Friday, June 22, 2007

A Critique of TNT's 'Heartland'

My first impression of this new TV show was...mmmm...dissapointing. The very first scene shows an IV bag hanging on a pole with the line running through a general use IV pump. That would be normal if the bag were say....sodium chloride, but they specifically showed the label on the bag as being MORPHINE. Ummm...hello technical writers....morphine is a controlled narcotic, and being in a regular IV bag using regular tubing and a regular pump is NOT being controlled. There is a reason why they put those things on a special pump that is locked and can only be opened by a specific person with the proper orders.

Later in the episode we see why there are rules in the use of narcotics when the Mom pulls the IV out of her daughter's arm, changes the flow rate, and then attempts to shove the IV in her own arm to supposedly commit suicide so that her daughter can have her heart. Hello again technical writers, they haven't used stiff metal IV needles in YEARS. Even the one they were using on the show was obviously white, meaning it was the normal flimsy poly/rubber type. For those of you who haven't had the misfortune of having an IV stuck in you lately, the IV needle itself is removed after establishing a patent line in the vein, the part remaining is a sleeve of very flimsy poly material plus a hub that remains on the outside of the skin.

At about ten minutes into the show, I have to force myself to continue watching, thinking that this has to get better. But, I really need to study (two tests this week in A&P). Still, I make myself continue to watch, hoping that there is something good to come of this show. After all, it might make some more open to organ donation, right? Well, if it doesn't scare everyone off first maybe.

It is then that I hear the main character in the show, a Dr. Grant, say that if a donor heart came available that night, that he would "make it work" for the little girl. we go again technical writers...did no one bother to contact UNOS and research the rules on how transplanted organs are allocated. First of all, when an organ becomes available for transplantation the hospital informs UNOS (United Network for Organ Sharing) of the donor's blood type, age, body size, etc., as well as its geographical location. UNOS then goes to their list and chooses the recipient candidates from the top of a list that has all of the potential candidates ranked according to need, geographic location, etc., and then informs the recipient's hospital of a potential donor. It is really more complicated than this, but you get the idea. So basically, it is not the Dr.'s choice as to who gets a donated organ, unlike the idea portrayed by this TV show.

Also, you can't "make an organ work" for someone, it either matches or it doesn't. There are many things to take into consideration when matching donor to recipient. I won't get into the technical scientific evaluations here, primarily because I don't really know them well myself, but there is much more to it than just simple blood type matching. Think about this for a moment, say that the mother of this child were successful in committing suicide (yes, I know this scenario won't work for many reasons, just go with me on this OK), the difference in body proportion isn't just external. The mother's heart is the appropriate size needed to pump the blood in an adult body, the little girl needs a heart that will pump the blood in her much smaller body. There isn't much extra space in the cardiac cavity (or any body cavity for that matter), so the mother's heart likely would not have fit. But then you also need to have a good tissue match. There are little protein molecules embedded into each of our body cells, and these proteins are in different arrangements in each of us. It's God's little way of making us unique. Our bodies recognize when there is something inside of us that does not match in these protein arrangements, and will then mount an immune response. So it is important to get as many of these little protein units to match as possible between the donor organ and the recipient so that there is a lesser chance of the recipient losing the new organ to rejection.

As for the rest of the show, I had to make myself ignore the technical inaccuracies and try to enjoy the show purely for the dramatic effect. Unfortunately, I did not derive much enjoyment out of dramatic aspects either. The relationship between the Dr. and his ex-wife/organ donation coordinator did not grab my attention, neither did their little "spat" they had in regards to his infidelity while they were on the plane on route to an organ allocation. I don't see professionals such as those who are portrayed here, having an argument about this subject in front of their colleagues.

I think what we have here is a good idea gone wrong by the influence of TV producers who feel that they need to change facts in order to sensationalize an already sensational story. I think that this story would still go over well if they had kept with the actual facts and rules that govern how organ transplants occur. The subject in and of itself is sensational, there is no need to change things in order to make it so. My fear is that this show will give people the wrong impression about organ donation. Unfortunately, not much of anything in the media is completely real, including the news. So much of what they broadcast is sensationalized because they think it will make people watch. Plus, they get many of the actual facts wrong as astroprof points out in his blog on science and the media

I for one will be interested to see if this show continues, and if it does will it continue in the path that it started on, or will we see any changes that might reflect a more accurate portrayal of organ donation/transplantation. It is my hope that it does continue, but only with real-life accuracy.

Saturday, June 16, 2007

Immunosuppressant medications

I thought I would share some of my personal struggles with the immunosuppressant medications that I must take in order to live.

The first issue is cost. Most people are aware that these types of medications are expensive, but just how expensive are they? Upon checking a few websites that give medication cost comparisons, I have found that my daily expense is approximately $70. (I don't actually know what my pharmacy charges because I am never billed.) I take a combination of Prograf and Rapamune. There are, of course, other medications that I must take on a daily basis (two of which are specifically meant to counteract the side effects of the immunosuppressants), however their expense seems quite small in comparison (roughly about $5 a day in total). Thankfully, I qualify for social security disability and Texas Medicaid so all of my health care costs are paid. I don't know what I would do if I had to try to pay my own expenses.

The second issue is the side effects. Although I am deeply grateful that these medications exist, the effects can make daily life difficult. The most irritating aspect for me is that my brain never stops. It feels like I am constantly caffeinated, like I've drank about a dozen espresso's. If my body could keep up, it might not be such a bad thing, but my body gets tired and I want to sleep, but I can't because my brain won't stop. So very irritating! However, the good thing is that I can now think about many different things at the same time, which is helpful for studying. I seem to be better able to remember the things now as opposed to before the transplant.

Another side effect is associated with the increased brain activity. The higher the level of medication in my blood stream, the more I shake. If I keep my blood levels at where my doctors would like for it to be, I would shake like I had actually drank all those espresso's! If I had a penny for every time someone asked me if I was nervous, I would be rich (but then I wouldn't qualify for medicaid so that would be bad). Like the increased brain activity, the shaking never stops. I remember back to the days immediately after the transplant when they had my immunosuppressant levels very high to ensure my new organs would stay with me. I shook so much that my entire bed would actually travel across the room (with the wheels locked) and need to be moved back every few hours. It isn't quite that bad now, but I do have the occasional day where I can't hold a pen well and my handwriting is illegible. I can actually follow how well I absorb my medications and how high my levels are by looking at the notes I have taken in class.

There are other side effects, but as yet they don't seem to interfere with my daily life, although, they are important to note. One side effect is elevated cholesterol, fortunately mine is still within normal range. The other potentially dangerous effect is that one of the medications causes a kind of toxicity to the kidney's. Not good considering I only have one that truly works, and it is transplanted. So I watch my kidney functions closely.

Even with all of the multiple issues that go along with having had an organ transplant, I am still very grateful for this life. I am still amazed each morning that I have lived to see another day:)

Wednesday, June 6, 2007

One hectic summer!

I had really planned to be posting much more than I have, but summer seems to be running away from me. I am in a new relationship with this really great guy:) , and I had forgotten how much time these sorts of things take out of my daily schedule. Plus I am taking a six week Anatomy and Physiology course (yikes, what was I thinking taking this during the summer!). And I am scheduled to take the MCAT July 24, so I am trying to study for it as well!

So basically I have several things that I want to blog about, but not enough time in the day to do it all, and take care of myself at the same time. But I will try to post something at least once a week, hopefully more. I do hope to blog about this week's plane crash involving the transplant team from the Unversity of Michigan, such a tragedy, it is so upsetting for me personally for many reasons. Unfortunately it is now midnight, and I have class with lab tomorrow, so that blog will have to once again wait.