. On day three, I
farted at Then she lifted
my gown and said, “Take a deep breath.” I did. She pulled the
catheter from my penis. The pain of this action was sharp and immediate and
indescribable to anyone who does not have a penis. “Now then,”
she said. “As long as you pee within the next five hours, I won’t
have to put this back in.” I was peeing
within the next hour. Walking got
easier. I asked for sleeping pills and the night nurse let me sleep through
the night. The patient in the next bed, a rather cranky man recovering from
leg surgery who would loudly proclaim to the nurse “I want to die, I
want to die” when asked how he was feeling at I went up to see
Amelia, who had her own room one floor up. She looked wonderful. She was
sitting up in bed, a big smile on her face. “I feel 8,000 percent
better,” she said. “How are you?” “Oh,”
I said, “bad gas, very bad gas.” “Yeah, I
know,” she said. “I get that too, sometimes.” But she was
smiling. The gas passed
eventually. I ate a bit of food and read my books. I was bored and ready to
leave. On Friday morning, the fourth day, I got up and walked down to the
lobby of the hospital and bought two newspapers. I came back to the room and
tried sitting in the chair. It didn’t feel too bad. I got up and packed
my bag. Judith arrived around When we walked
out through the hospital door back into the world, the first thing I felt was
the warm June sun on my face. How lovely that was. I took a deep breath. The
air was stinky. I loved it. The traffic on I spent two weeks at home recovering. Mostly
I sat on the front porch reading novels and watching the neighbours
come and go. I felt like James Stewart in Rear
Window. Sadly, there were no murders to observe. I couldn’t drive or
lift anything heavier than ten pounds. My body was still sore, especially the
mid-section. I had to carefully ease into and back out of a chair, or the
bed, or the passenger seat of the car. I moved slowly, not because I wanted
to, but because I had no choice in the matter. Three weeks after
surgery, I went back to work. Downtown Six weeks have
passed since the transplant. Amelia is doing very well. The Gauer kidney has
made her healthy again. She has the energy of three grandfathers. She is
still under quarantine but she’s back on normal food and plans to
return to work fulltime in September. Her doctor, Dr. Cardella,
who’s overseen her care at TGH since the late 1990s, hopes that a
plasma treatment she will undergo soon will destroy the disease that attacks
her kidney. She’s still takes a galaxy of medications, 16 in total, but
she feels better than she has in a long, long time. I’m proud
of what I’ve done. I feel a great tenderness towards Amelia that I find
hard to express to her in person. In an email to her recently, I wrote, “When
I think about what we’ve done, you and I, my heart is full to bursting.” She replied, “I
don't know if I will ever be able to fully express how I feel about the
events of the past few months but I know that I am extremely lucky to have
someone like you in my life and that is very special to me.” On the morning of
the day I left the hospital I got out of bed and went up to see Amelia. Her
room was filled with soft light from the window. She was asleep, glasses off,
her face neatly framed by tendrils of blonde hair. I didn’t wake her. She
looked very peaceful and much younger than 26. She was a child and a woman at
the same time. I stood and watched her for a moment, then turned and quietly
walked away.
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