Reality Show: Life After Transplant

So I had an idea the other day for a new reality show. It would be called Life After Transplant. It wouldn't be very popular, I'm afraid, because so much of life after transplant is not that fun. I'm sure today's TV producers would only consider implementing a pseudo-reality version, anyway, kind of like the physician-centric medical shows. If they did that, they could include all the fun, happy parts but go ahead and portray it as a reality show anyway; they're really good at that.

The idea came while I was rounding with the MICU physician team in my role as charge nurse. The family of a man with end stage liver and kidney disease had elected to forego further curative treatment, remove him from the transplant list, and transition to comfort care only. He was not vented but nearly unresponsive and had very low blood pressure that we had been fighting with pressors. The Native American family notified us by quietly shaking their heads "no" to the nurse when she entered the room to restart continuous dialysis. The MICU team came and a discussion was had. Soon after, the liver specialists appeared on the unit. They were "very disappointed," they said, moving about with stern faces that clearly expressed their disapproval.

Inside the room, our attending was talking with the family. I could faintly hear him citing numbers and statistics, possibilities, the way this particular physician always does. The residents waited outside. Wouldn't they want to observe and maybe even participate in these kinds of conversations? I was mystified by that, as I always have been.

The reality show idea surfaced and I immediately shared it with the residents. They looked at me, perplexed. Now, I'm not saying I'm against organ transplants, or anything of that sort. I'm merely noting that the realities of medication regimens, rejection episodes, and consequences of lifelong immunosuppression are not what transplant teams advertise.

Consider this: A few months back we cared for an amazing woman who was 10 years out from a lung transplant. She had done remarkably well for 9 and 3/4 years. She carried her pills in a large box, way, way bigger than anything sold for the purpose of organizing medications. It was one of those plastic cases composed of many small squares that teenage girls use to organize their jewelry-making supplies. Each square held pills of a different shape and color.

This woman had lived to see her son grow up and get married and had many wonderful adventures in her post transplant life. She told us very clearly that, while she was beyond thankful for the time the transplant had given her with friends and family, she would not even consider doing it again.

There are so many things worse than death. I say that acknowledging that I don't know death myself, not at all. Sure, I've seen it many, many times-- been present for the changing, the leaving, the crossing, whatever you want to call it. But I've only seen it from this side, so I can't really know for sure. Yet there is something in us, something that responds to an apparent, perceivable peace that tells those of us who witness-- truly witness-- grave suffering, and the passing of lives, that death is not the worst thing that can happen to a person. Or maybe we can only say it seems unlikely that death is worse than some of those things we do know.

So much mystery.

All I know is, that would be one not-very-fun reality show. But it would be real, and it sure would be educational.